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SB82 Hernias
SB82 Anatomy of hernias ABSITE review
| Question | Answer |
|---|---|
| The embyologic cause of indirect inguinal hernia | Failure of processus vaginalis to close |
| Abdominal muscle layer that forms the inguinal ligament | Inferior edge of external oblique which runs from ASIS to pubic tubercle |
| Borders of Hesselbach's triangle | Inguinal ligament (inferolateral), Inferior epigastric vessels (superolateral), and lateral border of the rectus abdominis muscle (medial) |
| Significance of Hesselbach's triangle | Direct inguinal hernias herniate through a defect in the inguinal floor (transversalis fascia) of this triangle |
| Borders of the femoral canal | Superior - Inguinal ligament, Inferior - Cooper's ligament, Medial - lacunar ligament, Lateral - femoral vein |
| Definition of Cooper's ligament | Thickening in transversalis fascia attached to linea terminalis, which fuses to periosteum of superior pubic ramus |
| Significance of Cooper's ligament | Forms floor of femoral ring and inferior border of femoral canal orifice, and acts as insertion site of iliopubic tract |
| Nerve running anterior to spermatic cord | Ilioinguinal nerve |
| Effect of disruption of ilioinguinal nerve | Numbness of scrotum and medial thigh |
| Contents of spermatic cord | Vas deferens and associated vessels, testicular vessels, genital branch of genitofemoral nerve, lymphatics, autonomic nerves |
| Source of cremasteric muscle fibers | Internal oblique |
| Female equivalent of male spermatic cord | Round ligament of the uterus, usually divided during herniorrhaphy |
| Definition of neurovascular plane | Space between internal oblique and transversus abdominis wherein the intercostal nerves run |
| Course of the femoral nerve | Arises at lateral border of psoas, descends in groove between psoas and iliacus muscles, and enters femoral triangle deep to inguinal ligament |
| Femoral nerve is _____________ in relation to femoral vessels | Lateral |
| Muscles supplied by femoral nerve | Knee extensors |
| Orientation of femoral vessels and nerve inferior to inguinal ligament | NAVEL: Nerve, artery, vein, empty space, lymphatics |
| Femoral hernia | Herniation of abdominal contents inferior to inguinal ligament through "empty space" |
| Course of the obturator nerve | Descends through psoas and pierces fascia to pass lateral to internal iliac vessels and ureter; then leaves pelvise via obturator foramen |
| Muscles supplied by obturator nerve | Thigh adductors |
| Definition of obturator hernia | Herniation of bowel through obturator forament (R>L) |
| Howship-Romberg sign | Pain along medial thigh with abduction/extension/internal rotation due to irritation of obturator nerve by obturator hernia |
| Three structure forming the covering of spermatic cord | Internal spermatic fascia, cremaster and its fascia, and external spermatic fascia |
| Structure connecting the testicle to the scrotum | Gubernaculum |
| Cause of testicular torsion | Incomplete attachment of gubernaculum, allowing the testicle to twist around its blood supply |
| Location of obturator foramen | Between body of ischium and pubic rami |
| Structures passing through obturator foramen | Obturator nerve, artery, vein |
| Two major types of congenital diaphragmatic hernias | Morgagni (anterior) and Bochdalek (lateral, R |
| Etiology of Morgagni hernia | Failure of formation of septum transversum |
| Etiology of Bochdalek hernia | Failure of formation of pleuroperitoneal membranes |
| Structure that forms floor of inguinal canal | Transversalis fascia |
| Lacunar ligament | The splaying-out of the inguinal ligament to insert on the pubis |
| Ileopubic tract | Portion of transversalis fascia running inferior to inguinal ligament from ASIS to pubis |
| Conjoint tendon | The joining of the internal oblique fascia to the transversus abdominis fascia |
| Pantaloon hernia | Has components of both direct and indirect hernias |
| Pediatric hernias are usually _________ (direct/indirect) | Indirect |
| Lichtenstein repair of inguinal hernia | Uses mesh and has lower rate of recurrence due to decreased tension |
| Bassini repair of inguinal hernia | Approximation of the conjoint tendon and transversalis fascia superiorly to the inguinal ligament inferiorly |
| McVay repair of inguinal hernia | Approximation of the conjoint tendon and transversalis fascia superiorly to Cooper's ligament inferiorly |
| Caveat to McVay repair | Requires a "relaxing incision" in the external oblique fascia |
| Indications for laparoscopic hernia repair | Bilateral inguinal hernias, recurrent inguinal hernia |
| Most common early complication following hernia repair | Urinary retention |
| Cause of testicular atrophy after hernia repair | Thrombosis of spermatic cord veins after vessel disruption caused by dissection of distal components of hernia sac |
| Testicular atrophy following herniorrhaphy is more common with _____________ (direct hernia/indirect hernia) | Indirect hernia |
| Most common cause of pain after herniorrhaphy | Damage to ilioinguinal nerve |
| Sequelae of ilioinguinal nerve injury | Loss fo cremasteric reflex, numbness of ipsilateral penis/scrotum/thigh |
| Sequelae of injury to genital branch of genitofemoral nerve | Loss of cremasteric reflex and sensation to scrotum |
| Sequelae of injury to femoral branch of genitofemoral nerve | Loss of sensation to upper lateral thigh |
| Cord lipomas _____________ (should/should not) be removed | Should |
| Trapezoid of doom | Femoral branch of genitofemoral nerve, lateral cutaneous nerve, femoral artery |
| Femoral hernias are more common in _________ (males/females) | Males |
| Clinical sign of femoral hernia | Characteristic bulge on anteromedial thigh below inguinal ligament |
| Repair of femoral hernia | Inguinal approach with McVay or Bassini repair |
| Umbilical hernias are more common in ___________ (Caucasians/African-Americans/Asians) | African-Americans |
| Risk of incarceration in umbilical hernias is more common in ____________ (adults/children) | Adults |
| Hernia through linea semilunaris lateral to rectus muscle, usually inferior to semicircularis, through area between muscle fibers of internal oblique and line of insertion of external oblique aponeurosis into rectus sheath is called a ________ hernia | Spigelian |
| Noncircumferential incarceration of antimesenteric bowel wall is called a _______'s hernia | Richter |
| Petit's hernia | Through lumbar triangle in posterolateral abdominal wall |
| Borders of lumbar triangle | Bounded anteriorly by the free margin of external oblique muscle, posteriorly by the latissimus dorsi and inferiorly by the iliac crest |
| Herniation through superior lumbar triangle is called _______________ hernia | Grynfeltt |
| Borders of superior lumbar triangle | Quadratus lumborum muscle, twelfth rib, and internal oblique muscle |
| Incarcerated Meckel's diverticulum is called a _________ hernia | Littre |
| Sciatic hernia | Through greater sciatic foramen; high rate of strangulation |
| Most common cause of incisional hernia | Inadequate closure |
| Treatment for true peristomal hernia | Remove and place in rectus muscle |
| Treatment for prolapse of stoma | Fix mesentery to prevent prolapse |
| Treatment for pseudo-peristomal hernia | Move to rectus (is usually in oblique when this occurs) |
| Spigelian hernia | Hernia through linea semilunaris lateral to rectus muscle, usually inferior to semicircularis, through area between muscle fibers of internal oblique and line of insertion of external oblique aponeurosis into rectus sheath |
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