Download Hernias - OSCEstop

Inguinal Hernias
Anatomy




Inguinal ligament = ASIS to pubic tubercle
Inguinal canal = ASIS to pubic symphysis
o contents
 males: spermatic cord (vas deferens, testicular artery, testicular nerves, pampiniform plexus, lymphatic
vessels), ilioinguinal nerve
 females: round ligament of the uterus, ilioinguinal nerve
o borders of the inguinal canal MALT
 Muscle (internal oblique)
- ROOF
 Aponeurosis (external oblique)
- ANTERIOR
 Ligament (inguinal ligament)
- FLOOR
 Tendon (transversalis fascia)
- POSTERIOR
‘Points’
o mid-inguinal point = halfway between ASIS to pubic symphysis = femoral artery
o midpoint of the inguinal ligament = midpoint between origins of inguinal ligament (ASIS to pubic tubercle) = deep
(internal) inguinal ring
Inguinal ring positions
o deep (internal) inguinal ring = midpoint of inguinal ligament
o superficial (external) inguinal ring = just superior and medial to pubic tubercle
Direct VS Indirect Inguinal Hernia


Direct inguinal hernia (40%)
o herniated abdominal contents come directly out of abdomen in a straight line
o penetrate through the external inguinal ring
o if reduced, cannot be controlled by applying pressure over the deep inguinal ring
Indirect inguinal hernia (60%)
o herniated abdominal contents run in the inguinal canal
o penetrate through the internal inguinal ring
o can go right the way down the canal into the scrotum in men (inguinal-scrotal hernia)
o due to failure of the closure of the processus vaginalis (4% of people)
o if reduced, can be controlled by applying pressure over the deep inguinal ring
Inguinal Hernia VS Femoral Hernia


Classical differences
o femoral hernia occurs below and lateral to pubic tubercle
o direct inguinal hernia occurs above and medial to the pubic tubercle
o indirect inguinal hernia can occur anywhere between the deep inguinal ring and the scrotum
Differentials
o psoas abscess (lateral to femoral artery)
o femoral neurofibroma (hard swelling lateral to femoral artery; painful if pressed)
© 2014 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students’ finals OSCE revision
Mid-inguinal point
Femoral artery position
Midpoint of inguinal ligament
Deep (internal) inguinal ring
position
Superficial (external) inguinal
ring position
© 2014 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students’ finals OSCE revision
Image copyright free from the 20th U.S. edition of Gray's Anatomy of the Human Body, originally published in 1918 and therefore lapsed into the public domain