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28 Cards in this Set
- Front
- Back
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The Nyhus classification of groin hernias:
Type 1 |
Indirect inguinal hernia with normal internal ring
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Type 2
type 2 |
Indirect inguinal hernia with enlarged internal ring
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Type 3a
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Direct inguinal hernia
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Type 3b
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Direct and indirect inguinal hernia (Pantaloon hernia)
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Type 3c
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Femoral hernia
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Type 4a
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Direct recurrent inguinal hernia
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Type 4b
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Indirect recurrent inguinal hernia
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Type 4c
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Recurrent femoral hernia
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Type 4d
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Combination of type 4a and 4b
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Sliding hernia
A sliding hernia is an indirect hernia where the posterior wall of the sac is formed by |
large bowel (ascending colon on the right, sigmoid/descending colon on the left)
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The boundaries of the femoral canal are:
Anteriorly - the inguinal ligament Medially - the lacunar ligament |
Laterally -the external iliac/femoral vein
Posteriorly - the pectineal fascia |
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Complications of groin hernias
Irreducibility - The hernia sac or its contents cannot be returned to the peritoneal cavity. Where the content of the sac is fat or omentum there may be no symptoms. When the sac contains bowel, |
however, the risk of obstruction increases.
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Complications of groin hernias
Intestinal obstruction - This results from a loop of bowel and its contents |
becoming trapped within a hernia sac.
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Complications of groin hernias
Strangulation - This results from interruption of the |
blood supply to a segment of bowel trapped within a hernia
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Scrotal swellings
Scrotal swellings include inguino-scrotal swellings, i.e. swellings which originate in the groin and extend into the scrotum. By far the commonest of these is the indirect inguinal hernia. Scrotal swellings may arise in: |
the testis, e.g. teratoma, seminoma
the epididymis, e.g. epididymal cyst spermatic cord structures, e.g. varicocoele. |
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Testicular tumours
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Seminoma and teratoma account for 85% of testicular tumours.
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Testicular tumours
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Seminomas are of lower grade malignancy with 5-year survival rates of 70-90%.
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Testicular tumours
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Teratomas arise from primitive germ cells and may contain elements of bone and cartilage. They characteristically produce the tumour markers alphafetoprotein (AFP) and human chorionic
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Hydrocoele is In the elderly hydrocoeles are almost always benign.
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fluid in the tunica vaginalis. The testis becomes surrounded by fluid and is impalpable.
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Hydrocoele
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In young men they may indicate an underlying pathology and demand investigation.
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Epididymal cyst is a fluid filled cyst which may form in ).
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any part of the epididymis (head, body or tail
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Varicocoele is a varicose dilatation of the veins of the pampiniform plexus. It almost always occurs on the left side for reasons that are not clear but
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probably related to the differing drainage of the spermatic vein - into the renal vein on the left side and directly into the inferior vena cava on the right.
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Undescended testis
An undescended testis is one whose normal line of descent from the posterior abdominal wall, through the inguinal canal into the scrotum has been . |
blocked at some point.
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The undescended testis is at increased risk of:
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torsion
tumour trauma infertility |
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Ectopic testis
An ectopic testis is one which has descended normally through the external inguinal ring but then |
continued along an abnormal line and become lodged in an ectopic position.
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The commonest positions for an ectopic testis are superficial inguinal, while
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perineal, femoral or pre-pubic positions are uncommon.
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Acute epididymo-orchitis
This is an acute pyogenic infection thought to be caused by bacteria from the |
urinary tract passing retrogradely down the vas deferens.
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Torsion of the testis.
This is a surgical emergency - delay in surgical treatment may lead to necrosis and loss of the testis. It probably results from ). |
a high attachment of the tunica vaginalis to the spermatic cord, which allows the testis to rotate within the tunica (the clapper-bell deformity
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