Anatomy
Lower Limb
A 49 year old overweight female presents to ED complaining of a lump in her groin. You examine the patient and diagnose a femoral hernia. Which of the following structures would be found immediately lateral to the hernia:
Answer:
The femoral vein will be immediately lateral. Femoral hernias result from the herniation of abdominal structures through the femoral ring, the proximal opening of the femoral canal, which is bordered medially by the lacunar ligament and laterally by the femoral vein. Femoral hernias, more common in women, typically present as a lump inferolaterally to the pubic tubercle, and are more prone to strangulation than inguinal hernias.Femoral Canal and Femoral Ring
Anatomy / Lower Limb / Femoral Triangle
Last Updated: 13th June 2019
Femoral canal
The femoral canal lies between the femoral vein and the medial edge of the femoral sheath. The femoral canal contains loose connective tissue, lymphatic vessels, deep inguinal lymph nodes and empty space. The femoral canal allows the femoral vein to expand, for example, when venous return from the leg is increased, or when increased intra-abdominal pressure causes a temporary stasis.
![By Henry Vandyke Carter [Public domain], via Wikimedia Commons](https://mrcemsuccess.com/wp-content/uploads/2017/01/Femoral-Sheath.png)
Femoral Sheath Open to Reveal Contents: Femoral Artery, Femoral Vein and Femoral Canal (Image by Henry Vandyke Carter [Public domain], via Wikimedia Commons)
Femoral ring
Table: Anatomical Borders of the Femoral Ring
| Femoral Ring | Structure |
|---|---|
| Anterior border | Inguinal ligament |
| Posterior border | Pectineal ligament |
| Medial border | Lacunar ligament |
| Lateral border | Femoral vein |
The femoral ring is formed by the proximal abdominal opening of the femoral canal, and is important clinically, as it is a common site of hernia. It is bordered anteriorly by the inguinal ligament, posteriorly by the pectineal ligament, medially by the lacunar ligament and laterally by the femoral vein.
![By Henry Vandyke Carter [Public domain], via Wikimedia Commons](https://mrcemsuccess.com/wp-content/uploads/2017/01/Femoral-Ring.png)
Femoral Ring. (Image by Henry Vandyke Carter [Public domain], via Wikimedia Commons)
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
