Anatomy
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Abdomen
A 52 year old man awaiting surgery for a direct inguinal hernia presents to ED with strangulation. A direct inguinal hernia is due to weakness in which of the following layers:
Answer:
A direct inguinal hernia is due to weakness in the posterior wall of the inguinal canal which is formed mainly by the transversalis fascia.Inguinal Hernia
Anatomy / Abdomen / Inguinal Region
Last Updated: 11th April 2019
An inguinal hernia is the protrusion of a peritoneal sac through a weakened part of the abdominal wall in the groin.
Table: Clinical Anatomy of Inguinal Hernia
| Hernia | Indirect Inguinal Hernia | Direct Inguinal Hernia |
|---|---|---|
| Aetiology | Congenital – patent processus vaginalis | Acquired – weakened abdominal musculature |
| Mechanism | Peritoneal sac herniates through deep inguinal ring | Peritoneal sac herniates directly through posterior wall of inguinal canal |
| Relation to inferior epigastric vessels | Lateral to inferior epigastric vessels | Medial to inferior epigastric vessels |
Indirect Inguinal Hernia
In indirect inguinal hernias, the most common type, the peritoneal sac enters the inguinal canal by passing through the deep inguinal ring, due to a patent embryonic processus vaginalis. If the entire processus vaginalis remains patent, the peritoneal sac may traverse the length of the canal, exit the superficial inguinal ring and continue into the scrotum or labia majora.
Direct Inguinal Hernia
In direct inguinal hernias, the peritoneal sac passes directly through the posterior wall of the inguinal canal. It usually occurs when abdominal musculature has been weakened, in older men, following surgery or due to persistent raised intra-abdominal pressure. This type of hernia does not traverse the inguinal canal, but may still exit the superficial inguinal ring to enter the scrotum.
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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 |
