Hernia and its related anatomy Under the supervision of Dr \Moheb Monier Anatomy Department

Team Members: 91-Esraa Raafat Ahmed Ghanem 92-Esraa Reda Hashem Tawfik 93-Esraa samy Farid Abd Elghaffar 94-Esraa Saad Abbas Hamed 95-Esraa Shawky Abdelhak Abolaban 96-Esraa Sobhi Mohamed Abdelaziz 97-Esraa Sabry Mohamed Ahmed Ali 98-Esraa Taher Elhossieny Farag 100-Esraa Ezzat Afify Sharf

Intended Learning outcomes(ILOS): By the end of this presentatioin you will be able to: 1- Define henia. 2-Define inguinal canal. 3-Know the extenet of it.  4-Enumerate the boundaries 5-Enumerate the contents 6-List some notes about femoral canal .   7-Explain causes of hernia  8- List the types of hernia in details. 9-Know symptoms and diagnosis of hernia in male and female.  10-Learn how to treat hernia and how to avoid it

Defintion of hernia: Hernia is a general term used to describe a bulge or protrusion of an organ through the structure or muscle that usually contains it. There are many different types of hernias. The most familiar type are those that occur in the abdomen, in which part of the intestines protrude through the abdominal wall. This may occur in different areas and, depending on the location, hernia is given a different name.

Definition of inguinal canal: It is found within the aponeurosis of the external oblique, immediately above the crest of the pubis, 1 centimeter above and lateral to the pubic tubercle. It has medial and lateral crura. It is at the layer of the aponeurosis of the obliquus externus abdominis.

Extent of inguinal canal 1-The superficial inguinal ring (subcutaneous inguinal ring ) is an anatomical structure in the anterior wall of the human abdomen. It is a triangular opening that forms the exit of the inguinal canal. At the other end of the canal, the deep inguinal ring forms the entrance,it is found through fascia transversalis. 2-The surface marking of the deep inguinal ring is classically described as immediately above the midpoint of the inguinal ligament (midway between the anterior superior iliac spine and the pubic tubercle).

Boundaries of the inguinal canal : Floor: - medial ½ of upper concave surface of inguinal ligament . . -the lacunar ligament at the medial end

Anterior wall : - External oblique aponeurosis (along its whole length ) -internal oblique ( in its lateral 1/3 )

Roof : - Arched fleshy fibers of the internal oblique and transversus abdominis

Posterior wall : From behind forwards - Fascia transversalis (along its whole length) Conjoint tendon ( in its medial ½ ) - Reflected part of the inguinal ligament (in its medial ¼ )

-Content of inguinal canal: The structures which pass through the canal differ between males and females:in males : the spermatic cord and its coverings the ilioinguinal nerve.in females : the round ligament of the uterus the ilioinguinal nerve.

Note : that the ilioinguinal nerve passes through the superficial ring to descend into the scrotum in males and labia majora in females, but does not formally run through the canal.

Femoral canal -femoral canal :lies in the medial border of femoral sheath . It is bordered: 1-Anterosuperiorly by the inguinal ligament 2-Posteriorly by the pectineal ligament lying anterior to the superior pubic ramus 3-Medially by the lacunar ligament 4-laterally by the femoral vein -The entrance of the femoral canal is the femoral ring through which bowel can sometimes enter causing femoral hernia.

What Causes a Hernia? muscle weakness strain

Common causes of muscle weakness: -Failure of the abdominal wall to close properly in the womb (congenital defect) -Age - suddenly gaining weight -Damage from injury or surgery

Factors that strain your body and may cause a hernia (especially if your muscles are weak) pregnancy heavy weight lifting Chronic coughing constipation ascites

Am I At Risk for a Hernia? Several factors increase your risk of developing a hernia, including: overweight or obese smoking a personal or family history of hernias (which can trigger a chronic cough) chronic constipation a chronic cough

Types of hernia:- The most common type of hernia is the inguinal hernia which is defined as extrosion of abdominal content throgh defect in the abdominal wall. -It has 2 types as : a- direct inguinal :- occurs in the inguinal triangle usually occur in the old age (weak muscles) the medial sac found medial to inferior epigastric artery.  b-indirect inguinal :- occurs in the inguinal canal occurs in young males lateral to inferior epigastric artery .

-Femoral hernia:  Femoral hernia occur just below the inguinal ligament when abdominal content pass through the femoral canal occurs in both female and male common in females due to the wider bony structure of pelvis . -It has 2 types :  A-reducible :occurs when femoral hernia can be pushed again into abdomen . b- irreducible. 

Other Types of hernia 1-Diaphrgmatic hernia : it is a defect in the diaphragm that allows the abdominal content to move into chest cavity hindering proper lung functions it may be congenital due to malformation of the diaphragm . 2 - Incisional hernia : it is caused by incomplete -healed surgical wound which may be caused by hematoma or increased intra abdominal pressure  3 - Umbilical hernia: due to congenital malformation of the umbilicus or acquired by obesity ,increased intra cranial pressure or heavy left  4 -Obturator hernia : rare type of hernia in the abdominal wall in which an abdomen content protrude through obturator canal causing pain in the medial thigh and knee due to compression of obturator nerve .

Signs and symptoms of hernia -Many hernias present no problem, showing a painless swelling that gives no symptoms, which may be worse when standing, straining, or lifting heavy items. -Immediate medical attention should be sought if an inguinal hernia produces acute abdominal complaints such as: 1-Pain 2-Nausea 3-Vomiting. 4-The swelling in these cases is typically firm and tender and cannot usually be reduced. 5-Hiatal hernia can produce symptoms of acid reflux - producing  heartburn  when stomach acid gets into the esophagus.

Diagnosis of hernia: 1-Your doctor or nurse can usually see or feel a hernia when they examine you. You may be asked to cough, bend, push, or lift. The hernia may get bigger when you do this. 2-The hernia (bulge) may not be easily seen in infants and children, except when the child is crying or coughing. 3-Ultrasound or CT scans may be done to look for a hernia. 4-If you may have a blockage in your bowel, you will need an x-ray of the abdomen.

Treatment of femoral hernia 1- Femoral hernia: If you feel sudden pain in your groin, a piece of intestine may be stuck in the hernia .This needs treatment right away in a hospital emergency room, and you may need emergency surgery. 1- Types of surgery: open 2-

Treatmant of inguinal hernia 1-Laparoscopic surgery — In laparoscopic hernia repair, a surgeon makes three small incisions in the abdominal wall and then inflates the abdomen with a harmless gas. The surgeon then inserts a laparoscope through the incisions. A laparoscope is a tube-like instrument with a small video camera and surgical instruments. While viewing the internal scene on a monitor, the surgeon pushes the herniated intestine back into place and repairs the hernia opening with surgical staples.

2-Open Surgery General anesthesia will be used, so you will not be awake during the surgery. Your surgeon might decide on a local anesthesia if the hernia is small. The surgeon will make an incision, locate the hernia, and separate it from surrounding tissues. The herniated tissue will be pushed back into place in your abdomen Stitches will be used to close up the tear or strengthen weak abdominal muscles. Sometimes mesh is attached to strengthen the abdominal tissues and reduce the risk of another hernia

3-Exercise to strengthen the abdominal muscles 1-Eat high-fiber foods 5- 4-Lose wieght How to avoid hernia? 3-Exercise to strengthen the abdominal muscles 2-Drink plenty of water

6-Avoid eating allergies How to avoid hernia? 7-Learn how to lift heavy objects or simply do not lift them at all.

-References: 1- www.webmd.com. 2- www.emedicine.org. 3- http://medind.nic.in 4- www.medscape.com 5- www.nicpi.com.