FACTS & HINTS

High-Yield Facts

Clinical Points

Inguinal Hernia

Most abdominal hernias occur in the inguinal region Most hernias are inguinal hernias

Inguinal hernias are more common in men About 20% are direct inguinal hernias.

Direct inguinal hernias protrude through the layers of the wall in Hesselbach's (the inguinal) triangle, medial to the epigastric vessels. The hernial sac consists of peritoneum containing a portion of a viscus (usuallysmall or large bowel)

Indirect hernias which leave the abdomen lateral to the epigastric vessels, entering the inguinal canal through its deep ring.

The hernial sac consists of peritoneum containing a portion of a viscus (usuallysmall or large bowel) and is covered bythe layers covering the spermatic cord.

The hernia maycontinue through the superficial ring and into the scrotum.

Clinical Points

Psoas Abscess

Usuallycaused bythe spread of lumbar vertebral tuberculosis to the psoas sheath.

The sheath becomes thickened and pus accumulates beneath it

Pus tracks inferiorlywithin the sheath, deep to the inguinal ligament, surfacing in the superior part of the thigh.

Should pus track to the adjacent iliac fascia, a recess mayform-the iliacosubfascial fossa.

The large bowel can become trapped in this fossa, with resulting severe pain.

Mnemonics

Memory Aids

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