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 (usually small 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 (usually small or large bowel) and is covered by the layers covering
the spermatic cord.
The hernia may continue through the superficial ring and into the scrotum.Clinical Points
Psoas Abscess
Usually caused by the spread of lumbar vertebral tuberculosis to the psoas sheath.
The sheath becomes thickened and pus accumulates beneath it
Pus tracks inferiorly within 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 may form-the iliacosubfascial fossa.
The large bowel can become trapped in this fossa, with resulting severe pain.Mnemonics
Memory Aids
Muscles of the abdominal wall: TIRE
Transversus abdominis
Internal oblique
Rectus abdominis
External oblique