Inguinal and femoral hernias (mechanism of disease)

This is a flowchart on inguinal and femoral hernias, covering the etiology, pathophysiology, and manifestations. ADDITIONAL TAGS: Risk factors / SDOH Cell / tissue damage Structural factors Inguinal and femoral hernias Medicine / iatrogenic Infectious / microbial Biochem / metabolic Immunology / inflammation Signs / symptoms Tests / imaging / labs Environmental, toxin Embryology / development Pressure / flow physiology Pathophysiology Etiology Manifestations Dennis M. DePace, PhD - CC BY-SA 4.0، https://commons.wikimedia.org/w/index... Usually older men Protrusion of abdominal contents (intraperitoneal fat, mesentery, bowels) … Hesselbach (inguinal) △ borders: Medially: rectus abdominis muscle Laterally: inferior epigastric vessels Inferiorly: inguinal ligament Femoral canal boundaries: Anterior: inguinal ligament Posterior: pubic ramus, pectineal lig Medial: lacunar ligament Lateral: femoral vein Medial to the inferior epigastric blood vessels (within Hesselbach triangle) and lateral to the rectus abdominis: direct inguinal hernia Lateral to the inferior epigastric blood vessels (outside Hesselbach triangle): indirect hernia Into the femoral canal through the femoral ring: femoral hernia Male infants, older men Typically acquired Weakening of the transversalis fascia ↑ intraabdominal pressure Skeletal muscle and connective tissue weakness Long term steroid use COPD with chronic cough Constipation Typically congenital incomplete obliteration of processus vaginalis Outpouching of the parietal peritoneum that extends through the inguinal canal; normally obliterated by birth May not become apparent until adulthood despite being present since birth. Female, advancing age Multiparity Previous abdominal surgery (such as for prior hernias) ↑ intraabdominal pressure Constipation Straining for micturition COPD + cough Obesity BPH in men Mass / swelling in respective region; reducible and soft Enlarges with cough, strain, Valsalva; smaller when supine Uncomplicated hernia Irreducible (cannot be pushed back into abd); but skin overlying the hernia is normal Incarcerated hernia Contents trapped in hernia sac Restriction of blood supply → ischemia, necrosis) Irreducible +/- severe sudden groin pain; +/- bowel obstruction; +/- warm, red, tender exfoliated, blistered skin Strangulated hernia