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، commons.wikime...
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

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