Definition:

Protrusion, bulge or projection of an organ or a part of an organ through the body wall that normally
contains it.

There are internal and external hernia

External hernia:

Inguinal 80%

Incisional 10%

Femoral 5% (more common in women, accounting for 70% of all femoral hernias)

Umbilical 4%

Epigastric <1%

Inguinal hernia is intestine bulging or pushing out the abdominal wall

An inguinal hernia is sometimes called a groin hernia. (“Inguinal” means “in the groin.”) It’s the most
common type of groin hernia. An inguinal hernia occurs in the inguinal canal, which is a passageway that
runs down either side of your pelvis into your sex organs. A less common type of groin hernia is the
femoral hernia, which happens in the smaller femoral canal that runs underneath it.

A hernia occurs when tissue from one body cavity bulges through an opening in your muscle wall into
another. Different types of hernias happen in different body compartments. Inguinal hernia is the most
common type of hernia. It takes place when abdominal tissue, such as belly fat or a loop of intestines,
bulges through an opening in your lower abdominal wall. This is the wall that separates your abdomen
from your groin.

Direct Inguinal Hernia: A direct inguinal hernia penetrates directly through the wall of your inguinal
canal. This type of hernia occurs in adults over time, from a combination of weakening abdominal
muscles and chronic pressure on the muscle wall.

Indirect Inguinal Hernia: An indirect inguinal hernia enters your inguinal canal through the top.

Etiology:

a. Genetics (According to studies and statistics (by an article from Beaumont hospital in
Farmington hills Michigan – Mohamad Hammoud and Jeffrey Gerken) Patients with known
family history of hernia are at least 4x more likely to have inguinal hernia than patients with no
known history)
(Inguinal Hernia - StatPearls - NCBI Bookshelf (nih.gov))
b. Age (as you old, your core muscles weaken, therefore easier for soft tissue to push through the
abdominal wall)
c. Sex (Male accounts for 90% of all inguinal hernia cases) (men have gaps in their groin muscles,
this allows blood to move to the testicle)
d. Increases abdominal pressure (chronic coughing, chronic constipation, heavy lifting)
 e. Weak abdominal wall (this can be a defect during fetal development) (10-14 th week of
pregnancy)
f. Smoking (due to the effect of nicotine, decreases the rate of collagen formation which weakens
the abdominal wall)

SLIDE 1:
▪ * Protrusion, bulge, or projection of an organ or part of an organ through the body wall that
normally contains it

(Essentially a hernia occurs when tissue from one body cavity bulges through an opening in your muscle
wall into another.)

 Different types of hernias happen in different body compartments. Inguinal hernia is the most
common type of hernia.
 There are internal and external hernia
 External hernia:
 Inguinal 80%
 Incisional 10%
 Femoral 5%
 Umbilical 4%
 Epigastric <1%

SLIDE 2:
Spermatic cord is a coiled tube that carries sperm out the testicle, it runs from the abdomen to the
testicle, and connects the testicle in the scrotum

The spermatic cord originates at the deep inguinal ring and exits through the superficial inguinal ring

The spermatic cord runs from the peritoneum, through the transversalis fascia, internal and external
oblique and through the external oblique aponeurosis.

Indirect: An indirect inguinal hernia enters your inguinal canal through the top.

An indirect hernia occurs more often on the right. This is believed to be attributed to the slower closure
of a patent processus vaginalis on the right side compared to the left.

patent processus vaginalis (PPV) – Communication between peritoneum and scrotum

(Pushes or bulges through an abdominal wall and goes into the scrotum, so it follow the spermatic cord
pathway)

(so the intestine goes through the deep inguinal ring to the superficial inguinal ring and this causes to
bulge out)

(Lateral to the inferior epigastric artery)

(Just bulges through the abdominal wall, and doesn’t follow the spermatic cord pathway)

(occurs as a result of weakness in the floor of inguinal canal)

(Passes only through the superficial ring)

(Medial to the inferior epigastric artery within the hesselbach’s triangle)

(so direct inguinal hernia occurs within the hesselbach’s triangle)

Borders of Hesselbach’s triangle include:

*Inferior Inguinal ligament

*Lateral Inferior epigastric

*And rectus abdominus medially

SLIDE 3:
*REDUCIBLE:

(flattens out when you lie down or push against it gently with manual pressure)

(This type of hernia is not an immediate danger to your health, although it may be painful and
worsen over time if left untreated.)

*NON-REDUCIBLE:

(the loop of the intestine is trapped and you lose the ability to make the bulge flatten out.)
(Non-reducible hernias are often very painful and require prompt medical attention.)

SLIDE 4:
Most causative factors of Inguinal Hernia:

Predisposing Factors

Genetics – (Known family history has 4x more chances)

According to studies and statistics (by an article from Beaumont hospital in Farmington hills Michigan –
Mohamad Hammoud and Jeffrey Gerken) Patients with known family history of hernia are at least 4x
more likely to have inguinal hernia than patients with no known history)

(Inguinal Hernia - StatPearls - NCBI Bookshelf (nih.gov))

Age – (Older age is more prone to inguinal hernia)

(as you old, your core muscles weaken, therefore easier for soft tissue to push through the abdominal
wall)

Sex – (Male are more prone to inguinal hernia)

Weak abdominal wall

(this can be a defect during fetal development) (10-14th week of pregnancy)

SLIDE 5:
Precipitating factors:

Increased Abdominal Pressure

(chronic coughing, chronic constipation, heavy lifting, straining during urination or bowel movements)

Weak abdominal muscles

(this can be from poor diet, lack of exercise or both)

Being overweight

(causes strain and pressure on abdominal muscles, making them weaker and prone for hernias)

Recent or Large weight loss

(with periods of profound weight loss may be at higher risk, this is due to the bowel more easily to slip
through the opening that were made in the mesentery)

Smoking – (Due to effects of nicotine)

(this decreases the rate of collagen formation which weakens the abdominal wall)

SLIDE 6:
Predisposing Factors + Precipitating Factors

(Predisposing factors combined with the precipitating factors)

INCREASED ABDOMINAL PRESSURE DEVELOPS

(Increased pressure in the compartment of the abdomen develops)

INGUINAL CANAL WALLS WEAKENS

(Intra-abdominal wall of Inguinal canal into the scrotum becomes weakened)

INGUINAL RING NOT CLOSING

(the weakening of inguinal walls causes the inguinal ring not to close)

BECOMES A HOLE OR DEFECT

SLIDE 7:
PART OF SMALL INTESTINE SLIDE THROUGH

(Fat or part of the small intestine slides through the inguinal canal)

SWOLLEN OR ENLARGED SCROTUM

WEAKNESS OR PRESSURE IN THE GROIN AREA

PAIN AND DISCOMFORT

(there is visible Swelling or enlargement of scrotum, feeling of weakness or pressure being felt in the
groin, that comes with pain and discomfort)

SOURCES

*Robertson, S. (2021, May 17). Hernia pathophysiology. News. Retrieved October 25, 2022,
from https://www.news-medical.net/health/Hernia-Pathophysiology.aspx#:~:text=Inguinal
%20hernia,-This%20is%20the&text=This%20type%20of%20hernia%20mainly,which
%20contains%20the%20spermatic%20cord.

*J;, H. (n.d.). Inguinal hernia. Retrieved October 25, 2022, from

*Inguinal hernia pathophysiology. (n.d.). Retrieved October 25, 2022, from

POSSIBLE:

*Incisional Hernias - A hernia that appears in the abdomen at the site of a previous surgery is
known as an incisional hernia. These hernias can appear weeks, months, or even years after
surgery and can vary in size from small to very large and complex.

*Femoral Hernias - Femoral hernias, along with inguinal hernias are groin hernias. They are much more
common in women but can occur in men. These hernias appear just below the groin crease. A weakness
in the lower groin allows an intestinal sac to drop into the femoral canal, a space near the femoral vein
that carries blood from the leg.

*Umbilical Hernias - Umbilical hernias occur near the bellybutton or navel, which has a natural weakness
from the blood vessels of the umbilical cord. These hernias may occur in infants at or just after birth and
may resolve by three or four years of age. However, the area of weakness can persist throughout life
and can occur in men, women, and children at any time. In adults, umbilical hernias will not resolve and
may progressively worsen over time. They are sometimes caused by abdominal pressure due to being
overweight, excessive coughing, or pregnancy.

*Epigastric Hernias - Epigastric hernias are more common in men than women. They occur due to a
weakness, gap, or opening in the muscles or tendons of the upper abdominal wall