38 - Hernias, Abd, Surg Tech Flashcards
Forms the shelving edge and roof of the inguinal ligament at inferior portion of inguinal canal
External oblique fascia
Forms cremasteric muscles
Internal oblique
Forms inguinal canal floor, along with conjoined tendon
Transversalis Muscle
Composed of the aponeurosis of the internal oblique and transversalis fascia
Conjoined tendon
Originates from external oblique fascia, runs from anterior superior iliac spine to pubis; anterior to femoral vessels
Inguinal ligament
Where inguinal ligament splays out to insert on pubis
Lacunar ligament
Pectineal ligament; posterior to femoral vessels, lays on bone
Cooper’s ligament
Runs medial to cord structures
Vas deferens
Components of Hesselbach’s triangle
rectus muscle, inferior inguinal ligament, inferior epigastrics
Hernia inferior/medial to epigastric vessels
Direct hernia
Hernia superior/lateral to epigastric vessels
Indirect hernia
Indirect hernia forms from _
Patent processus vaginalis
Direct and indirect hernia components
Pantaloon hernia
Can lead to bowel strangulation, should be repaired emergently
Incarcerated hernia
When retroperitoneal organ makes up part of the hernia sac
Sliding hernia
Most common organ involvement in sliding hernias for males and females
Males - sigmoid, cecum
Female - Ovaries, fallopian tube
Hernia repair type with mesh hernia repair type with mesh
Lichtenstein repair
Approximation of the conjoined tendon to the free edge of inguinal ligament repair type
Bassini repair
Approximation of the conjoined tendon to Cooper’s ligament repair type
Cooper’s ligament repair
Indicated for bilateral or recurrent inguinal hernia
Laparoscopic hernia repair
Often used for femoral hernia repair
Cooper’s ligament repair
Most common early complication following hernia repair
Urinary retention
Hernia recurrence rate
2%
Complication often occurring secondary to dissection of the distal component of the hernia sac causing vessel disruption
Testicular atrophy
Testicular atrophy can result from thrombosis of
spermatic cord veins
Pain after hernia usually results from
Compression of ilioinguinal nerve
Ilioinguinal nerve injury can results in (2)
Loss of cremasteric reflex
Numbness on ipsilateral penis, scrotum and thigh
Ilioinginal nerve injury runs _ to spermatic cord
Anterior
Usually injured with laparoscopic hernia repiar
Genitofemoral nerve injury
Genital branch of genitofemoral nerve innervation
Cremaster (motor), Scrotum (sensory)
Femoral branch of genitofemoral nerve innervation
Upper lateral thigh
Femoral canal boundaries
Cooper's ligament (posterior) Inguinal ligament (anterior) Femoral vein (lateral) Lacunar ligament (medial)
Location of femoral hernia
Medial to femoral vein, lateral to lymphatics
May require division to reduce bowel in incarcerated femoral hernia
Inguinal ligament
Characteristic presentation of femoral hernia
Anterior-medial thigh bulge
Age to delay repair of umbilical hernia
5 yrs old
Location of Spigelian hernia
Lateral to rectus muscle, along linea semilunares
Can present as tender medial thigh mass or SBO
Obturator hernia (anterior pelvis)
Howship-romberg sign
inner thigh pain with internal rotation
Posterior pelvis hernia
Sciatic hernia
Sciatic hernias herniate through
Greater sciatic foramen
Type of hernia most likely to recur
Incisional hernia
Posterior rectus sheath is absent below
Semicircularis/umbilicus
Fothergrill’s sign
Rectus hematoma sign of more prominent and painful mass with flexion of rectus muscle
Medical tx of desmoid tumor
Sulindac and tamoxifen
Can occur with hypersensitivity to methysergide
Retroperitoneal fibrosis
Most sensitive test for retroperitoneal fibrosis
IVP (intravenous pyelogram)
Tx of retroperitoneal fibrosis
Steroids
Typical location of malignant mesenteric tumors
Root of mesentery
Typical location of benign mesenteric tumors
Periphery of mesentery
1 malignant mesenteric tumor
Liposarcoma
Most common malignant retroperitoneal tumor
Lymphoma
Retroperitoneal sarcomas metastasizes to _
Lung
Most common omental solid tumor is _
Metastatic disease
Removed with peritoneal dialysis (4)
Lead
NH3
Fe
Ca
Increased with CO2 pneumoperitoneum (5)
Mean arterial pressure Pulmonary artery pressure Mean airway pressure HR Systemic vascular resistance CVP Peak inspiratory pressure
Decreased with CO2 pneumoperitoneum (4)
pH
Venous return (IVC compression)
Cardiac output
Renal flow (2/2 decreased CO)
CO2 embolus signs
Sudden increase in end tidal CO2 -> drop with hypotension
Tx of CO2 embolus
Head down, turn pt to left, aspirate through central line
Cost effective tool for medium vessels
Harmonic scalpel
Ultrasound most commonly used mode, assesses relative density of structures
B-mode
Dark area on US posterior to object indicating mass
Shadowing
Brighter area on US posterior to object indicating fluid filled cyst
Enhancement
Deep structures on US are seen on _ frequency
Lower
Superficial structures on US are seen on _ frequency
Higher
Adds doppler on US, color visual description of blood flow
Duplex
Argon beam acts by causing _
Superficial necrosis
Acts by coagulation and vaporizing
Laser
Good for deep tissue penetration and bronchial lesions
Nd:YAG laser
Graft which you cannot get fibroblast ingrowth
PTFE (gore-tex)
Graft which allows for fibroblast ingrowth
Dacron
Incidence of bowel/vascular injury with Veress needle
0.1%
