38 Hernias, Abdomen, Tech Flashcards by Ryan Lee

What forms the cremasteric muscles?

internal oblique

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What forms the inguinal canal floor?

transversalis muscle

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Where does the inguinal ligament come from?

external oblique

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What forms where the inguinal ligament splays out to insert in the pubis?

Lacunar ligament

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What comes from the transversalis, runs from asis to the pubis and is below the inguinal ligament?

ileopubic tract

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Cooper’s ligament aka?

pectineal ligament

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What runs medial to the cord structures?

vas deferens

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What forms Hesselbach’s triangle?

rectus muscle, inferior inguinal ligament, and inferior epigastrics

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What type of inguinal hernia is most common and comes from a patent processus vaginalis?

indirect hernia

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What type of inguinal hernia has a lower risk of incarceration, rare in females, and has a higher recurrence than indirect?

direct hernia

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What type of hernia has direct and indirect components?

Pantaloon hernia

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What type of hernia occurs when the wall of the hernia sac is an organ?

sliding hernia

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What are the 2 most common organs involved in a sliding inguinal hernia in women? and men?

ovaries or fallopian tubes

cecum or sigmoid

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3 steps in repair of female with ovary in inguinal canal?

ligate the round ligament, return ovary to peritoneum, perform biopsy if looks abnormal

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Inguinal hernia in children is almost always what type? and what is the treatment?

nearly always indirect, just perform high ligation (open sac prior to ligation)

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Describe the Bassini repair

approximation of the conjoined tendon and transversalis fascia (superior) to the free edge of the inguinal ligament (inferior)

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Describe the McVay repair

approximation of the conjoined tendon and transversalis fascia (superior) to Cooper’s ligament (pectineal ligament, inferior)

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The McVay repair needs a relaxing incision where?

external abdominal oblique fascia

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When is laparoscopic inguinal hernia repair indicated?

bilateral or recurrent

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What is the advantage of the Lichtenstein mesh repair?

decreased recurrence due to decreased tension

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What is the most common early complication following hernia repair?

urinary retention

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What is the infection rate for inguinal hernia repair? and recurrence rate?

2%, 2%

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What can occur secondary to dissection of the distal components of the hernia sac causing vessel disruption and thrombosis of spermatic cord veins?

testicular atrophy

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Pain after hernia is usually caused by what? What is the tx?

compression of ilioinguinal nerve, local infiltration (diagnostic and therapueutic)

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Loss of cremasteric reflex; numbness on ipsilateral penis, scrotum and thigh are sx of what?

ilioinguinal nerve injury

Where is the ilioinguinal nerve injury usually occur?

at the external ring; nerve runs on top of cord

What nerve is usually injured with laparscopic hernia repair?

genitofemoral

What are the two branches of the genitofemoral nerve and what do they do?

genital branch - cremasteric (motor) and scotum (sensory) | femoral branch - uppler lateral thigh (sensory)

What is the tx for cord lipomas?

should be removed

What is in the trapezoid of doom in laparoscopic hernia repairs?

femoral branch of genitofemoral nerve, lateral cutaneous nerve and femoral artery

What are the boundaries of the femoral canal?

Cooper's ligament, inguinal ligament and femoral vein

Where in NAVEL dose femoral hernias occur?

Empty space

Fermoral hernias carry a high risk of incarceration. What may be necessary to divide to reduce bowel?

inguinal ligament

Femoral hernias are usually repaired through what approach? and what two possible tissue repairs?

inguinal approach, McVay or Bassini

What patient population has an increased risk of umbilical hernias?

african americans

Until what age should umbilical hernia repair be delayed?

5 years

Is the risk of incarceration of umbilical hernia in children or adults?

Adults

Where does a Spigelian hernia occur?

lateral border of the rectus muscle through linea semilunaris, almost always inferior to the semicircularis

What is as noncircumferencial incarceration of the nonmesenteric bowel wall?

Richter's hernia

What is an incarcerated Meckel's called?

Littre's

What is an inferior lumbar hernia called? and superior lumbar hernia?

Petit's hernia is inferior lumbar. Grynfeltt's is a superior lumbar hernia

What type of hernia goes through the greater sciatic foramen and has a high rate of strangulation?

Sciatic hernia

What is the tx for obturator hernia?

operative reduction, may need mesh, check other side for similar defect. diagnosis usually made at the time of surgery for small bowel obstruction

What type of hernia is the most likely to recur? what is the most common cause of this hernia?

incisional, inadequate closure

Peristomal hernias can be true of pseudo what is the cause and tx for both?

missed the rectus, need to move and place in rectus muscle

What is the tx for peristomal hernia - prolapse?

keep stoma at the same site, fix mesentery (is in rectus but prolapsing through)

What Fothergill's sign and what can it indicate?

abdominal wall mass more prominent and painful with flexion of the rectus muscle

Tx for rectus sheath hematoma is usually nonoperative. When do you operate?

if expanding

desmoid tumors occur more often in women, are benign but locally invasive and recurr. What syndrome are they associated with?

Gardner's

What is the tx for desmoid tumor?

Wide local incision, if involving small bowel, excision may not be indicated -> often not completely resectable and can cause worsening fibrosis

What are 2 possible medical treatments for desmoid tumors?

NSAIDs and antiestrogens

Retroperitoneal fibrosis can occur with hypersensitivity to what?

methysergide (former migraine/cluster headache tx)

What are the sx of retroperitoneal fibrosis and what is the most sensitive text?

trapped ureters and lymphatic obstruction, IVP is most sensitive

Tx for retroperitoneal fibrosis includes what medical tx? or what procedure if infection is present?

steroids, nephrostomy if infection is present

What is the indication for surgery in retroperitoneal fibriosis? and what is done in the surgery?

surgery if renal function becomes compromised, free up ureters and wrap in omentum

Of the primary mesenteric tumors, most are cystic. Where are malignant tumors located? and benign?

malignant closer to the root of the mesentery, benign more peripheral

Most solid tumors of the mesentery are benign. What two malignant types?

liposcarcoma, leiomyosarcoma

Retroperitoneal tumors, 15% in children, others in 5th-6th decade. Malignant > benign. What are the #1 and #2 malignant retroperitoneal tumors?

#1 lymphoma, #2 liposarcoma

Retropertoneal sarcomas what % are resectable? what is the 5 year survival rate?

<25%, 10%

Retroperitoneal sarcomas have a pseudocapsule but cannot shell out -> leave residual tumor. Where do the mets go?

to the lung

What is the most common omental solid tumor?

metastatic disease

Omentectomy for metastatic cancer has a role for some cancers such as ovarian CA. Omental cysts are usually asymptomatic, can ungergo torsion. Primary solid omental tumors are rate 1/3 maligant. What is the dx and tx?

No biopsy -> can bleed. Tx: resection

Most drugs are not removed with peritoneal dialysis: NH3, Ca, Fe and lead are removed. What is the rate saline is absorbed through the peritoneal membrane?

35 cc/hr

CO2 pneumoperitoneum, cardiopulmonary dysfunction can occur with intra-abdominal pressure > ?

What are the sx of CO2 embolus? the tx?

sudden rise in ETCO2, hypotension; head down, turn patient to the left

What is the difference in fibroblast ingrowth with Gore-Tex (PTFE) and Dacron (polypropylene)?

Gore-Tex (PTFE) – cannot get fibroblast ingrowth | Dacron (polypropylene) – allows fibroblast ingrowth

What is the incidence of vascular or bowel injury with Veress needle or trocar?

0.1%