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Sugery - AS PACES > Abdo > Flashcards

Abdo Flashcards

1
Q

Anatomy of the inguinal canal

A

Anterior: external oblique and internal oblique for the lateral third
Posterior: transversalis fascia and conjoint tendon for medial third
Floor: inguinal ligament
Roof: arching fibre of transversus and internal oblique

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2
Q

Contents of the spermatic cord

A 
Three layers of fascia:
1. External spermatic fascia 
2. Cremestatic fascia
3. Internal spermatic 
Three ateries and three viens 
1. Testicular
2. Cresmenteric 
3. Vas 
Two nerves
1. Sympathetic 
2. Gential branch of gen fem nerve 
Lymphatic 
Vas 
Process vaginalis
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3
Q

Contents of inguinal canal

A

M: spermatic cord and illoinguinal nerve
F: round ligament, illoinguinal nerve , gen branch of gen fem nerve

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4
Q

Hesselbach’s triangle

A

Medial: rectus abdominis
Lateral: inferior epigastric artery
Inferior: inguinal ligament

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5
Q

Classification of inguinal hernia

A 
Indirect - 80% 
- patent processus vaginalis 
- arise lateral to inferior epigastric artery 
Direct -20% 
- emerge through hesselbach's triangle 
- due to acquired weak wall of canal
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6
Q

Laparoscopic techniques for inguinal hernia

A

TEP: totally extra peritoneal
TAPP: transabdominal pre- peritoneal

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7
Q

Complications of inguinal hernia repair

A 
Early 
- urinary retention 
- haematoma/ seroma formation - 10% 
- infection - 1% 
- intrabdominal Injury - lap 
Late 
- reoccurrence
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8
Q

Borders of the femoral canal

A

Medial: lacunar ligament
Lateral: femoral vien
Anterior: inguinal ligament
Posterior: pectineal ligament of cooper

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9
Q

Operative management of a femoral hernia

A

Elective: Lockwood low approach
Emergency: McEvedy high approach

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10
Q

Definition of an inguinal hernia

A

Extrusion of peritoneum and abdominal contents through a previously acquired defect

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11
Q

Risk factors for incscional hernias

A

Pre-op: increased age, co-mobrdities ( malignancy and obesity )
Intra - op: surgical technique ( width of suture bites, suture material, midline, placing drain through wounds )
Post op: incensed IAP, infection, heamatoma

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12
Q

Cause of a paraumbilcal hernia

A

Acquired defect in linea Alba just above or below the umbilicus

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13
Q

Definition of a hernia

A

Protrusion of a viscus or part of a viscus into an abnormal position through a defect in its containing cavity

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14
Q

Risk factor for umbilical hernias

A

Afro-carribean
Trisomy 21
Congenital hypothyroidism

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15
Q

Definition of a hydroele

A

Accumulation of fluid within the tunica vaginalis

Tunica vaginalis is a rememant of the processus vaginalis

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16
Q

Anatomical classification of hydroele

A

Vaginal: accumulation in the tunica vaginalis that does not extend up the cord
Congenital: proximal part of the processus has not obliterated and sac communicates directly with preitoneum
Infantile: processus is obliterated at the deep ring but still extend up the cord
Hydroele of the cord: fluid accumulate around the ductus deferens

17
Q

Cause of hydroceles

A

Primary: patent processus vaginalis
Secondary: testicualr tumours, epidymo-orchitis, trauma, torsion

18
Q

Surgical treatment of hydrocele

A

Lords repair: plication of the tunica vaignalis

Jaboulay’s repair: eversion of the sac

19
Q

Definition of a varicocele

A

Dilated viens of the pampinifrom plexus

20
Q

Operation for varicocele

A

Palomo operation

21
Q

Risk factor for testicualr cancer

A

Undescended testis
Infant hernia
Infertility

22
Q

Royal marsden classification of testicualr cancer

A
  1. Disease only in testis
  2. Sub diaphragmatic para-aortic node involvement
  3. Supra and infra diaphragmatic lymph nodes involved
  4. Extra lymphatic spread - lungs liver
23
Q

No scars and stoma =

A

Colonoscopy assisted trephine colostomy

24
Q

Definition of a stoma

A

Artificial union between conduits or between a conduit and the outside

25
Fistula definition
Abnormal connection between two hollow epithelial surface
26
Indication for a stoma
``` Exteriorisation - perforated or contaminated bowel - permenant Diversion - protection of distal anastomosis - acute chrons - urinary diversion following cystectomy Decompression: bypass of distal obstructing lesion Feeding: gastrostomy/ jejunostomy Laveage: appendecictomy ```
27
How to site a stoma
Avoid: bony prominences, skin folds/creases, waistline, old wounds, umbilicus Chose - a site that is easily accessible to the patient - ideally below the belt line for concealment - within the rectus: decreased risk of hernia or prolapse
28
Complication of a stoma
``` Early - haemorrhage - ischemia - hight out put leading to electrolyte disturbances - parastomal abscess - stoma retraction Delayed - parastomal hernia - more common on the lateral side -obstruction: adhesion or herniation through lateral space around stoma - dermatitis - stoma prolapse - stenosis or stricture - fistula - psychosexual dysfunction ```
29
Layers of tissues around abdomen
``` Skin Campers fascia Scarpas fascia Linea Alba Transversalis fascia Pre-peritoneal fat Preitoneum ``` Some catholic sluts like to practise phallactio
30
Jenkins rule
Length of suture should be 4 times the length of the incscion
31
Indication for midline stenotomy
Trauma Vascular: AAA, Vascualr bypass Gastro: perforated Dueodenal ulcer, Hartmann, colectomy
32
Indications for a roof top incscion
``` Hepatobillary: - liver transplant - whipples - liver resection Gastric surgery ```
33
Lateral layers of the abdominal wall
``` Skin Campers fascia Scarpas fascia External oblique Internal oblique Transversus Transversalis fascia Pre-peritoneal fat Preitoneum ```
34
Nerves at risk in appendicetomy
Ilioinguinal | Iliohypogastric
35
Cause of post op jaundice
Pre-hepatic: heamolysis after a transfusion Hepatic: halogenated anaesthetic, sepsis, intra-post operative hypotension Post hepatic: billary injury in lap Chloe
36
Cause of gynecomastia
Drugs - recreational: marijuana, diazepam, anabolic steroid - prescription: spirolactone, digoxin, catopril, verapamil, ranitidine Physiological - puberty resolve by adulthood Pathological - decreased androgen production: hypogoandism: hyperprolactinemia, renal failure, testicualr atrophy, post-orchitis, bilateral torsion, klienfelter XXY - increased oestrogen - increased production: sex-cord stromal tumours, lung ca - increased peripheral aromatisation: CLD, thyrotoxicosis
37
Risk factors for oesophageal cancer
``` GORD EtOH Smoking Achalasia Plummer Vinson syndrome ```
38
What's is a pharyngeal pouch
Outpouching between crico and thyro pharyngeal components of the inferior pharyngeal constrictiors Pulsion diverticulum Area of weakness is called killians dehiscnse
39
Riglers triad
Small bowel obstruction Pneumobillia Gallstone in right iliac fossa

Sugery - AS PACES (7 decks)

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