Abdominal Trauma And Hernias

Question 1

When performing abdominocentesis, the bladder should be __ . What area the 2 methods of abdominocentesis?

Answer 1

When performing abdominocentesis, the bladder should be emptied.

1. Hawaiian Punch: Two 1.5 inch 22G needles and a 1ml syringe
2. Four Quadrants: Linea Alba, umbilicus and 5-25 ml/kg of fluid

Question 2

In cases of abdominal trauma, __ should be managed conservatively, ___ and __ should be stabilized then moved to surgery and __ or __ should have emergency surgical intervention

Answer 2

In cases of abdominal trauma, hemp abdomen should be managed conservatively, uroabdomen and hernias should be stabilized then moved to surgery and ruptured hollow viscous organs or no response to medical management should have emergency surgical intervention

Question 3

In a hemodynamically unstable patient when should you choose an exploratory laparotomy

Answer 3

If there is identifiable free fluid on ultrasound ; or aspiration of gross blood, RBC > 100K/mm3, WBC > 500mm3, particulate matter or bile on diagnostic peritoneal lavage

Question 4

Hernia definition

Answer 4

The protrusion of an organ through a defect in an anatomical cavity

Question 5

A ___ is when the contents are contained in an anatomical hernia sac while a __ is when the contents lack a sac

Answer 5

A true hernia is when the contents are contained in an anatomical hernia sac while a false hernia is when the contents lack a sac

Question 6

Briefly explain the classifications of hernias

Answer 6

Hernias may be reducible, non reducible, incarcerated (luminal obstruction), strangulated (compromised blood supply), acquired or congenital

Question 7

Patients with abdominal hernias often have a history of __, ___ swelling and may have pain caused by ___ hernias or they may __.

Answer 7

Patients with abdominal hernias often have a history of trauma , reducible swelling and may have pain caused by non reducible/strangulating hernias or they may vomit.

Question 8

Herniorrhaphy aim to do what 5 things?

Answer 8

1. Return contents to normal location
2. Secure ring closure
3. Obliterate tissue in sac
4. Utilize patient tissues
5. Tension free closure

Question 9

In a herniorrhaphy, when returning the contents to their normal location the tissue may be __ and you can __ the ring if necessary or breakdown incarcerated hernias. Then when you secure the ring closure do so at the __ of the hernia and make sure you do __ approximation of the tissues and DO NOT ___ the edges. Sutures should be placed in the holding layer which is likely the ____.

Answer 9

In a herniorrhaphy, when returning the contents to their normal location the tissue may be friable and you can enlarge the ring if necessary or breakdown incarcerated hernias. Then when you secure the ring closure do so at the neck of the hernia and make sure you do direct approximation of the tissues and DO NOT freshen the edges. Sutures should be placed in the holding layer which is likely the external oblique.

Question 10

When performing a herniorrhaphy, the tissues in the sac should be __and then utilize patient tissues followed by a tension free closure which may be accomplished by __,__ or __.

Answer 10

When performing a herniorrhaphy, the tissues in the sac should be obliterated and then utilize patient tissues followed by a tension free closure which may be accomplished by flaps ,mesh or swine intestinal submucosa.

Question 11

What is the most common type of abdominal hernia?

Answer 11

Umbilical hernia

Question 12

Umbilical hernias <2-3mm can be given __ months to resolve on their own but after that its a lifelong issue that needs attention

Answer 12

Umbilical hernias can be given 6 months to resolve on their own but after that its a lifelong issue that needs attention

Question 13

Explain the surgical correction of an umbilical hernia

Answer 13

1. Dissect skin and SQ off sac then expose the linea alba cranial and caudal to the ring
2. Open the hernia sac
3. Replace contents into abdomen and excise the sac
4. Debride edges of the ring and close linea with simple continuous sutures
5. Excise excess skin
6. Close routinely

Question 14

When are congenital and acquired hernias most common?

Answer 14

Congenital are uncommon but happen more in males

Acquired are common in middle aged intact females

Question 15

Inguinal hernias are typically __ and can be diagnosed by physical exam and __

Answer 15

Inguinal hernias are typically non-painful and can be diagnosed by physical exam and imaging (Rads, AUS, CT)

Question 16

Inguinal hernias are typically __ and can be diagnosed by physical exam and __

Answer 16

Inguinal hernias are typically non-painful and can be diagnosed by physical exam and imaging (Rads, AUS, CT)

Question 17

Surgical correction of an Inguinal hernia

Answer 17

Approach over the ring on ventral midline, ligature the hernial sac, close the external ring and achieve tension free apposition.

Question 18

Scrotal hernias will have __ swelling, __ scrotal skin, and may be __. They can be corrected like Inguinal hernias and castration is recommended

Answer 18

Scrotal hernias will have unilateral swelling, darker scrotal skin, and may be painful. They can be corrected like Inguinal hernias and castration is recommended

Question 19

Most traumatic hernias are __ emergencies

Answer 19

Most traumatic hernias are not emergencies

Question 20

When would a traumatic abdominal hernia be an emergency?

Answer 20

• penetrating wounds
• incarcerated or strangulate tissues
• severe hemorrhage, septic abdomen, pneumoperitoneum

Question 21

Traumatic abdominal hernia surgeries can be postponed__ days until the patient is stabilized which allows for declaration of non viable tissues

Answer 21

Traumatic abdominal hernia surgeries can be postponed 3-5 days until the patient is stabilized which allows for declaration of non viable tissues

Question 22

Surgical considerations for a traumatic hernia

Answer 22

1. Ventral midline celiotomy
2. FULL EXPLORATORY
3. Reduce hernial contents
4. Repair other internal injuries
5. Close affected tissue planes