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CP3 Medicine > Abdominal Wall > Flashcards

Abdominal Wall Flashcards

1
Q

Def hernia

A

Protrusion of an organ through a defect in the wall of the cavity containing it, into an abnormal position

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2
Q

Reducible hernia

A

The contents of the hernia can be completely replaced into the cavity

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3
Q

Irreducible hernia

A

Contents of the hernia can’t be completely replaced into the cavity

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4
Q

Obstructed hernia

A

Bowel contents can’t pass through the hernaited bowel

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5
Q

Strangulated hernia

A

There is ischaemia of contents of hernia (b/c constructed vv return) - which unless relived –> gangrene + perforation

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6
Q

Incarcerated hernia

A

Contents of hernia sac = stuck inside by adhesions

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7
Q

Mx hernia if irreversible

A

Elective surgery - Lichenstein repair mesh technique being gold standard

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8
Q

Mx of hernia if strangulated/obstructed

A

Emergency Hartmanns procedure

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9
Q

Mx congenital inguinal hernia in infants

A

Herniotomy + ligation processus vaginalis at 1y

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10
Q

What is the inguinal canal formed from?

A

Relocation of testes during foetal development

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11
Q

what does the inguinal contain?

A

3aa
3nn
3 other

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12
Q

3aa contained in the inguinal canal

A

testicular/ovarian aa
aa to vas deferens
cremasteric aa

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13
Q

3 nn contained in the inguinal canal

A

genital branch genitofemoral
ilioinguinal
sympathetic nn

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14
Q

what are the 3 other structures contained in the inguinal canal

A

vas deferens/ round ligament uterus
pampiniform plexus
testicular lymphatics

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15
Q

what are the 3fascial coverings related to the mm layers of the abdomen

A

Internal spermatic fascia
Cremasteric fascia
External spermatic fascia

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16
Q

Where is the deep inguinal ring located

A

1cm superior to mid point of inguinal ligament

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17
Q

WHere is the midpoint of the inguinal ligament

A

Halfway between ASIS to PT

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18
Q

where is the mid inguinal point

A

Halfway between ASIS to PS

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19
Q

Where is the superficial inguinal ring located

A

1cm superior.+ lat to PT

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20
Q

what are the 4 boundaries of the inguinal ligament

A

Superior wall M
Anterior wall A
Inferior wall L
Posterior wall T

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21
Q

superior wall inguinal ligament (2Mms)

A

Int oblique

Transversus abdominalis

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22
Q

anterior wall inguinal ligament (2 aponeurosis)

A

Aponeurosis of: int oblique + ext oblique

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23
Q

Inferior wall inguinal ligament (2 ligaments)

A

lacunar ligament

inguinal ligament

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24
Q

posterior wall inguinal ligament (2 Ts)

A

Transversalis fascia

Conjoint tendon

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25
Q

What % of inguinal hernias are indirect

A

66%

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26
Q

What is the hernia covered by in indirect inguinal hernia

A

processus vaginalis

all 3 fascia coverigns

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27
Q

Where does indirect inguinal hernia exit

A

exits superficial ring inside cord . can pass into scrotum

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28
Q

Why are indirect inguinal hernias more likely to strangulate

A

B/c superficial ring is not dilated

29
Q

Direct inguinal hernia

A

Contents pass through weakness in anterior abdo wall in inguinal triangle

30
Q

Cause direct inguinal hernia (4)

A

chronic cough
straining at micturition/defacation
heavy lifting
smoking

31
Q

coverings direct inguinal hernia

A

peritoneium + transveralis fascia

32
Q

Exit direct inguinal hernia

A

Exits superficial ring lateral to the cord

33
Q

Ix if you cannot feeel the inguinal hernia

A

USS

34
Q

How is absolute differentiation between the 2 rtypes of inguinal hernia achieved

A

in theatre
indirect passes lateral to inf epigastric aa
direct passes medial to inf epigastric aa

35
Q

Physical findings inguinal hernia

A

Ask pt to cough /
Scrotal continuation
Increased bowel sounds

36
Q

features of incarcerated inguinal hernia (4)

A

Constipation
Distention
Vomiting
Pain

37
Q

Which sex is femoral hernia more common in

A

F

38
Q

borders of the femoral triangle

A

SUP: inguinal ligament
LAT: med border of sartorius
MED: lat border of adductor longus

39
Q

What does the femoral triangle contain

A

NAVY (lat to med)
Femoral nn
Femoral aa
Femoral vv

40
Q

What is the femoral sheath

A

inferior prolongation of transversalis/iliapsoas fascia that passes deep to inguinal ligament to allow passage of female aa/vv into triangle

41
Q

Where is the femoral canal

A

At medial extremity of femoral sheath

42
Q

where does bowel exit the abdominal cavity in a femoral hernia

A

femoral ring

43
Q

Why is there a high risk of strangulation/obstruction in femoral hernia

A

Femoral canal is v small w/ strong borders

44
Q

What is a Richter’s hernia

A

Hernia involving only 1 sidewall of bowel + not bowel lumen

45
Q

Where is a Richter’s hernia particularly likely

A

Femoral sac

46
Q

Sx femoral hernia

A

globular lump below + lat to PT

47
Q

What % femoral hernia present as an emergency

A

50%

48
Q

If a femoral hernia is hard and tender - what has likely happened

A

Strangulation.obstruction

49
Q

DDx lump in groin (6)

A 
Inguinal hernia 
Lipoma 
Femoral aa aneurysm 
Saphenous ovarix 
Psoas abscess 
LN
50
Q

what are true umbilical hernias due to

A

incomplete closure of umbilical cicatrix

51
Q

Which babies are more at risk of true umbilical hernias? (3)

A

Black
Male
Premature

52
Q

Sx true umbilical hernia

A

Usually asymp

53
Q

What % umbilical hernia retract by age 2

A

90%

54
Q

what is a paraumbilical hernia

A

Acquired hernia that occurs just above/below umbilicus

55
Q

Cause paraumbilical hernia

A

raised IAP

56
Q

Who is paraambulical hernia more common in

A

Obese, middle aged, multiparous F

57
Q

PS paraumbilical hernia

A

localised dragging pain
Enlarged hernia over time
Tender

58
Q

Mx paraumbilical hernia

A

Early operative

Excision of sac + stitching of rectus sheath = Mayo’s operation

59
Q

What % of hernias are incisional

A

10%

60
Q

Pre-op RF incisional hernias (7)

A 
Old age
Poor nutrition 
Sepsis 
Uraemia 
jaundice 
obesity 
steroids
61
Q

Operative RF incisional hernia (3)

A

Veritcal incisions
KNots that are too loose/tight
Presence of drains

62
Q

Postop RF incisional hernia (4)

A

Post op ileus
Coughing
Obesity
Wound infections

63
Q

Sx incisional hernia

A

Bulge in scar

Local discomfort

64
Q

Which type of incision most commonly leads to incisional hernia

A

midline laparotomy scars

65
Q

Def epigastric hernia

A

1 or > protrusions through linea alba above umbilicus usually containing only extraperitoneal fat

66
Q

What % epigastric hernia are asymp

A

75%

67
Q

When is pain of an epigastric hernia worst

A

On physical exertion

After meals

68
Q

What is divarification of rectus mm

A

when the rectus mm do not meet at the midline of linea alba - hence split apart when pt flexes abdo mm

69
Q

Who gets divarification of rectus mm

A

Obese men
Parous F
People w/ chronically raised IAP

CP3 Medicine (29 decks)

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