abdominal wall and hernia Flashcards
hernia
protrusion of all or part of a structure through the tissues that normally contain it
what nerve is most frequently injured during an open inguinal hernia repair
ilioinguinal nerve
injury to genitofemoral nerves can leave permanent
numbness to the groin, scrotum and anterior thigh
layers of the abdominal wall
skin, subcutaneous tissue, ext oblique, int oblique, transversus muscle, transversalis fascia, peritoneum
most widely used abdominal incision
midline vertical incision; through the line alba; no vasculature; choice in trauma or lack of preop dx
incision of choice for pecs surgery
transverse incision; made along Langer’s lines= better cosmetic scars; postop coughing/exercise close incision rather than open it
what are retroperitoneal incisions used for
access to aorta and vessels, kidneys, and anterior spine
what incision is most prone to herniation or disruption
paramedian incision
what incision is used for obstetric, gyn, and urologic procedures
pfannenstiel incision
incision for appendix
McBurney*, rocky davis
what is there a risk of if hernia originates through a relatively small aperture
incarceration since can’t be reduced back into abd cavity
mc cause bowel obstruction in ppl who have not had previous abdominal surgery
incarcerated hernia
strangulation
vascular compromise of an incarcerated organ; result is bowel necrosis which can lead to perforation
when should strangulation be suspected
erythema of overlying skin, tachycardia, fever, elev wbc
bowel, omentum, or another intra-abdominal organ protrudes through the internal inguinal ring descending within the continuous peritoneal coverage of a patent processus vaginalis, which is anteromedial to the spermatic cord
indirect inguinal hernia
hernia lateral to epigastric vessels
indirect inguinal hernia
what is necessary for an indirect hernia to dev
patency of the processes vaginalis
causes of indirect inguinal hernias
lifting, coughing, constipation
workup of man >50 presenting w new hernia
rectal exam w palpation of prostate, hemoccult , routine screening colonoscopy
mc hernias in both sexes and all ages
indirect hernias
which side to indirect hernias occur more on
right because of delayed descent of that testicle
hernia bulges directly through the posterior inguinal wall
direct inguinal hernia
bulge medial to inferior epigastric vessels and are not assoc w patent processus vaginalis
direct hernia
portion of the posterior inguinal wall through which a direct hernia occurs
Hesselbach’s triangle: linea semilunaris muscle medially, inferior epigastric vessels superolaterally, and inguinal ligament inferiorly
occur over time as a result of pressure and tension on fascial layers; acquired
direct hernia
hernia more common in older men
direct hernia
predisposition for femoral hernia
short medial attachment of transverses abominis muscle onto Coopers ligament which results in enlarged femoral ring
femoral canal
lacunar ligament medially and femoral vein laterally
femoral triangle
inguinal ligament superiorly, adductor longus muscle medially, and sartorius muscle laterally
hernia much lower in groin and very susceptible to incarceration and strangulation
femoral
occur in pts who have experienced wl as they age
femoral
manual attempt at reduction of groin hernia
pt in Trendelenburg position, pain meds, steady pressure applied to incarcerated hernia, pressure applied in cephalic, lateral, and slightly dorsal direction along course of spermatic cord through the inguinal canal