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Phase 4 > Abdominal Wall Surgery > Flashcards

Abdominal Wall Surgery Flashcards

1
Q

Anatomically where would you feel for the deep inguinal ring?

A

Mid point of the inguinal ligament
- 2cm lateral to the mid-inguinal point

*this differs from the mid-inguinal point - which is where the femoral artery is felt.

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2
Q

What symptoms may be present in an inguinal hernia?

What investigation should be done?

A
  • asymptomatic
  • Dragging sensation, especially by the end of the day
  • Aching
  • Specific activity pain - like lifting

Investigations:

  • Physical exam
  • Ultrasound - if there is doubt
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3
Q

Compare and contrast direct and indirect hernias:

A

Indirect;

  • usually younger
  • congenital - patent processes vaginalis
  • lateral to inferior epigastric
  • often into scrotum
  • deep ring occlusion controls it
  • narrow neck
  • strangulation is more likely

Direct:

  • usually older patients
  • acquired all weakness - not congenital
  • medial to inferior epigastric
  • deep ring occlusion doesn’t control it
  • wide neck
  • strangulation is rare
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4
Q

What are the complications that can occur with hernias?

A

Incarceration
Obstruction
Strangulation

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5
Q

What is the broad management approaches to hernias?

A

observe
- appropriate in patients with low risk of complications

Open repair
- open mesh

Laparoscopic repair
- Trans - abdominal preperitoneal ( TAPP)

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6
Q

What are the boundaries to hesselbach’s triangle?

A

RIP:
Rectus abdominis - medial
Inferior epigastric artery - lateral / superior border
Poupart’s ligament/ inguinal ligament - inferior border

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7
Q

What are some differentials to an inguinal hernia?

A

Femoral hernia

Enlarged lymph node

Ectopic/ undescended testis

Swollen teste

  • hydrocele
  • varicocele
  • testis mass

Abscess

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8
Q

What are the borders of the femoral canal?

A

FLIP

Femoral vein - laterally
Lacunar ligament - medially
Inguinal ligament - superiorly
Pectineal ligament - posteriorly

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9
Q

List several types of hernias:

A 
Inguinal 
Femoral 
Incisional 
Obturator 
Umbilical 
Paraumbilical 
Hiatus
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10
Q

How does an obturator hernia present?

How is it diagnosed?

A

Typically in females with multiple pregnancies

Pain on the inside of the thigh, radiating to the knee

  • when hip is internally rotated
  • compresses the obturator nerve

**the hernia is due to weakness in the pelvic floor

Diagnosed via MRI

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11
Q

What is the hernia called when there is a tear in the linea alba? how is it tested?

A

Diastasis Recti

Diagnosed by lying patient down and getting them to lift head up.

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12
Q

What is a hernia called when only part of the bowel wall protrudes out, and what is worrisome about them?

A

Richter’s hernia

  • they can easily strangulate
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13
Q

If a new born presents with an umbilical hernia, what is the management?

A

Reassure parents vast majority disappear by age 4-5 years old.

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14
Q

If a new born presents with an inguinal hernia, what is the management?

A

Surgical - this is likely to be an indirect hernia and as such is at risk of rupturing

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15
Q

What are some complications of hernia repair surgery?

A

Scrotal haematoma

Urinary retention

Damage to the ilioinguinal nerve
- it is within the inguinal canal but not the spermatic cord

Recurrence

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16
Q

What are the options for inguinal hernias that are not going to be operated on?

A

Hernia Truss

- helps to hold the hernia in

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17
Q

What are some risk factors for inguinal hernia?

A 
Age 
Obesity 
Male 
Increased intraabdominal pressure 
- sneezing, coughing, lifting heavy
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18
Q

How does a strangulated hernia present?

A

An irreducible lump which is tense and tender with pain being out of proportion to clinical signs. This may also be in combination with symptoms of obstruction

19
Q

What key things are you assessing for when examining an inguinal hernia?

A

Reducibility
- lying down/ minimal pressure

Location - supra-medial to the pubis tubercle - inguinal
infra- lateral to the pubis tubercle - femoral

Cough impulse

20
Q

What type of surgery is most applicable to recurrent inguinal hernias?

A

Laparoscopic repair

21
Q

Define hernia:

A

A hernia is the protrusion of a tissue or viscus beyond the normal coverings or cavity in which it is usually contained

22
Q

What are the principles of making incisions?

A

Follow Langer’s lines

  • skin tension areas
  • maximal wound strength and minimal scarring
23
Q

How can wounds be closed?

A

Suturing
Staples
Tissue glue
Steri Strips

24
Q

What incisions can be done to access the appendix?

A

Lanz Incision

Gridiron Incision

25
Q

What is the type of incision made if access to the gallbladder is needed?

A

Kocher Incision

26
Q

What are some features of generalised peritonitis?

A

Patient remains very still
- does not want to move

Tachycardia

Involuntary guarding

Rigid abdomen

Absent bowel sounds

27
Q

What are some routine tests wanted in peritonism?

A

Bloods:

  • FBC
  • U&Es
  • LFTs
  • Amylase
  • Group and Save *always do cause of surgery

Orifices:

  • Pregnancy test
  • Urine analysis - exclude GU causes

X-ray:

  • CXR - erect
  • ABX
  • Ultrasound - kidneys, biliary tree, ovaries

ECG :
- all patients should get an ECG with abdominal pain to rule out cardiogenic causes

28
Q

What is the general management into peritonism?

A

IV access

Nil by mouth

Analgesia

IV fluids

+/-
Antibiotics
NG tube

*monitor fluid output

29
Q

Where does the direct inguinal hernia come through?

A

Hasselbach’s triangle

30
Q

What are some key signs of a hernia:

A

Occur at anatomically weak spots

Reducible
- to begin with

Have a cough impulse

31
Q

What are the differentials to an inguinal hernia?

A

Lipoma

Femoral hernia

Saphena varix (Varicose veins of the groin)

Inguinal Lymphadenopathy

In the scrotum:

  • varicocele
  • Hydrocele
32
Q

What examinations should be done on a suspected inguinal hernia?

A

Palpation

Reducibility
- both lying down and standing

Cough Impulse

Ascertain if the hernia can be put into the deep inguinal ring and controlled

Auscultation
- listen for bowel sounds

Feel the other side `

33
Q

If there strangulation but no signs of obstruction with a hernia, what type of hernia is it likely to be?

A

Richter’s hernia

- only part of the bowel wall is trapped with strangulation, but there is a still a patent lumen for contents.

34
Q

What is it called when there is a direct and indirect hernia in the same groin?

A

Pantaloon hernia

35
Q

What is the most common hernia in women?

A

Inguinal

*the femoral is just more common in women than men, but inguinal is still the most common

36
Q

How are femoral hernias diagnosed and how are they managed?

A

Clinical but usually:
- US
- CT
is needed to clarify diagnosis

Managed with Surgical input as there is a high risk of strangulation
- high approach - used during surgical emergencies (above the inguinal canal)

  • Low approach (below the inguinal canal)
37
Q

What does the surgical operation for a femoral hernia consists of?

A

Reducing the hernia

Tightening the femoral canal to prevent reoccurance

38
Q

What are the two things that may be inside the inguinal hernia:

A

Bowel
- will hear bowel sounds

Omentum

39
Q

Why is looking for appendectomy scars important?

A

Damage to the Iliohypogastric nerve can lead to weakness in the transverse muscle causing hernia

40
Q

What is Maydl’s hernia?

A

Where the bowel double backs and causes strangulation internally

41
Q

Whats it called when the hernia is pushed back in but is still herniated causes incarceration:

A

Reduction-en-mass

42
Q

What are the indications for laparoscopic repair?

A

Bilateral hernias

Reoccurring

Female

43
Q

Complications of inguinal hernia surgery:

A

Haematoma
- into the groin

Wound infection

Urinary retention

Testicular damage to due to damage to testicular artery

Phase 4 (49 decks)

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