Anatomy and Surgery 1 Flashcards
1
Q
Lining of epidermis
A
Stratified squamous epithelium
2
Q
Immune cells in the epidermis
A
Langerhan’s cells
3
Q
Nerve cells in dermis
A
Meissner’s (light touch), Pacinian (pressure)
4
Q
Major chemoattractant for fibroblasts during the proliferation phase of wound healing
A
PDGF
5
Q
Threshold of pressure injury
A
At least 1 hour of 60mmHg pressure
6
Q
Apocrine gland blockage, infection and abscess formation
A
Hidradenitis suppurativa
7
Q
Present as nodules and spread to form draining tracts. (+) sulfur granules on histology
A
Actinomycosis - follows tooth extraction, osontogenic infection, facial trauma
8
Q
Rapidly enlarging, necrotic ulcer with violet border and surrounding erythematous halo
A
Pyoderma gangrenosum - linked to ulcerative colitis, IBD
9
Q
Immune mediated, separation of skin at dermo-epidermal junction and >30% TBSA involvement
A
Toxic Epidermal Necrolysis
10
Q
Most common site of dermoid cyst
A
Eyebrow
11
Q
Skin lesions that yellow, non-tender, pruritic with a velvety greasy texture. Found in chest, back and abdomen,
A
Seborrheic keratoses - unrelated to sun exposure
12
Q
Sudden multiple eruptions of seborrheic keratoses associated with ovarian or gastric Ca
A
Lesser Trelat Sign
13
Q
Tender, warty, brown or black lesions on sun exposed areas
A
Solar (actinic) keratoses - premalignant (SCC)
14
Q
Treatment for congenital nevi
A
Excision, since it is premalignant
15
Q
Most common benign head and neck tumor in adults
A
Hemangioma - initial rapid proliferation followed by slow involution
16
Q
Consumptive coagulopathy due to a hemangioma
A
Kasabach Merritt Syndrome
17
Q
Benign neoplasm usually affecting hands
A
Glomus tumor - blue, subungual discolortion associated with tenderness and cold sensitivity
18
Q
Most common soft tissue tumor
A
Lipoma
19
Q
Neural tumor that invades striated skeletal muscles
A
Granular Cell Tumor
20
Q
Histology: Neurilemoma
A
Schwann cells packed in palisading rows
21
Q
Most common type of skin cancer?
A
Basal Cell Carcinoma - waxy, cream colored with rolled, pearly borders surrounding a central ulcer
22
Q
Histopath: Squamous cell carcinoma
A
Keratin pearls
23
Q
SCC in situ
A
Bowen’s Disease
24
Q
SCC in penis
A
Erythroplasia of Queyrat
25
SCC arising from burn areas
Marjolin's Ulcer - has an earlier metastasis
26
Most common spread of malignant melanoma
Superficial spread (70%) - anywhere except hands and feet
27
Malignant melanoma with the best prognosis
Lentigo maligna - face, neck, hands of elderly
28
Least common malignant melanoma, most common on great toe or thumb
Acral lentiginous - (+) Hutchinson's sign or pigment in paronychial area
29
Provides structural support to the breast
Cooper's suspensory ligaments - anchors the dermis to the pectoralis fascia
30
Provides a route for Breast Ca metastases to bone
Batson's Vertebral Plexus
31
Measurement of gynecomastia
At least 2cm in diameter
32
Thrombophlebitis that involves the superficial veins of the anterior chest wall and breast
Mondor's Disease - acute pain on lateral side, tender and firm cord following vein distribution
33
Veins involved in Mondor's Disease
Lateral thoracic vein, thoracoepigastric vein, superficial epigastric vein
34
Epidemic puerperal mastitis is due to?
MRSA
35
Tx for non epidemic (sporadic) mastitis
Empty breast using suction pumps, I&D cannot be done
36
Mimics Breast Ca on PE, mammogram and gross pathologic examination
Radial Scars and Complex Sclerosing Lesions - need to do biopsy
37
Large, pale, vacuolated cells in the rete pegs of epithelium of the breast
Paget Cells - chronic eczematous eruption of the nipple
38
Differentiate Paget's Disease from Melanoma
(+) CEA - Paget's Disease, (+) S 100 - Melanoma
39
Most common invasive Breast Ca
Invasive ductal Ca - (+) axillary LN, central stellate configuration with chalky white or yellow streaks
40
Invasive Breast Ca associated with BRCA 1 cancers
Medullary Ca - soft, hemorrhagic and bulky
41
Invasive Breast Ca with the best prognosis
Tubular Ca
42
Histopathology: Indian file configuration of cells, Signet ring cell Ca
Invasive Lobular Carcinoma
43
Biopsy method for breast lesions
Core needle biopsy
44
Gold standard in Breast Ca management
MRM - removal of all breast tissue and pectoralis fascia, ALND (I and II)
45
Moveable, midline neck mass
Thyroglossal Duct Cyst - Tx is Sistrunk Operation
46
Most common Branchial Cleft Anomaly
2nd - lateral neck at SCM and tonsillar fossa openings
47
Mucous retention cyst involving the sublingual gland
Ranula - found in the floor of the mouth, treat with Marsupialization
48
Granulomatous lesion in the oral cavity that is an exaggerated inflammatory response
Epulis - Tx is excision if symptomatic, same appearance as a malignant lesion in the gingiva
49
Expansive endosteal lesion of the mandible, of bony origin
Central Giant Cell Reparative Granuloma - Tx is curettage
50
Rare benign tumor of tongue (mid 1/3), derived from Schwann cells
Granular Cell Myoblastoma or Abrikossof tumor - Tx is wedge excision to r/o SCC of tongue
51
Benign lesion but highly expansile and destructive fibrovascular neoplasms of the nose among adolescent males
Juvenile Nasopharyngeal Angiofibroma - massive epistaxis
52
Tx for Juvenile Nasopharyngeal Angiofibroma
Angioembolization or open surgery (Weber Ferguson approach)
53
Removes cervical LN I-V, spinal accessory nerve, IJV, SCM
Radical neck dissection: Crile Procedure
54
Removes cervical LN I-V
Modified RN/Functional Neck Dissection: Bocca Procedure
55
Selective neck dissection for oral malignancies
Supraomohyoid (I,II, III)
56
Selective neck dissection for laryngeal malignancies
Lateral (II, III, IV)
57
Selective neck dissection for thyroid malignancies
Posterolateral (II, III, IV and V)
58
Cervical LN with the highest yield for biopsy
Level IV
59
Majority of lip Ca occurs in the lower lip except?
BCC in the upper lip
60
Paresthesia in Ca of lip indicates?
Mental nerve involvement
61
Most common location of tongue Ca
Lateral and ventral surface
62
Blind biopsies in unknown primary head and neck Ca
Base of tongue, pyriform sinus, tonsillar fossa, nasopharynx
63
Tx for subglottic laryngeal Ca
Total laryngectomy with bilateral neck dissection (MRND)
64
True or false: the smaller the salivary gland, the higher the risk of malignancy
True
65
Most common benign epithelial salivary gland tumor
Pleomorphic adenoma
66
Most important branch of the facial nerve to preserve
Temporal branch - closes the eyes
67
Young patients with long standing nodule and symptoms of hyperthyroidism
Toxic Adenoma (Plummer's Disease) - unilateral lobectomy + isthmusectomy
68
Given 7-10 days pre-op to decrease vascularity of the thyroid and lessen risk of thyroid storm
Lugol's iodine solution
69
Condition to suspect when a patient has recurrent Acute Suppurative Thyroiditis
Persistent pyriform sinus fistula - 3rd branchial cleft anomaly
70
Autoimmune disorder involving HLA-B8 and HLA-DR3
Grave's Disease
71
Autoimmune disorder involving CD 8 T-helper cells, HLA-B8 HLA-DR3 and HLA-DR 5
Chronic thyroiditis or Hashimoto's Lymphocytic Thyroiditis
72
Most common inflammatory disorder of the thyroid gland and leading cause of hypothyroidism
Hashimoto's Thyroiditis - diffuse infiltration by small lymphocytes and plasma cells
73
Presentation is a painless, hard anterior neck mass with compressive symptoms in weeks
Reidel's thyroiditis - invasive fibrous thrombosis, diagnose through open biopsy and treat with wedge excision
74
FNAB: orphan annie nuclei, psammoma bodies
Papillary Thyroid Ca
75
Most important prognostic factor in Papillary thyroid Ca
Age
76
Thyroid Ca that cannot be diagnosed by FNAB
Follicular and Hurthle Cell Ca
77
Thyroid Ca common in iodine deficient areas
Follicular Ca - minimum Tx is lobectomy+isthmusectomy
78
Dx of Follicular Ca and Hurthle Cell Ca
Capsular and vascular invasion
79
Tx for unresectable, locally invasive or recurrent disease and for bony metastases
External beam RT - involves carotids and prevertebral fascia
80
When are thyroglobulin levels measured post-op?
6 months initially then annually - increased levels is suggestive of metastatic or persistent normal thyroid tissue
81
Ca that arises from the parafollicular or C cells locate at the superolateral lobes of the thyroid gland
Medullary Thyroid Ca
82
Medullary Thyroid Ca premalignant lesion for familial cases
C Cell hyperplasia
83
Familial MTC is secondary to?
Germ line mutation at the ret proto oncogene
84
Earliest symptom of hypocalcemia
Perioral numbness
85
Blood supply of parathyroids
Inferior thyroid artery - from thyrocervical trunk
86
Most common location of ectopic parathyroids
Paraesophageal
87
Most common cause of primary hyperparathyroidism
Parathyroid adenoma - only 1 gland involved
88
Pentad of Primary Hyperparathyroidism
Kidney stones, painful bones, abdominal groans, psychic moans, and fatigue overtones
89
Preoperative localization test for primary hyperparathyroidism
Sestamibi scan
90
Mainstay Tx for hypercalcemic crisis
IV 0.9% saline hydration to dilute the calcium
91
Secondary hyperparathyroidism happens among?
Patients with chronic renal failure
92
Level of esophagus
From C6 to T1
93
Relation of Vagus nerve to the esophagus
Left vagus - anterior surface, Right vagus - posterior surface
94
Hernia of the abdominal part of the esophagus and part of stomach
Hiatal hernia
95
Hernia of the fundus or body of the stomach
Paraesophageal hernia
96
Histology of the esophagus
Stratified squamous non-keratinized epithelium
97
Definitive Tx for GERD
Nissen Fundoplication - 360 degree wrap
98
Esophageal lengthening procedure
Collis gastroplasty
99
Procedure that anchors the esophagus to its new position in the crura
Hill posterior gastropexy
100
Borchardt's Triad: indicative of incarcerated intra thoracic stomach
Chest pain, retching with inability to vomit, inability to pass NGT
101
Most common esophageal diverticula
Zenker's Diverticula - found in Killian's Triangle
102
Killian's Triangle
Area of potential weakness situated behind the esophagus at the level of the cricopharyngeus muscle
103
Most common esophageal motility disorder
Achalasia - due to neurogenic degradation
104
Triad of Achalasia
Hypertensive LES, aperistalsis of esophageal body, failure of LES to relax
105
Gold standard in diagnosing Achalasia
Manometry
106
Tx for Achalasia
Heller's Myotomy + Partial fundoplication
107
Esophogeal motility disorder with continuous high amplitude peristalsis
Nutcracker esophagus - increased mean duration of contraction
108
Spontaneous rupture of the esophagus into the left pleural cavity or just above the gastroesophageal junction
Boerhaave's syndrome
109
Diagnosis of esophageal rupture
Water soluble contrast esophagogram (Gastrografin) shows extravasation in the lateral decubitus position
110
Grading in caustic injuries with pseudomembrane formation
2nd degree
111
Most common type of esophageal Ca
Esophageal SCC - located in middle 3rd of the thoracic esophagus
112
Plummer Vinson Syndrome: predisposing condition to esophageal Ca
Triad - dysphagia, IDA, esophageal webs
113
Precursor lesion of Esophageal Adenocarcinoma
Barret's metaplasia - squamous mucosa of the esophagus turns to columnar
114
Surgical Tx for Esophageal Ca
Ivor Lewis Procedure: trans thoracic esophagectomy, trans hiatal esophagectomy
115
Thin submucosal ring in the lower esophagus
Schatzki's Ring
116
Longitudinal tears at the gastroesophageal junction
Mallory Weiss Tear
117
Remnant of umbilical vein
Ligamentum teres or round ligament - between L lobe and quadrate lobe
118
Remnant of ductus venosus
Ligamentum venosum - between L lobe and caudate lobe
119
Connects the liver to the anterior abdominal wall
Falciform ligament
120
Portal Triad
Portal vein, Hepatic Artery, Bile Duct
121
Porta Hepatis
CBD, Portal Vein, Hepatic Artery, Lymphatics
122
Blood supply of liver
Portal vein (superior mesenteric and splenic vein), Hepatic artery (celiac artery)
123
Where is biopsy of the liver done?
R 10th ICS, mid axillary line
124
Phagocytic cells of the liver
Kupffer Cells
125
Fat storing cells of the liver
Eto cells
126
Interlobar fissure that divides the liver into R and L lobes
Cantlie's Line
127
Liver venous drainage: segments 5-8
R hepatic vein
128
Liver venous drainage: segments 4, 5, 8
Middle hepatic vein
129
Liver venous drainage: segments 2, 3
Left hepatic vein
130
Liver venous drainage: caudate lobe
IVC - hardest to resect, not removed in a L hepatectomy
131
All clotting factors are synthesized in the liver except:
Factor 8
132
Removes phosphate from phosphoryl choline, maintains solubility of cholesterol in the bile
Alkaline phosphatase
133
Serum bilirubin levels in jaundice
>2.5 to 3mg/dL
134
Monomicrobial cause of spontaneous bacterial peritonitis
E. coli
135
Predicts the surgical risks of intra-abdominal operations performed on patients with cirrhosis
Child Turcotte Pugh Score - nutritional status, ascites, encephalopathy, serum bilirubin, serum albumin, prothrombin time
136
Criteria for Portal Hypertension
Direct portal venous pressure > 5mmHg of IVC pressure, Splenic pressure > 15mmHg
137
Most accurate method of determining portal HTN
Hepatic venography
138
Most significant manifestation of portal HTN
Esophageal varices - can do prophylactic Endoscopic Variceal Ligation
139
Preferred medical management for acute variceal bleeding
Octreotide
140
Non selective shunt for acute variceal bleeding
Totally diverts blood away from the liver to the systemic circulation. For Child's A. Decrease in portal pressure. Encephalopathy as possible complication
141
Congestive hepatopathy characterized by obstruction to hepatic venous outflow
Budd Chiari Syndrome - caused by polycythemia vera, pregnancy, OCP use
142
Tx of Budd Chiari Syndrome
Systemic anticoagulants - most patients are Child C
143
Most common cause is impaired biliary drainage. Organism most implicated is E coli
Pyogenic liver abscess - elevated WBC, ESR, alkaline phosphatase
144
Pyogenic liver abscess UTZ
Hypoechoic lesions with well defined borders and variable internal echoes
145
Pyogenic liver abscess CT:
Hypodense lesions with peripheral enhancement
146
Organism in amebic liver abscess
Entamoeba histolytica - located at superior anterior aspect of R lobe
147
Amebic liver abscess
Necrotic central portion containing reddish brown pus like material (anchovy paste)
148
Tx for Amebic liver abscess
Metronidazole 750mg TID for 7-10 days, aspiration for abscess >10cm
149
Liver disease caused by Echinococcus granulosus
Hydatid Disease - cyst in the anteroinferior or posteroinferior portions of the R lobe
150
Result of cyst rupture in Hydatid Disease
Allergic or anaphylactic reaction
151
Most common benign solid masses in the liver
Hemangioma - common among women, pain is the most common symptom and an indication for resection
152
Hemangioma MRI:
Hypointense on T1 and Hyperintense on T2
153
Clearest risk factor for hepatic adenoma
Use of OCP - Tx is resection since it may undergo malignant degeneration
154
Tx for Liver Focal Nodular Hyperplasia
Observe, resect if with abdominal pain - no malignant degeneration
155
Diagnosis of Hepatocellular Ca
AFP >500ng/dL
156
Proximal or hilar cholangiocarcinoma
Klatskin Tumor - Tx through resection
157
Gallbladder contracts to expel bile upon release of this hormone
Cholecystokinin
158
Infundibulum of the GB, junction between neck and cystic duct
Hartmann's Pouch
159
Triangle of Calot
Liver (superior), cystic duct (inferior) common hepatic duct (medial)
160
Blood supply of GB
Cystic artery from R hepatic artery (SMA)
161
Common site of an impacted gallstone
Hepatopancreatic ampulla
162
Referred pain in gallstones
Dull, aching, poorly localized pain over the T5 through L1 dermatomes
163
Form from the invagination of the epithelium through the fibromusculat layer in the GB
Rokitansky Aschoff Sinus - result of inflammation and an increase in intraluminal pressure
164
Whipple Procedure
Head of the pancreas, a portion of the bile duct, the gallbladder and the duodenum is removed
165
Normal GB wall thickness
<4mm
166
True or false: GB lacks muscularis mucosa and submucosa
True
167
Location of Hepatic Artery
Anterior to the portal vein and medial to CBD
168
Common source of postcholecystectomy biliary leaks
Ducts of Luschka
169
Action of Cholecystokinin
GB contraction and sphincter of Oddi relaxation
170
Hormones that cause GB contraction
CCK and Vagus
171
Hormones that inhibit GB contraction
VIP, Somatostatin
172
Bile duct opens into this structure, 10cm distal to pylorus, that is surrounded by the sphincter of Oddi
Ampulla of Vater
173
Regulates the flow of bile and pancreatic juice into the duodenum
Sphincter of Oddi - prevents regurgitation of duodenal contents into the biliary tree
174
GB stones UTZ:
Acoustically dense, (+) posterior shadow, moves with changes in position
175
Acute Cholecystitis UTZ:
GB thickening, pericholecystic fluid, sonographic murphy sign
176
Multiple, multifaceted mulberry shaped stone
Mixed type (>70% cholesterol)
177
Soft and mushy pigment stones secondary to bacterial infection of bile stasis
Brown Pigment Stones
178
Small, brittle, spiculated stones due to hemolytic disorders and cirrhosis
Black Pigment Stones - precipitation of unconjugated bilirubin
179
Disease due to partial obstruction of the cystic duct
Chronic cholecystitis (Biliary Colic) - episodic, subsides spontaneously
180
Stone in CBD
Choledocholithiasis
181
Primary choledocholithiasis
Brown pigment stone formed in CBD - biliary stasis and infection
182
Secondary choledocholithiasis
Cholesterol stone formed in the GB and migrate to CBD
183
Gold standard test for Choledocholithiasis
ERCP - diagnostic and therapeutic
184
Ascending bacterial infection associated with partial or complete blockage of bile duct
Cholangitis - gallstones most common cause
185
Charcot's Triad
Cholangitis - fever, pain and jaundice
186
Reynold's Pentad
Cholangitis - Charcot's Triad plus septic shock and disorientation
187
Tx for Cholangitis with distal obstruction
ERCP or stent
188
Tx Cholangitis with proximal obstruction
Percutaneous transhepatic cholangiogram
189
Congenital cystic dilatations of the biliary tree
Choledochal cysts - pancreatic secretions refluxes into the bile duct. (Abdominal pain, jaundice, mass)
190
Most common type of choledochal cyst
Type 1 Fusiform - Tx with excision + roux en Y hepaticojejunostomy
191
Choledochal cyst: Choledochocoele
Type 3 - Tx sphincterotomy
192
Tx for Type 4 choledochal cyst
Segmental liver resection
193
Type 5 choledochal cyst: Caroli's Disease
Tx liver transplantation
194
Inflammatory strictures involving both extra and intrahepatic biliary tree
Sclerosing Cholangitis - may degenerate into cholangiocarcinoma
195
Dx and Tx for sclerosing cholangitis
Dx ERCP/PTC, Tx is liver transplantation
196
Most common Gallbladder carcinoma
Adenocarcinoma - gallstones most important risk factor
197
Gallbladder Ca limited to muscular layer
T1 - Tx cholecystectomy
198
Gallbladder Ca reaching perimuscular connective tissue
T2 - Tx extended cholecystectomy, liver segments IVB and V
199
Gallbladder Ca with spread to other organs
T3 or T4 - Tx extended R hepatectomy, liver segments IV to VIII
200
Tumor that most commonly involves the hepatic duct bifurcation
Bile Duct Carcinoma - adenocarcinoma, nodular type most common
201
Tumor markers for Bile Duct Ca
CA 125, CEA, CA 19-9
202
Dx method for Bile Duct Ca that can determine its resectability
Percutaneous Transhepatic Cholangiogram
203
Retroperitoneal exocrine and endocrine gland
Pancreas
204
Pancreas: embraced by the C shaped curve of the duodenum
Head - Ca obstructs the bile duct causing obstructive jaundice
205
Projection from the inferior part of the head
Uncinate process - Ca here compresses the SMA
206
Begins in the tail of the pancreas and runs through the parenchyma to the head where it merges with the bile duct and opens to the 2nd part of the duodenum
Main Pancreatic Duct of Wirsung
207
Blood supply of the pancreatic head and neck
Superior pancreaticoduodenal artery (gastroduodenal) and Inferior pancreaticoduodenal artery (SMA)
208
Blood supply of the body and tail of the pancreas
Pancreatic arteries (splenic)
209
Venous drainage of pancreas
Pancreatic veins, empty into splenic veins
210
Cancer of neck and body of the pancreas
Portal or IVC obstruction
211
Dorsal and ventral fusion of the pancreas
Annular pancreas - ring of pancreatic tissue around duodenum
212
X ray: duodenal obstruction
Double bubble sign - dilation of stomach and distal duodenum
213
Pancreatic duct that drains the upper half of the head and opens in the duodenum on the minor duodenal papilla
Accessory Duct of Santorini - often absent
214
Most common congenital anomaly of the pancreas
Pancreas divisum - risk factor for acute and chronic pancreatitis
215
Tx of Annular Pancreas
Bypass, duodeno-duodenostomy (connect D1 and D3)
216
Flank ecchymosis: acute pancreatitis
Grey Turner's Sign
217
Periumbilical ecchymosis: Acute Pancreatitis
Cullen's Sign - blood dissects up the falciform ligament
218
Ecchymosis in the inguinal area: Hemorrhagic Pancreatitis
Fox's Sign
219
Gold standard in Dx Pancreatitis: Abdominal CT Scan
Peripancreatic fat stranding, fluid collections, non enhancing pancreatic parenchyma with gas (necrosis)
220
Colonic spasm adjacent to an inflamed pancreas
Cut-Off sign
221
Focal duodenal and jejunal ileus in the area of the head of the pancreas
Reversed 3 or Inverted 3 Sign
222
DOC for severe pancreatitis
Imipinem
223
Primary pathologic process of Chronic Pancreatitis
Chronic alcoholic pancreatitis - DM and steatorrhea are common
224
Calcifications in the pancreas establishes the diagnosis of?
Chronic Pancreatitis
225
Tx for chronic pancreatitis with a normal duct
Whipple - pancreaticoduodenectomy
226
Tx for chronic pancreatitis with dilated duct
Puestow - longitudinal pancreaticojejunostomy
227
Umbilicus is normally at the level of?
L3
228
External oblique vs Internal oblique
EO - downward and medially, IO - upward and medially
229
Innermost, flat abdominal muscle
Transversus abdominis
230
What makes up the conjoint tendon?
Internal oblique + Transversus abdominis
231
Cremaster muscle is derived from what layer of the abdominal wall?
Internal oblique
232
Congenital type of hernia
Indirect
233
Acquired type of hernia
Direct
234
Neck of hernial sac is narrow, lateral to inferior epigastric vessels, enters the scrotum
Indirect
235
Neck of hernial sac is wide, medial to inferior epigastric vessels, never enters the scrotum
Direct
236
Hernia that protrudes through the anterior abdominal wall and covered by peritoneum and layers of spermatic cord
Indirect
237
Hernia that passes directly through Hesselbach's Triangle
Direct
238
Hesselbach's Triangle
Medial - rectus abdominis. Superior and Lateral - inferior epigastric artery. Inferior and lateral - Poupart's or inguinal ligament.
239
Scrotal derivative of abdominal superficial fascia
Dartos muscle - gives the wrinkled appearance of the scrotum
240
Sensory and motor fibers of cremasteric reflex
Sensory - ilioinguinal nerve. Motor - genital branch of genitofemoral nerve.
241
Peritoneum: sensitive to pressure, heat and cold. Pain is localized
Parietal peritoneum
242
Peritoneum: stimulated by stretching, poorly localized pain
Visceral peritoneum
243
Opening or connection between the lesser peritoneal sac and greater peritoneal sac
Epiploic Foramen of Winslow
244
Connects the stomach with other viscera
Omentum
245
Abdominal policeman. From the greater curvature of the stomach to transverse colon
Greater omentum
246
From the lesser curvature of the stomach and proximal duodenum to the liver
Lesser omentum
247
Hepatoduodenal ligament conducts the Portal Triad
Portal vein lying posterior, CBD anterior and to the R, Hepatic artery anterior and to the L
248
Medial, fan shaped part of inguinal ligament
Lacunar (Gimbernat's) Ligament
249
Preperitoneal space behind pubic symphysis. Site of laparoscopic hernia repairs
Space of Retzius
250
Arching fibers that press down during increase in intra-abdominal pressure
Shutter mechanism - prevents hernia even if there is a weak spot or patent procesus
251
Triangle of Doom contains:
Iliac artery, Iliac vein
252
Lower expanded part of procesus vaginalis that is normally closed off just before birth
Tunica vaginalis
253
Inguinal hernia relation to pubic tubercle
Neck is above and medial to the pubic tubercle
254
Femoral hernia relation to pubic tubercle
Neck below and lateral to pubic tubercle
255
Hernia that is more common among elderly females
Femoral hernia
256
Repair for femoral hernia
McVay Repair - repair attached to pectineal or Cooper's ligament
257
Tension less repair of ernia
Lichtenstein Hernioplasty
258
Laparoscopic repair for recurrent, bilateral and femoral hernias
Transabdominal preperitoneal
259
Lumbar Hernia
Grynfeltt's hernia - superior lumbar triangle. Petit's hernia - inferior lumbar triangle.
260
Hernia at the posterior diaphragm
Bochdaleck's hernia
261
Hernia lateral to the rectus muscle
Spigelian hernia
262
Hernia that contains a Meckel's diverticulum
Littre's Hernia
263
Hernia with 2 loops in the same ring (W shaped)
Maydl's hernia
264
Hernia in the anterior diaphragm
Morgagni's hernia
265
Most common early postoperative complication of hernia repair
Urinary retention
