Ch 84 - Abdominal Wall Reconstruction and Hernias Flashcards
What is an auto-penetrating hernia?
A traumatic abdominal wall hernia caused by a fractured rib penetrating through abdominal musculature
In the cranial, middle and caudal thirds of the abdomen, which aponeuroses are sitting superficial and deep to the rectus abdominis?
Cranial:
- External Abdominal Oblique - Superficial
- Internal abdominal oblique - Both
- Transverse Abdominis - Deep
Middle
- External Abdominal Oblique - Superficial
- Internal Abdominal Oblique - Superficial
- Transverse Abdominus - Deep
Caudal
- All superficial
Where do the internal and external abdominal obliques and the transverse abdominis originate from?
External abdominal oblique
- Originates from 4/5th to 12th rib and from last rib and thoracodorsal fascia
- Runs in caudoventral direction
Internal Obdominal oblique
- Originates from thoracolumbar fascia caudal to last rib and from tuber coxae
- Runc cranioventrally
Transverse Abdominis
- Lumbar portion arising from the transverse processes of the lumbar vertebrae and thoracolumbar fascia
- Costal portion - Arising from medial sides of 12th and 13th rib as well as 8th-11th costal cartilages
- Runs in dorsoventral direction
What are substernal midline defects often associated with?
- Congenital peritoneal pericardial diaphragmatic hernia
- PPDH often assoc with incompletely fused caudal sternebrae
List methods of explansion used in human surgery for loss of domain
- Progressive pneumoperitoneum
- Silastic expanders
- Staged reduction
- Prosthetic material
How can intestinal strangulation lead to rapid systemic illness?
- Bacterial transmigration
- Vasoactive substances release (arachidonic acid metabolites, cytokines, leucotrienes, kinins) from tissue and blood cell autolysis
- Redistribution of fluids and severe cardiopulmonary effects
What is the embryological cause of ventral abdominal wall hernias?
Failure of fusion or delayed fusion of the lateral folds (primarily the rectus abdominis)
What disorders have been associated with congenital ventral abdominal hernias?
- Fucosidosis
- Ectodermal dysplasia
- Cryptorchidism
What initially protects an omphalocoele?
A thin transparent membrane of amniotic tissue
What is gastroschisis?
A congenital ventral abdominal hernia, very similar in appearance to an omphalocoele but it is paramedian
What breeds are predisposed to umbilical hernias?
- Airedale terriers
- Basenjis
- Pekingese
- Pointers
- Weimeraners
What are the 2 broad classifications of inguinal hernias?
- Indirect - hernia contents enters the cavity of the vaginal process
- Direct - Hernia contents pass through the inguinal ring adjacent to the vaginal process (less common)
Are inguinal hernias common?
- Congenital is rare
- Acquired is common
Describe the anatomical boundaries of the inguinal rings?
- Internal inguinal ring: Bound by rectus abdominis, inguinal ligament and internal abdominal oblique
- External inguinal ring: Longitudinal slit in the aponeurosis of the external abdominal oblique
What structures pass throught the inguinal canal?
- Genital branch of genitofemoral nerve, artery and vein
- Cremaster muscle passes through external ring
- Pass through the caudomedial aspect