Chapter 35: Hernias- IntraOP Questions Flashcards
What is the first identifiable subcutaneous named layer?
Scarpa’s fascia (thin in adults)
What is the name of the subcutaneous vein that is ligated?
Superficial epigastric vein
What happens if you cut the ilioinguinal nerve?
Numbness of inner thigh or lateral scrotum; usually goes away in 6 months
From what abdominal muscle layer is the cremaster muscle derived?
Internal oblique muscle
From what abdominal muscle layer is the inguinal ligament (a.k.a. “Poupart’s ligament”) derived?
External oblique muscle aponeurosis
To what does the inguinal (Poupart’s) ligament attach?
Anterior-superior iliac spine to the pubic tubercle
Which nerve travels on the spermatic cord?
Ilioinguinal nerve
Why do some surgeons deliberately cut the ilioinguinal nerve?
First they obtain preoperative consent and cut so as to remove the risk of entrapment and postoperative pain
What is in the spermatic cord (6)?
- Cremasteric muscle fibers
- Vas deferens
- Testicular artery
- Testicular pampiniform venous plexus
- ± Hernia sac
- Genital branch of the genitofemoral nerve
What is the hernia sac made of?
Peritoneum (direct) or a patent processus vaginalis (indirect)
What attaches the testicle to the scrotum?
Gubernaculum
What is the most common organ in an inguinal hernia sac in men?
Small intestine
What is the most common organ in an inguinal hernia sac in women?
Ovary/fallopian tube
What lies in the inguinal canal in females instead of the VAS?
Round ligament
Where in the inguinal canal does the hernia sac lie in relation to the other structures?
Anteromedially
What is a “cord lipoma”?
Preperitoneal fat on the cord structures (pushed in by the hernia sac); not a real lipoma; remove surgically, if feasible
What is a small outpouching of testicular tissue off the testicle?
Testicular appendage (a.k.a. “the appendix testes”); remove with electrocautery
What action should be taken if a suture is placed through the femoral artery or vein during an inguinal herniorrhaphy?
Remove the suture as soon as possible and apply pressure (i.e., do not tie thesuture down!)
What nerve is found on top of the spermatic cord?
Ilioinguinal nerve
What nerve travels within the spermatic cord?
Genital branch of the genitofemoral nerve
What are the borders of Hesselbach’s triangle?
Epigastric vessels
Inguinal ligament
Lateral border of the rectus
What type of hernia goes through Hesselbach’s triangle?
Direct hernia due to a weak abdominal floor
What is a “relaxing incision”?
Incision(s) in the rectus sheath to relax the conjoint tendon so that it can be approximated to the reflection of the inguinal ligament without tension
What is a conjoint tendon?
Aponeurotic attachments of the “conjoining” of the internal oblique and transversus abdominis to the pubic tubercle
