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Fiser's ABSITE Review > Chapter 38 - Hernias, Abdomen & Surgical Technology > Flashcards

Chapter 38 - Hernias, Abdomen & Surgical Technology Flashcards

1
Q

What forms the shelving edge in inguinal hernias?

A

External abdominal oblique (and fascia)

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2
Q

What forms the cremasteric muscles?

A

Internal abdominal oblique

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3
Q

What forms the inguinal canal floor?

A

Transversalis muscle

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4
Q

Where does the inguinal ligament run? What is it made from?

A

From ASIS to pubis

From external abdominal oblique

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5
Q

What makes up the lacunar ligament?

A

Where the inguinal ligament splays out to insert in the pubis

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6
Q

Where does the ileopubic tract run? What makes it up?

A

Runs from ASIS to pubis below inguinal ligament

From transversalis

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7
Q

What is another name for Cooper’s ligament?

A

Pectineal ligament

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8
Q

What makes up the conjoined tendon?

A

Aponeurosis of the internal abdominal oblique and transversus abdominis muscle

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9
Q

Where does the vas deferens run in relation to the cord structures?

A

Medial to cord structures

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10
Q

What are the borders of Hesselbach’s triangle?

A

Rectus muscle, inferior inguinal ligament, inferior epigastrics

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11
Q

Where are direct hernias in relation to Hesselbach’s triangle? Indirect hernias?

A

Direct: inferior, medial to epigastric vessels (in triangle)
Indirect: Superior/lateral to epigastric vessels

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12
Q

Risk factors for inguinal hernia in adults?

A

Age, obesity, heavy lifting, COPD, chronic constipation, straining, ascites, pregnancy, peritoneal dialysis

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13
Q

Which type of inguinal hernia is most common?

A

Indirect; from persistently patent processus vaginalis

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14
Q

Which inguinal hernia has lower risk of incarceration? Higher recurrence?

A

Direct

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15
Q

What is a pantaloon hernia?

A

Direct and indirect component

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16
Q

What is most commonly contained in sliding hernias in females? Males?

A

Females: ovaries or fallopian tubes
Males: cecum or sigmoid

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17
Q

What is the procedure for a female with ovary in canal?

A

Ligate round ligament, return ovary to peritoneum, perform biopsy if looks abnormal

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18
Q

What is the procedure for hernias in infants and children?

A

High ligation (almost always indirect), open sac prior to ligation

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19
Q

What is a Lichtenstein repair?

A

Mesh; decreased recurrence

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20
Q

What is Bassini repair?

A

Approximation of conjoined tendon and transversalis fascia (superior) to the free edge of the inguinal ligament (inferior)

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21
Q

What is McVay repair?

A

Approximation of the conjoined tendon and transversalis fascia (superior) to Cooper’s ligament (inferior); needs relaxing incision in external abdominal oblique fascia

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22
Q

What are the indications for lap hernia repair?

A

Bilateral or recurrent inguinal hernia

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23
Q

What is the most common early complication following hernia repair?

A

Urinary retention

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24
Q

What is the % of wound infections with hernia repair?

A

2%

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25
Q

What is the recurrence rate after hernia repair?

A

2%

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26
Q

When does testicular atrophy occur?

A

Usually with indirect hernias; secondary to dissection of the distal component of the hernia sac causing vessel disruption and thrombosis of spermatic cord veins

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27
Q

What is the most common cause of pain after hernia? Treatment?

A

Compression of ilioinguinal nerve

Local infiltration can be diagnostic and therapeutic

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28
Q

What is the result of ilioinguinal nerve injury?

A

Loss of cremasteric reflex; numbness on ipsilateral penis, scrotum and thigh

29
Q

What is the result of genitofemoral nerve injury?

A

Usually injured with lap repair
Genital branch: cremaster (motor), and sensory to scrotum
Femoral branch: sensory to upper lateral thigh

30
Q

What should be done with cord lipomas?

A

Removal

31
Q

What is the trapezoid of doom?

A

In lap hernia repairs
Femoral branch of genitofemoral nerve, lateral cutaneous nerve, femoral artery
Need to dissect lateral to vessels, stay along inguinal ligament

32
Q

What are femoral canal boundaries?

A

Cooper’s ligament, inguinal ligament, femoral vein

33
Q

What may need to be done to reduce bowel in femoral hernia?

A

Divide the inguinal ligament

34
Q

How is a femoral hernia usually repaired?

A

Through an inguinal approach with McVay or Bassini repair

35
Q

How long do you delay repair of umbilical hernia in children?

A

Until after 5 years

36
Q

Where are Spigelian hernias?

A

Lateral border of the rectus muscle, through linea semilunaris
Almost always inferior to the semicircularis
Occurs between internal abdominal oblique muscle and line of insertion of the external abdominal oblique aponeurosis into rectus sheath

37
Q

What is Richter’s hernia?

A

Noncircumferential incarceration of the nonmesenteric bowel wall

38
Q

What is Littre’s hernia?

A

Incarcerated Meckel’s

39
Q

What is Petit’s hernia?

A

Inferior lumbar hernia

External abdominal oblique, lat dorsi, iliac crest

40
Q

What is Grynfeltt’s hernia?

A

Superior lumbar hernia

Internal abdominal oblique, lumbodoral aponeurosis, 12th rib

41
Q

What is Sciatic hernia?

A

Herniation through greater sciatic foramen; high rate of strangulation

42
Q

What is Howship-Romberg sign?

A

Inner thigh pain with internal rotation; characteristic of obturator hernia

43
Q

Who gets obturator hernias?

A

Elderly women, previous pregnancy, bowel gas below superior pubic ramus

44
Q

Treatment for obturator hernia?

A

Operative reduction, may need mesh; check other side for similar defect

45
Q

What type of hernia is most likely to recur?

A

Incisional hernia

46
Q

What causes rectus sheath hematomas? Treatment?

A

Most common after trauma, due to epigastric vessel injury

Nonoperative, surgery if expanding

47
Q

What is Fothergill’s sign?

A

Rectus sheath hematoma: mass more prominent and painful with flexion of the rectus muscle

48
Q

Characteristics of desmoid tumors?

A

Women, benign but locally invasive, high rate of recurrence

49
Q

What syndrome is associated with desmoid tumors?

A

Gardner’s

50
Q

Treatment for desmoid tumor?

A

WLE; if involving small bowel may need excision
Often not completely resectable and can cause worsening fibrosis
NSAIDs, antiestrogens

51
Q

What is a possible cause of retroperitoneal fibrosis?

A

Hypersensitivity to methysergide

52
Q

What is the most sensitive test for retroperitoneal fibrosis?

A

IVP

53
Q

Symptoms of retroperitoneal fibrosis? Treatment?

A

Symptoms related to trapped ureters and lymphatic obstruction
Steroids, nephrostomy and surgery if renal fxn becomes compromised

54
Q

Where are malignant mesenteric tumors? Benign?

A

Malignant: closer to root of mesentery
Benign: more peripheral

55
Q

What are malignant mesenteric tumor types?

A

Liposarcoma, leiomyosarcoma

56
Q

What age group at risk for retroperitoneal tumors?

A

15% in children

5th-6th decade

57
Q

What is the most common malignant retroperitoneal tumor?

A

1 lymphoma, #2 liposarcoma

58
Q

What is the 5 yr survival rate for retroperitoneal sarcomas? % resectable?

A

10% 5yr survival

<25% resectable

59
Q

Where do mets from retroperitoneal sarcomas go?

A

Lung

60
Q

What is the most common omental solid tumor?

A

Metastatic disease

61
Q

Treatment of omental tumors?

A

Resection, do not biopsy due to risk of bleed

62
Q

At what rate is saline absorbed from peritoneal membrane?

A

35cc/hr

63
Q

What is removed with peritoneal dialysis?

A

NH3, Ca, Fe, lead; most drugs not removed

64
Q

At what intraabdominal pressure can cardiopulmonary dysfunction occur?

A

> 20mmHg

65
Q

Treatment for CO2 embolus?

A

Head down, turn pt to the left

Sudden risk in ETCO2 hypotension

66
Q

How does the harmonic scalpel work?

A

Disrupts protein H-bonds, causes coagulation

67
Q

How does Argon beam work? What is it’s depth of penetration?

A

Energy transferred across argon gas

Depth of necrosis related to power setting (2mm)

68
Q

What type of graft (Gore-Tex/PTFE vs Dacron/polypropylene) allows fibroblast ingrowth?

A

Dacron

69
Q

What is the incidence of vascular or bowel injury with Veress needle?

A

0.1%

Fiser's ABSITE Review (50 decks)

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