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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
What is the recurrence rate after hernia repair?
2%
26
When does testicular atrophy occur?
Usually with indirect hernias; secondary to dissection of the distal component of the hernia sac causing vessel disruption and thrombosis of spermatic cord veins
27
What is the most common cause of pain after hernia? Treatment?
Compression of ilioinguinal nerve | Local infiltration can be diagnostic and therapeutic
28
What is the result of ilioinguinal nerve injury?
Loss of cremasteric reflex; numbness on ipsilateral penis, scrotum and thigh
29
What is the result of genitofemoral nerve injury?
Usually injured with lap repair Genital branch: cremaster (motor), and sensory to scrotum Femoral branch: sensory to upper lateral thigh
30
What should be done with cord lipomas?
Removal
31
What is the trapezoid of doom?
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
What are femoral canal boundaries?
Cooper's ligament, inguinal ligament, femoral vein
33
What may need to be done to reduce bowel in femoral hernia?
Divide the inguinal ligament
34
How is a femoral hernia usually repaired?
Through an inguinal approach with McVay or Bassini repair
35
How long do you delay repair of umbilical hernia in children?
Until after 5 years
36
Where are Spigelian hernias?
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
What is Richter's hernia?
Noncircumferential incarceration of the nonmesenteric bowel wall
38
What is Littre's hernia?
Incarcerated Meckel's
39
What is Petit's hernia?
Inferior lumbar hernia | External abdominal oblique, lat dorsi, iliac crest
40
What is Grynfeltt's hernia?
Superior lumbar hernia | Internal abdominal oblique, lumbodoral aponeurosis, 12th rib
41
What is Sciatic hernia?
Herniation through greater sciatic foramen; high rate of strangulation
42
What is Howship-Romberg sign?
Inner thigh pain with internal rotation; characteristic of obturator hernia
43
Who gets obturator hernias?
Elderly women, previous pregnancy, bowel gas below superior pubic ramus
44
Treatment for obturator hernia?
Operative reduction, may need mesh; check other side for similar defect
45
What type of hernia is most likely to recur?
Incisional hernia
46
What causes rectus sheath hematomas? Treatment?
Most common after trauma, due to epigastric vessel injury | Nonoperative, surgery if expanding
47
What is Fothergill's sign?
Rectus sheath hematoma: mass more prominent and painful with flexion of the rectus muscle
48
Characteristics of desmoid tumors?
Women, benign but locally invasive, high rate of recurrence
49
What syndrome is associated with desmoid tumors?
Gardner's
50
Treatment for desmoid tumor?
WLE; if involving small bowel may need excision Often not completely resectable and can cause worsening fibrosis NSAIDs, antiestrogens
51
What is a possible cause of retroperitoneal fibrosis?
Hypersensitivity to methysergide
52
What is the most sensitive test for retroperitoneal fibrosis?
IVP
53
Symptoms of retroperitoneal fibrosis? Treatment?
Symptoms related to trapped ureters and lymphatic obstruction Steroids, nephrostomy and surgery if renal fxn becomes compromised
54
Where are malignant mesenteric tumors? Benign?
Malignant: closer to root of mesentery Benign: more peripheral
55
What are malignant mesenteric tumor types?
Liposarcoma, leiomyosarcoma
56
What age group at risk for retroperitoneal tumors?
15% in children | 5th-6th decade
57
What is the most common malignant retroperitoneal tumor?
#1 lymphoma, #2 liposarcoma
58
What is the 5 yr survival rate for retroperitoneal sarcomas? % resectable?
10% 5yr survival | <25% resectable
59
Where do mets from retroperitoneal sarcomas go?
Lung
60
What is the most common omental solid tumor?
Metastatic disease
61
Treatment of omental tumors?
Resection, do not biopsy due to risk of bleed
62
At what rate is saline absorbed from peritoneal membrane?
35cc/hr
63
What is removed with peritoneal dialysis?
NH3, Ca, Fe, lead; most drugs not removed
64
At what intraabdominal pressure can cardiopulmonary dysfunction occur?
>20mmHg
65
Treatment for CO2 embolus?
Head down, turn pt to the left | Sudden risk in ETCO2 hypotension
66
How does the harmonic scalpel work?
Disrupts protein H-bonds, causes coagulation
67
How does Argon beam work? What is it's depth of penetration?
Energy transferred across argon gas | Depth of necrosis related to power setting (2mm)
68
What type of graft (Gore-Tex/PTFE vs Dacron/polypropylene) allows fibroblast ingrowth?
Dacron
69
What is the incidence of vascular or bowel injury with Veress needle?
0.1%

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