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Gastrointestinal System > EXAM #3: HERNIAS > Flashcards

EXAM #3: HERNIAS Flashcards

1
Q

What is the general school of thought for the surgical management of hernias?

A

Repair before they cause problems

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2
Q

What is the most common type of all hernias?

A

Inguinal

Far more common in men

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3
Q

Review the abdominal wall layers.

A

1) Skin
2) Subcutaneous tissue
- Camper’s Fascia (fatty)
- Scarpa’s Fascia (fibrous)
3) External Oblique
4) Internal Oblique
5) Transversus Abdominis m.
6) Transversalis fascia
7) Peritoneum

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4
Q

Review the anatomy of the inguinal canal.

A

N/A

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5
Q

What is an indirect inguinal hernia?

A
  • Hernia through the internal inguinal ring
  • Lateral to the inferior epigastric vessels
  • Within the spermatic cord

MD’s Don’t Lie

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6
Q

Where does a direct inguinal hernia pass through?

A

Hasselbach’s Triangle

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7
Q

What is a direct inguinal hernia?

A

Hernia that occurs

  • Adjacent to rectus abdominus
  • Medial to inferior epigastirc vessels
  • Superior to inguinal ligament
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8
Q

What patient’s more commonly have femoral hernias?

A

Female

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9
Q

What is a femoral hernia?

A

Hernia that passes into the femoral canal, below the inguinal ligament

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10
Q

How can an inguinal hernia be repaired with a “tissue repair?”

A

1) Bassini repair= single layer reconstruction of inguinal floor
2) Shouldice repair= four layer reconstruction of inginal floor
3) McVay repair= inguinal floor brought to Cooper’s Ligament–closes the femoral space

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11
Q

What is the best tissue repair for an incarcerated femoral hernia?

A

McVay b.c is closes the femoral repair

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12
Q

Why perform a tissue repair?

A

1) No mesh available

2) INFECTION

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13
Q

What is the current standard hernia repair?

A

Lichtenstein Mesh Repair

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14
Q

What are the key characteristics of a Lichtenstein Mesh Repair?

A

1) Mesh reconstruction of inguinal floor
2) Tension-free

*Lowest risk of recurrence

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15
Q

What is the risk of a Lichtenstein Mesh Repair?

A

Prosthetic mesh infection

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16
Q

What is a Pre-Peritoneal Mesh Repair?

A

Mesh is placed INSIDE of fascia (vs. outside)

Mesh is between peritoneum and transversus abdominus

17
Q

How do you place pre-peritoneal mesh?

A

Open or Laparoscopic

18
Q

What are the benefits of Laparoscopic repair for pre-peritoneal mesh repair?

A

1) Less post-op pain
2) Less infection and hematoma
3) Quicker recovery with fewer work restrictions

19
Q

What are the two approaches to the pre-peritoneal repair?

A

TAP and TEP

20
Q

What is the TAP approach?

A

TransAbdominal Preperitoneal Laparoscopic Hernia Repair

21
Q

What is the TEP approach?

A

Total Extraperitoneal Preperitoneal

22
Q

How does the TEP differ from the TAP?

A

TAP= standard laprascopic approach

TEP= entry in RECTUS SHEATH

23
Q

What are the evidence-based indications for laprascopic hernia repair?

A

1) Bilateral inguinal hernias
2) Comorbid umbilical
3) Young healthy individual that wants to return to work earlier

24
Q

What is a Spigelian hernia?

A

Hernia along the semilunar line

25
Q

What is the difference between an umbilical hernia in a kid and adult?

A

Kid= frequently regress (congenital)

Adult= acquired and progress/enlarge

26
Q

How are umbilical hernias repaired?

A

1) Primary if 1-2cm

2) Mesh reinforcement for 2cm+ defects

27
Q

What is an incisional hernia?

A

Failure of fascia healing

28
Q

What are the risk factors for incisional hernias?

A 
Infection 
Early return to work 
Obesity 
Old-age 
Male 
Sleep apnea*
Emphysema*

*Chronic hypoxia states

29
Q

How long should people be lifting restricted to prevent an incisional hernia?

A

6 weeks

30
Q

What is a unique feature of epigastric hernias?

A

Small defect above the umbilicus that is PAINFUL

*Repaired to alleviate pain

31
Q

What is the proposed etiology of Spigelian Hernias?

A

Vascular defects of the semilunar lines

32
Q

What is a primary repair for an abdominal wall hernia?

A

Cut down a simply suture the defect

*Note that these are associated with a high recurrence rate

33
Q

When is a primary repair done for a hernia?

A

1) Strangulation
2) Skin breakdown
3) Bowel resection

34
Q

What is a mesh reinforeced repair for an abdominal wall hernia?

A

Mesh is placed to help reinforce the defect

35
Q

When is a mesh reinforced repair CONTRAindicated?

A

Contaminated field/ infection

36
Q

Where is abdominal wall mesh placed most commonly?

A

“Underlay” i.e. intraperitoneal

37
Q

What is the gold standard for abdominal wall mesh placement?

A

“Retrorectus” i.e posterior to the rectus sheath

38
Q

Is an incarcerated hernia a surgical emergency?

A

NO–an incarcerated hernia is one that cannot be reduced

A STRANGULATED hernia is an incarcerated hernia with compromised blood flow/ infection; this is a surgical emergency

39
Q

What are the clinical features of a strangulated hernia?

A

1) Erythema of the overlying skin
2) Fever
3) Tachycardia
4) Elevated WBC count

Gastrointestinal System (42 decks)

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