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Surgery > Fiser ABSITE Ch. 38 Abdominal Wall and Hernias > Flashcards

Fiser ABSITE Ch. 38 Abdominal Wall and Hernias Flashcards

1
Q

What forms the cremasteric muscles?

A

internal oblique

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2
Q

What forms the inguinal canal floor?

A

transversalis muscle

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3
Q

Where does the inguinal ligament come from?

A

external oblique

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4
Q

What forms where the inguinal ligament splays out to insert in the pubis?

A

Lacunar ligament

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5
Q

What comes from the transversalis, runs from asis to the pubis and is below the inguinal ligament?

A

ileopubic tract

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6
Q

Cooper’s ligament aka?

A

pectineal ligament

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7
Q

What runs medial to the cord structures?

A

vas deferens

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8
Q

What forms Hesselbach’s triangle?

A

rectus muscle, inferior inguinal ligament, and inferior epigastrics

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9
Q

What type of inguinal hernia is most common and comes from a patent processus vaginalis?

A

indirect hernia

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10
Q

What type of inguinal hernia has a lower risk of incarceration, rare in females, and has a higher recurrence than indirect?

A

direct hernia

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11
Q

What type of hernia has direct and indirect components?

A

Pantaloon hernia

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12
Q

What type of hernia occurs when the wall of the hernia sac is an organ?

A

sliding hernia

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13
Q

What are the 2 most common organs involved in a sliding inguinal hernia in women? and men?

A

ovaries or fallopian tubes

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14
Q

3 steps in repair of female with ovary in inguinal canal?

A

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

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15
Q

Inguinal hernia in children is almost always what type? and what is the treatment?

A

nearly always indirect, just perform high ligation (open sac prior to ligation)

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16
Q

Describe the Bassini repair

A

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

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17
Q

Describe the McVay repair

A

approximation of the conjoined tendon and transversalis fascia (superior) to Cooper’s ligament (pectineal ligament, inferior)

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18
Q

The McVay repair needs a relaxing incision where?

A

external abdominal oblique fascia

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19
Q

When is laparoscopic inguinal hernia repair indicated?

A

bilateral or recurrent

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20
Q

What is the advantage of the Lichtenstein mesh repair?

A

decreased recurrence due to decreased tension

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21
Q

What is the most common early complication following hernia repair?

A

urinary retention

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22
Q

What is the infection rate for inguinal hernia repair? and recurrence rate?

A

2%, 2%

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23
Q

What can occur secondary to dissection of the distal components of the hernia sac causing vessel disruption and thrombosis of spermatic cord veins?

A

testicular atrophy

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24
Q

Pain after hernia is usually caused by what? What is the tx?

A

compression of ilioinguinal nerve, local infiltration (diagnostic and therapueutic)

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25
Q

Loss of cremasteric reflex; numbness on ipsilateral penis, scrotum and thigh are sx of what?

A

ilioinguinal nerve injury

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26
Q

Where is the ilioinguinal nerve injury usually occur?

A

at the external ring; nerve runs on top of cord

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27
Q

What nerve is usually injured with laparscopic hernia repair?

A

genitofemoral

28
Q

What are the two branches of the genitofemoral nerve and what do they do?

A

genital branch - cremasteric (motor) and scotum (sensory); femoral branch - uppler lateral thigh (sensory)

29
Q

What is the tx for cord lipomas?

A

should be removed

30
Q

What is in the trapezoid of doom in laparoscopic hernia repairs?

A

femoral branch of genitofemoral nerve, lateral cutaneous nerve and femoral artery

31
Q

What are the boundaries of the femoral canal?

A

Cooper’s ligament, inguinal ligament and femoral vein

32
Q

Where in NAVEL dose femoral hernias occur?

A

Empty space

33
Q

Fermoral hernias carry a high risk of incarceration. What may be necessary to divide to reduce bowel?

A

inguinal ligament

34
Q

Femoral hernias are usually repaired through what approach? and what two possible tissue repairs?

A

inguinal approach, McVay or Bassini

35
Q

What patient population has an increased risk of umbilical hernias?

A

african americans

36
Q

Until what age should umbilical hernia repair be delayed?

A

5 years

37
Q

Is the risk of incarceration of umbilical hernia in children or adults?

A

Adults

38
Q

Where does a Spigelian hernia occur?

A

lateral border of the rectus muscle through linea semilunaris, almost always inferior to the semicircularis

39
Q

What is as noncircumferencial incarceration of the nonmesenteric bowel wall?

A

Richter’s hernia

40
Q

What is an incarcerated Meckel’s called?

A

Littre’s

41
Q

What is an inferior lumbar hernia called? and superior lumbar hernia?

A

Petit’s hernia is inferior lumbar. Grynfeltt’s is a superior lumbar hernia

42
Q

What type of hernia goes through the greater sciatic foramen and has a high rate of strangulation?

A

Sciatic hernia

43
Q

What is the tx for obturator hernia?

A

operative reduction, may need mesh, check other side for similar defect. diagnosis usually made at the time of surgery for small bowel obstruction

44
Q

What type of hernia is the most likely to recur? what is the most common cause of this hernia?

A

incisional, inadequate closure

45
Q

What Fothergill’s sign and what can it indicate?

A

abdominal wall mass more prominent and painful with flexion of the rectus muscle

46
Q

Tx for rectus sheath hematoma is usually nonoperative. When do you operate?

A

if expanding

47
Q

desmoid tumors occur more often in women, are benign but locally invasive and recurr. What syndrome are they associated with?

A

Gardner’s

48
Q

What are 2 possible medical treatments for desmoid tumors?

A

NSAIDs and antiestrogens

49
Q

Retroperitoneal fibrosis can occur with hypersensitivity to what?

A

methysergide (former migraine/cluster headache tx)

50
Q

What are the sx of retroperitoneal fibrosis and what is the most sensitive text?

A

trapped ureters and lymphatic obstruction, IVP is most sensitive

51
Q

Tx for retroperitoneal fibrosis includes what medical tx? or what procedure if infection is present?

A

steroids, nephrostomy if infection is present

52
Q

What is the indication for surgery in retroperitoneal fibriosis? and what is done in the surgery?

A

surgery if renal function becomes compromised, free up ureters and wrap in omentum

53
Q

Of the primary mesenteric tumors, most are cystic. Where are malignant tumors located? and benign?

A

malignant closer to the root of the mesentery, benign more peripheral

54
Q

Most solid tumors of the mesentery are benign. What two malignant types?

A

liposcarcoma, leiomyosarcoma

55
Q

Retroperitoneal tumors, 15% in children, others in 5th-6th decade. Malignant > benign. What are the #1 and #2 malignant retroperitoneal tumors?

A

1 lymphoma, #2 liposarcoma

56
Q

Peristomal hernias can be true of pseudo what is the cause and tx for both?

A

missed the rectus, need to move and place in rectus muscle

57
Q

What is the tx for peristomal hernia - prolapse?

A

keep stoma at the same site, fix mesentery (is in rectus but prolapsing through)

58
Q

What is the tx for desmoid tumor?

A

Wide local incision, if involving small bowel, excision may not be indicated -> often not completely resectable and can cause worsening fibrosis

59
Q

Retropertoneal sarcomas what % are resectable? what is the 5 year survival rate?

A
60
Q

Retroperitoneal sarcomas have a pseudocapsule but cannot shell out -> leave residual tumor. Where do the mets go?

A

to the lung

61
Q

What is the most common omental solid tumor?

A

metastatic disease

62
Q

Omentectomy for metastatic cancer has a role for some cancers such as ovarian CA. Omental cysts are usually asymptomatic, can ungergo torsion. Primary solid omental tumors are rate 1/3 maligant. What is the dx and tx?

A

No biopsy -> can bleed. Tx: resection

63
Q

Most drugs are not removed with peritoneal dialysis: NH3, Ca, Fe and lead are removed. What is the rate saline is absorbed through the peritoneal membrane?

A

35 cc/hr

64
Q

CO2 pneumoperitoneum, cardiopulmonary dysfunction can occur with intra-abdominal pressure > ?

A

20

65
Q

What are the sx of CO2 embolus? the tx?

A

sudden rise in ETCO2, hypotension; head down, turn patient to the left

66
Q

What is the difference in fibroblast ingrowth with Gore-Tex (PTFE) and Dacron (polypropylene)?

A

Gore-Tex (PTFE) - cannot get fibroblast ingrowth

Surgery (33 decks)

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