Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ABSITE > Fiser Chapter 38 HERNIAS, ABDOMEN, AND SURGICAL TECHNOLOGY > Flashcards

Fiser Chapter 38 HERNIAS, ABDOMEN, AND SURGICAL TECHNOLOGY Flashcards

1
Q

What does the external oblique fascia form in inguinal canal?

A

Inguinal ligament (shelving edge) at inferior portion of inguinal canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does the internal oblique form in the inguinal canal?

A

Cremasteric muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does the transversalis muscle and fascia form in the inguinal canal?

A

Conjoined tendon and inguinal floor (respectively)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Lacunar ligament

A

Where the inguinal ligament splays out to insert in the pubis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Cooper’s ligament (pectineal ligament)

A

Posterior to femoral vessels, lies against bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the vas deferens in inguinal canal?

A

Runs medial to cord structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hesselbach’s triangle

A

Recus muscle lateral border, inguinal ligament, inferior epigastrics

Direct hernias are in the triangle, indirect hernias are lateral to epigastric vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Etiology of indirect hernia

A

Persistent patent processor vaginalis; most common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Direct hernias

A

Lower risk of incarceration, rare in females, higher recurrence than indirect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pantaloon hernia

A

Both direct and indirect components

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Risk factors for inguinal hernia in adults

A

Age

Obesity

Heavy lifting

COPD (coughing)

Chronic constipation

Straining (BPH)

Ascites

Pregnancy

Peritoneal dialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Incarcerated hernia

A

Can lead to bowel strangulation and should be repaired emergently

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Sliding hernias

A

Retroperitoneal organ in hernia sac (ovaries, fallopian tubes, cecum, sigmoid bladder)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Tx of female with ovary in inguinal canal

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Infants and children with inguinal hernia

A

Open sac and then perform high ligation (almost always indirect)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Lichtenstein inguinal hernia repair

A

Mesh (less tension, decreases recurrence)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Bassini inguinal hernia repair

A

Approximate conjoined tendon and transversalis fascia to the free shelving edge of the inguinal ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Cooper’s (pectineal) ligament inguinal hernia repair

A

Approximate conjoined tendon and transversalis fascia to Cooper’s ligament

  • Needs relaxing incision in external oblique fascia
  • Can use for femoral hernia repair
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Indication for laparoscopic inguinal hernia repair

A

Bilateral or recurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Most common early complication following inguinal hernia repair

A

-Urinary retention

  • Recurrent 2%
  • Wound infection 1%
  • Testicular atrophy (d/t dissection of distal component of sac causing vessel disruption, spermatic cord vein thrombosis, usually with indirect hernias)
  • Pain (ilioinguinal nerve compression, tx is local infiltration)
  • Nerve injury to ilioinguinal or genitofemoral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Postop inguinal hernia repair, patient has loss of cremasteric reflex, numbness on ipsilateral penis, scrotum, and thigh

A

Ilioinguinal nerve injury, usual at external ring, runs on top of cord

22
Q

Postop laparoscopic inguinal hernia repair, patient has loss of cremastric reflex, scrotum numbness, and upper lateral thigh numbness

A

-Genitofemoral nerve injury

23
Q

Femoral hernia characteristics

A

Bulge on anterior-medial thigh, below inguinal ligament; usually repair through inguinal approach with Cooper’s ligament repair

Most common in females over males (but indirect inguinal hernia still most common in females)

Hernia passes under inguinal ligament, medial to femoral vein, lateral to lymphatics (in empty space)

High risk of incarceration -> may need to divide inguinal ligament to reduce bowel

24
Q

Femoral canal boundaries

A

Cooper’s (pectineal) ligament posteriorly

Inguinal ligament anteriosuperiorly

Femoral vein laterally

Lacunar ligament medially

Contains lymph node of Cloquet

25
Q

Umbilical hernia characteristics

A

Increased in African Americans

Delay repair until 5yo, often close on own

Risk of incarceration in adults, not kids

26
Q

Spigelian hernia characteristics

A

Lateral border of rectus muscle, adjacent to linea semilunaris; almost always inferior to semicircularis

Occurs between muscle fibers of internal oblique muscle and insertion of external oblique aponeurosis into rectus sheath

27
Q

Old woman with previous pregnancies, presents with tender medial thigh mass and SBO, has inner thigh pain with internal rotation (Hoship-Romberg sign)

A

Obturator hernia (anterior pelvis)

Tx: operative reduction, may need mesh; check other side for similar defect

28
Q

Sciatic thigh hernia characteristics

A

Posterior pelvis (versus obturator hernia)

Herniation through greater sciatic foramen

High rate of strangulation

29
Q

Incisional hernia characteristics

A

Most likely to recur

Inadequate closure most common cause

30
Q

Rectus sheath above and below arcuate line

A

Anterior present all the way down

Posterior is present until arcuate line: is made of posterior aponeurosis of internal oblique and transversalis aponeurosis

31
Q

Painful abdominal wall mass after trauma, most prominent and painful with flexion of rectus muscle (Fothergill’s sign)

A

Recut sheath hematoma: epigastric vessel injury

Tx: Nonoperative, surgical if expanding

32
Q

Woman with Gardner’s syndrome has a painless abdominal wall mass

A

Desmoid tumor, benign but locally invasive, high recurrence

Tx: WLE if possible

Medical tx: Sulindac and tamoxifen (If involves significant small bowel mesentery, may not be resectable)

33
Q

Retroperitoneal fibrosis

A

Can occur with hypersensitivity to methysergide (5-HT antagonist formerly used for cluster headaches)

Dx: IVP most sensitive test: see constricted ureters. Symptoms usually related to trapped ureters and lymphatic obstruction

Tx: Steroids, nephrostomy if infection, surgery if renal function compromised (to free ureters and wrap in omentum)

34
Q

Mesenteric tumors

A

Most are cystic

Malignant (liposarcoma, leiomyosarcoma) are closer to root of mesentery; benign are more peripheral

Dx: abdominal CT

Tx: Resection

35
Q

Kid presents with vague abdominal and back pain, and found to have a retroperitoneal tumor

A

Malignant most common: 1. lymphoma, 2. liposarcoma

Sarcomas: < 25% are resectable, 40% have local recurrence, 10% 5-year survival

  • Pseudocapsule but cannot shell out -> leave residual tumor
  • Mets go to lung
36
Q

Omental tumors

A

Most common omental solid tumor is metastatic disease

Omentectomy for some (e.g. ovarian cancer)

Usually asymptomatic but can undergo torsion

Primary solid omental tumors are rare, 1/3 are malignant

  • do NOT biopsy, as can bleed
  • Tx: resection
37
Q

Peritoneal membrane and how peritoneal dialysis works

A

Blood absorbed through fenestrated lymphatic channels in peritoneum. Movement of fluid into peritoneal cavity can occur with hypertonic intra-peritoneal saline load (mechanism of peritoneal dialysis); can cause hypotension

NH3, Ca, Fe, lead removed

Most drugs NOT removed with PD.

38
Q

CO2 pneumoperitoneum, physiological effects

A
  • Cardiopulmonary dysfunction with intra-abdominal pressure > 20
  • Increased MAP, pulmonary artery pressure, HR, systemic vascular resistance, CVP, mean airway pressure, peak inspiratory pressure, and CO2
  • Decreased pH, venous return (IVC compression), CO (and renal flow), decreased myocardial contractility (from CO2)
39
Q

Problem of hypovolemia with pneumoperitoneum

A

Lowers the pressure necessary to cause compromise of CO and venous return

40
Q

Problem of PEEP and pneumoperitoneum

A

PEEP worsens effects of pneumoperitoneum

41
Q

Sudden rise in ETCO2 and hypotension in pneumoperitoneum

A

CO2 embolus: head down, turn patient to left, try to aspirate CO2 through central line, prolonged CPR

42
Q

Harmonic scalpel

A
  • Cost-effective for medium vessels (short gastrics)

- Disrupts protein H-bond, causes coagulation

43
Q

Surgical ultrasound

A

B-mode used most commonly (B - brightness; assesses relative density of structures)

44
Q

Shadowing versus enhancement in ultrasound

A

Shadowing- dark area posterior to object indicates mass

Enhancement- brighter area posterior to object indicates fluid-filled cyst

45
Q

Ultrasound duplex: lower versus higher frequencies

A

Lower for deep structures

Higher for superficial structures

46
Q

Argon beam

A

Energy transferred across argon gas

Depth of necrosis related to power setting (2 mm); causes superficial coagulation

Is non-contact: good for hemostasis of liver and spleen; smokeless

47
Q

Surgical laser

A

Return of electrons to ground state releases energy as heat -> coagulates and vaporizes

Used for condylomata acuminata (wear mask)

48
Q

Nd:YAG laser

A

Good for deep tissue penetration, bronchial lesions

1-2 mm cuts, 3-10 mm vaporizes, 1-2 cm coagulates

49
Q

Gore-Tex versus Dacron

A

Gore-Tex (PTFE): No fibroblast ingrowth

Dacron (polypropylene): allows fibroblast ingrowth

50
Q

Incidence of vascular or bowel injury with Veress needle or trocar

A

0.1 %

ABSITE (34 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions