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ABSITE UTH > Fiser - Hernias, Abd, Surg Tech > Flashcards

Fiser - Hernias, Abd, Surg Tech Flashcards

1
Q

What is the external abd oblique fascia’s contribution to the inguinal canal?

A

forms inguinal ligament (shelving edge & roof) at inferior portion

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2
Q

What is the internal abdominal oblique’s contribution to the inguinal canal?

A

Forms cremasteric muscles.

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3
Q

What is the transversalis muscle’s contribution to the inguinal canal?

A

Forms the floor of the canal.

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4
Q

What is the conjoined tendon made of?

A

Composed of aponeurosis of the internal abdominal oblique & transversalis fascia.

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5
Q

Describe the path of the inguinal ligament.

A

From External abd oblique fascia, runs from ASIS to the pubis; anterior to femoral vessels.

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6
Q

Alternative name to inguinal ligament?

A

Poupart’s (French physician & anatomist who described the ligament [16??-1708])

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7
Q

Describe the lacunar ligament.

A

Where the inguinal ligament splays out to insert to the pubis.

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8
Q

Describe Cooper’s ligament.

A

pectineal ligament; posterior to femoral vessels, lies against bone.

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9
Q

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

A

It runs medial to cord structures.

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10
Q

Define the borders of Hesselbach’s triangle.

A

Medial border - rectus muscle.
Inferior border - inferior inguinal ligament.
Lateral border - inferior epigastric vessels.

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11
Q

Who was Hesselbach?

A

Franz Kaspar Hesselbach - 18th century German anatomist and surgeon who described multiple hernia operations.

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12
Q

Indirect hernias are derived from…

A

Persistently patent processus vaginalis. Most common.

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13
Q

Indirect inguinal hernia location is…

A

Superior/lateral to the epigastric vessels.

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14
Q

Direct inguinal hernia location is…

A

Inferior/medial to epigastric vessels.

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15
Q

Describe a pantaloon hernia.

A

Has direct and indirect components.

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16
Q

List the risk factors for inguinal hernias in adults. (9)

A

Age, obesity, heavy lifting, COPD (coughing), chronic constipation, straining (e.g. BPH), ascites, pregnancy, peritoneal dialysis

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17
Q

Describe sliding hernias.

A

Involve retroperitoneal organs making up part of the hernia sac. Bladder can also be involved.

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18
Q

Most common components of sliding hernia in females.

A

Ovaries or fallopian tubes.

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19
Q

Most common components of sliding hernia in males.

A

Cecum or sigmoid.

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20
Q

If an ovary is in the canal during repair, what do you do?

A

Ligate the round ligament.
Return ovary to peritoneum.
Perform biopsy if appearance abnormal.

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21
Q

Method of inguinal hernia repair in infants/children.

A

High ligation (nearly always indirect). Open sac prior to ligation.

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22
Q

Describe the Bassini repair.

A

B - approximation of conjoined tendon to free edge of inguinal ligament

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23
Q

Describe Cooper’s ligament repair.

A

Approximation of conjoined tendon to Cooper’s. Needs a relaxing incision in ext abd oblique fascia.

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24
Q

Indication for laparoscopic hernia repair.

A

Bilateral or recurrent inguinal hernia.

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25
Q

What is the most common early complication of a hernia repair?

A

Urinary retention.

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26
Q

What is the incidence rate of wound infection in hernia repairs? Recurrence rate?

A

Infection - 1%

Recurrence - 2%

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27
Q

What leads to testicular atrophy after a hernia repair?

A

Dissection of the distal component of the hernia sac causing vessel disruption. Thrombosis of spermatic cord veins.

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28
Q

Pain after IHR is usually cause by…

A

Compression of the ilioinguinal nerve.

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29
Q

How do you diagnose/treat pain secondary to ilioinguinal nerve compression?

A

Local infiltration of anesthetic near the ASIS.

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30
Q

What are signs of an ilioinguinal nerve injury?

A

Loss of cremasteric reflex. Numbness on ipsilateral penis, scrotum, thigh.

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31
Q

Where does an ilioinguinal nerve injury occur in IHR?

A

Usually at the external ring. Nerve runs on top of cord (anterior).

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32
Q

What are the signs of a genitofemoral nerve injury?

A

Genital branch - cremaster (motor), scrotum (sensory)

Femoral - upper lateral thigh (sensory) loss

33
Q

When is the genitofemoral nerve injured?

A

Usually injured in laparoscopic repair.

34
Q

Cord lipomas in IHR…

A

Should be removed.

35
Q

Femoral canal boundaries?

A

Posterior - Cooper’s (pectineal)
Anterior - inguinal ligament
Medial - lacunar ligament

36
Q

Space that femoral hernia fills?

A

medial to femoral vein, lateral to lymphatics (in empty space)

37
Q

Maneuver to reduce risk of incarceration in femoral hernia?

A

divide the inguinal ligament

38
Q

Approach to repair femoral hernia?

A

Inguinal approach with Cooper’s ligament repair

39
Q

Femoral hernia - characteristic exam

A

bulge on the anterior-medial thigh below inguinal ligament

40
Q

Age of repair for umbilical hernia

A

Delay until age 5 yrs

41
Q

Spigelian hernia - location

A

Lateral border of the rectus muscle, adjacent to linea semilunaris, inferior to semicircularis; between the muscle fibers of IAO muscle and insertion of EAO apo into the rectus sheath

42
Q

Obturator hernia - presentation

A

tender medial thigh mass or SBO

XR - bowel gas below superior pubic ramus

43
Q

Howship-Romberg sign

A

inner thigh pain with internal rotation in obturator hernia

44
Q

Obturator hernia treatment

A

operative reduction, may need mesh; examine other side for defect

45
Q

Obturator hernia risk factors

A

elderly women, prior pregnancy

46
Q

Sciatic foramen location

A

posterior pelvis, through the greater sciatic foramen

High rate of strangulation

47
Q

Posterior rectus sheath absent starting where?

A

Below semicircularis (below umbilicus). Posterior aponeurosis of IAO & transversalis moves anterior.

48
Q

Rectus sheath hematoma - risk factors

A

most common after trauma, epigastric vessel injury

49
Q

Rectus sheath hematoma - Presentation

A

Painful abdominal wall mass, more prominent and painful with flexion of rectus muscle (Fothergill’s)

50
Q

Rectus Sheath hematoma - Management

A

Nonop, surgery if expanding

51
Q

Rectus Sheath hematoma - Types

A

Type I - small, confined to muscle, does not cross midline
Type II - within muscle, but can cross midline or dissect along fascial plane
Type III - large, crosses midline, usually below arcuate line. Hemoperitoneum or blood in retropubic space (prevesical space of Retzius)

52
Q

Desmoid Tumors - Presentation/Risk factors

A

Women, Gardner’s Syndrome, painless mass; increased recurrence

53
Q

Desmoid tumors - Surgical Management

A

WLE if possible, may not be indicated if significant small bowel mesentery involvement

54
Q

Desmoid tumors - Medical Management

A

Sulindac, tamoxifen

55
Q

Retroperitoneal fibrosis - Risk factors, diagnostic test

A

Hypersensitivity to methysergide (migraine med)

IVP most sensitive - constricted ureters

56
Q

Retroperitoneal fibrosis - Symptoms caused by

A

related to trapped ureters & lymphatic obstruction

57
Q

Retroperitoneal fibrosis - Treatment

A

steroids, nephrostomy if infection present

Surgery if renal function compromised (free up ureters, wrap in omentum)

58
Q

Mesenteric Tumors - Benign vs Malignant locations

A

Benign - more peripheral

Malignant - closer to root of mesentery

59
Q

Mesenteric Tumors - Most common malignant

A

liposarcoma

60
Q

Mesenteric Tumors - Dx & Tx

A

Dx: abdominal CT
Tx: resection

61
Q

Retroperitoneal Tumors - Most common malignant types

A 
#1 = Lymphoma
#2 = Liposarcoma
62
Q

Retroperitoneal Sarcomas - Characteristics

A

<25% resectable.
Pseudocapsule, but cannot shell out - would leave residual tumor.
Mets go to lung.

63
Q

Omental Tumors - most common solid tumor, management

A

Metastatic disease

Omentectomy for some cancers (e.g. ovarian)

64
Q

Omental cysts - presentation

A

usually asymptomatic, can undergo torsion

65
Q

Primary solid omental tumors

A

Rare, 1/3 malignant
No biopsy, can bleed.
Tx: resection

66
Q

Mechanism of peritoneal dialysis (peritoneal membrane function)

A

Blood absorbed through fenestrated lymphatic channels; movement of fluid can occur with hypertonic saline load, can cause hypotension

67
Q

CO2 Pneumoperitoneum - Normal v Abnormal level

A

Normal = 10-15

Abnormal >20, IAP where cardiopulmonary dysfunction can occur

68
Q

CO2 Pneumoperitneum increases…

A

MAP, PAP, HR, SVR, CVP, mean airway pressure, peak insp pressure, CO2

69
Q

CO2 Pneumoperitneum decreases…

A

pH, venous return (IVC compression), CO, renal flow

70
Q

PEEP in pneumoperitoneum

A

Can worsen effects

71
Q

CO2 effect on myocardium

A

Can decrease contractility

72
Q

CO2 embolus - presentation

A

sudden transient rise in ETCO2, followed by drop, then hypotension

73
Q

CO2 embolus - Treatment

A

head down, pt turned to left; aspirate CO2 through central line, prolonged CPR

74
Q

Harmonic scalpel

A

Disrupts protein H-bonds, causes coagulation

Okay for medium vessels (short gastrics)

75
Q

Argon Beam

A

energy tranferred across argon gas.
Depth of necrosis related to power setting, causes superficial coagulation.
Non-contact, good for liver & spleen. Smokeless.

76
Q

Laser use in hemostasis, clinical uses

A

return of electrons to ground state releases energy as heat, coagulates and vaporizes.
Clinical - condyloma acuminata (wear mask)

77
Q

Nd:YAG Laser

A

Good for deep tissue penetration, bronchial lesions

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

78
Q

Gore-Tex (PTFE) v Dacron

A

PTFE cannot get fibroblast ingrowth. Dacron allows fibroblast growth.

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