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General Surgery > Hernia > Flashcards

Hernia Flashcards

1
Q

What is a pantaloon hernia

A

direct + indirect hernia

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2
Q

___ more common in females, but most common in female still ___

A

femoral hernia
indirect hernia

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3
Q

What is Richter hernia

A

hernia of only part of bowel (not entire circumference)

knuckle is strangulated, but lumen still patent

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4
Q

What is spigelian hernia

A

herniation of linea semilunaris

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5
Q

Lumbar hernias can occur in ___ or ___

A

petit triangle (lower lumbar)
grynfeltt triangle (upper lumbar)

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6
Q

Little old lady hernia is the ___ hernia

A

obturator

causes pain in medial thigh down to knee caused by compression of obturator nerve

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7
Q

What is littre hernia

A

hernia containing Meckel’s diverticulum

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8
Q

What is amyand’s hernia

A

hernia that contains appendix

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9
Q

6 layers of anterior abdominal wall

A
  1. skin + subcutaneous fat
  2. superficial fascia (camper’s + scarpa’s)
  3. myofascial (abdominal muscles + fascia + rectus sheath)
  4. transversalis fascia
  5. extra-peritoneal fat
  6. parietal peritoneum
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10
Q

Innervation of abdominal muscles

A

rectus abdominis: thoracoabdominal n

external oblique: thoracoabdominal + subcostal n

internal o, transversus abdominis: thoracoabdominal + subcostal + ilioinguinal nerve

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11
Q

What does arcuate line signify

A

lower limit of posterior rectus sheath

where inferior epigastric vessels (from external iliac) perforate rectus abdominis and anastomose with superior epigastric vessels

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12
Q

Deep inguinal ring is a defect in ___

Superficial inguinal ring is a defect in ___

A

transversalis fascia

external oblique aponeurosis

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13
Q

where do indirect & direct hernias begin relative to inferior epigastric vessels

A

indirect: lateral to vessels
direct: medial to vessels

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14
Q

Boundaries of the inguinal canal

A

Anterior: EO aponeurosis
Posterior: transversalis fascia
Roof: conjoint tendon
Floor: inguinal ligament

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15
Q

Contents of spermatic cord

A

Males: 5 sets of 3 things

3 coverings: external spermatic fascia, cremasteric fascia & muscle, internal spermatic fascia

3 artery: testicular, vas, cremasteric

3 veins: testicular (pampiniform plexus), vas, cremasteric

3 nerves: genital branch of genitofemoral, sympathetic (T10), ilioinguinal nerve (on spermatic cord)

3 others: remains of processus vaginalis, vas deferens, lymphatics

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16
Q

Boundaries of Hasselbach’s triangle & significance

A

Medial: lateral border of rectus abdominis
Inferior: inguinal ligament
Lateral: inferior epigastric vessels

where direct hernias emerge

17
Q

Incarcerated inguinal hernias present with

A

pain + nausea + abdominal distension + vomiting

18
Q

Obstructed vs strangulated hernia

A

Obstructed: lumen of bowel is obstructed but not blood supply. Pt has IO.

Strangulated: blood supply is cut off, impending ischemic bowel. 4-6 hours to gangrene. Pt has symptoms of IO + acute pain

19
Q

Types of open hernia repair

A

1) Herniotomy - removal of hernia sac (only kids)
2) Herniorrhaphy - herniotomy + repair of posterior inguinal canal wall
3) Hernioplasty - reinforcement of posterior inguinal canal wall with synthetic mesh (Lichtenstein repair)

20
Q

Inguinal & femoral hernia location relative to pubic tubercle

A

Inguinal: medial and above
femoral: lateral and below

21
Q

Contents of the femoral canal

A

NAVEL - lateral to medial

femoral nerve, artery, vein
empty space (where femoral hernia sac is)
lymphatics

22
Q

Boundaries of femoral triangle

A

Superior - inguinal ligament
Medial - medial border of adductor longus
Lateral - medial border of Sartorius
Floor - iliacus, psoas, pectineus
Roof - superficial fascia

23
Q

Femoral hernia usually not ___, no ___. Carries a high risk of ____.

A

reducible
cough impulse
strangulation

24
Q

Umbilical/paraumbilical hernia risk factors

A

Congenital umbilical:
- common in african, infants, newborn

Congenital paraumbilical:
- common in adults >40yrs
- 5x more common in female

Acquired:
- pregnancy, obesity, liver ascites

25
Q

Types of abdo scars (7)

A

1) Midline - bloodless, rapid entry into peritoneal cavity
2) Paramedian
3) Kocher - R for HPB, L for spleen
4) Gridiron - open appendicectomy
5) Lanz - same as gridiron
6) Roof top - access pancreas, biliary tree

26
Q

Risk factors for incisional hernias

A

Pt factors: age, raised abdominal pressure (cough, BPH, constipation), steroids, steroids

Surgery factors: wrong suture material, wrong technique

Disease factors: post-op infection, wound breakdown, reoperation

General Surgery (13 decks)

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