Hernia Flashcards
What is a pantaloon hernia
direct + indirect hernia
___ more common in females, but most common in female still ___
femoral hernia
indirect hernia
What is Richter hernia
hernia of only part of bowel (not entire circumference)
knuckle is strangulated, but lumen still patent
What is spigelian hernia
herniation of linea semilunaris
Lumbar hernias can occur in ___ or ___
petit triangle (lower lumbar)
grynfeltt triangle (upper lumbar)
Little old lady hernia is the ___ hernia
obturator
causes pain in medial thigh down to knee caused by compression of obturator nerve
What is littre hernia
hernia containing Meckel’s diverticulum
What is amyand’s hernia
hernia that contains appendix
6 layers of anterior abdominal wall
- skin + subcutaneous fat
- superficial fascia (camper’s + scarpa’s)
- myofascial (abdominal muscles + fascia + rectus sheath)
- transversalis fascia
- extra-peritoneal fat
- parietal peritoneum
Innervation of abdominal muscles
rectus abdominis: thoracoabdominal n
external oblique: thoracoabdominal + subcostal n
internal o, transversus abdominis: thoracoabdominal + subcostal + ilioinguinal nerve
What does arcuate line signify
lower limit of posterior rectus sheath
where inferior epigastric vessels (from external iliac) perforate rectus abdominis and anastomose with superior epigastric vessels
Deep inguinal ring is a defect in ___
Superficial inguinal ring is a defect in ___
transversalis fascia
external oblique aponeurosis
where do indirect & direct hernias begin relative to inferior epigastric vessels
indirect: lateral to vessels
direct: medial to vessels
Boundaries of the inguinal canal
Anterior: EO aponeurosis
Posterior: transversalis fascia
Roof: conjoint tendon
Floor: inguinal ligament
Contents of spermatic cord
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
Boundaries of Hasselbach’s triangle & significance
Medial: lateral border of rectus abdominis
Inferior: inguinal ligament
Lateral: inferior epigastric vessels
where direct hernias emerge
Incarcerated inguinal hernias present with
pain + nausea + abdominal distension + vomiting
Obstructed vs strangulated hernia
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
Types of open hernia repair
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)
Inguinal & femoral hernia location relative to pubic tubercle
Inguinal: medial and above
femoral: lateral and below
Contents of the femoral canal
NAVEL - lateral to medial
femoral nerve, artery, vein
empty space (where femoral hernia sac is)
lymphatics
Boundaries of femoral triangle
Superior - inguinal ligament
Medial - medial border of adductor longus
Lateral - medial border of Sartorius
Floor - iliacus, psoas, pectineus
Roof - superficial fascia
Femoral hernia usually not ___, no ___. Carries a high risk of ____.
reducible
cough impulse
strangulation
Umbilical/paraumbilical hernia risk factors
Congenital umbilical:
- common in african, infants, newborn
Congenital paraumbilical:
- common in adults >40yrs
- 5x more common in female
Acquired:
- pregnancy, obesity, liver ascites
Types of abdo scars (7)
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
Risk factors for incisional hernias
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
