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*OldSurgery > Hernia > Flashcards

Hernia Flashcards

1
Q

Protrusion of visceral contents through abdominal wall

A

Hernia

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2
Q

2 components of a hernia

A

fascial defect

hernia sac and its contents

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3
Q

what is the anatomy of the abdominal wall

A 
Skin
Camper's fascia (unlikely to notice)
Scarpa's fascia
external oblique aponeurosis & muscle
internal oblique aponeurosis & muscle 
Transversus abdominis aponeurosis & muscle 
transversalis fascia
preperitoneal fat
peritoneum
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4
Q

direction of external oblique fibers

A

hands into pocket

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5
Q

where is a femoral inguinal ligament (rarest)

A

below inguinal ligament

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6
Q

inguinal ligament start and end point

A

ASIS and public tubercle

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7
Q

who are femoral hernias usually found in?

A

women, elderly and thin

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8
Q

a hernia which cannot be reduced

A

incarcerated hernia

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9
Q

contents of sac have a compromised blood supply

A

strangulated hernia

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10
Q

a retroperitoneal organ makes up part of the sac

A

sliding hernia

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11
Q

antimesenteric portion of intestine is in the sac

non-obstructive hernia with part of wall stuck in there

A

Richter’s hernia

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12
Q

Any hernia near an incision is a ____ until proven otherwise

A

VIH (ventral incisional hernia)

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13
Q

what in the women is analogous to the spermatic cord

A

round ligament of the ovary

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14
Q

what attaches the testicle to the scrotum

A

gubernaculum

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15
Q

beyond what age should an umbilical hernia be evaluated for surgery

A

3

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16
Q

why should a hernia be fixed earlier

A

get bigger

more difficult to mix

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17
Q

contents of the inguinal canal

A 
spermatic cord
round ligament (no suspensory capacity)
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18
Q

anterior border of the inguinal canal

A

external oblique aponeurosis

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19
Q

superior border of the inguinal cancal

A

internal and transversus abdominal muscles

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20
Q

inferior border of inguinal canal

A

inguinal lacunar ligaments (right by pubic tubercle)

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21
Q

posterior border inguinal canal

A

transversalis fascia

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22
Q

what do the cremaster attach to (come from these)?

A

internal obliques

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23
Q

what is Hesselbach’s triangle

A

Lateral - inguinal ligament
Medial - rectus sheath
Superior - inferior epigastric vessels

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24
Q

type of hernia - protrudes through Hesselbach’s triangle. Doesn’t involve spermatic cord

A

direct hernia

25
Q

type of hernia Protrudes lateral to inferior epigastric vessels. If it inside substance of spermatic cord it is this.

A

indirect hernia

26
Q

hernia that is a combination of direct and indirect hernia (There are 2 different ones)

A

pantaloon hernia

27
Q

what is the lateral border of the femoral triangle

A

femoral vein

28
Q

contents of the femoral canal

A 
NAVEL (lateral to medial) 
nerve
artery
vein
empty space
lymphatics
29
Q

what does the vas defernes feel like?

A

iphone cord

30
Q

what type hernia is more likely to have bowel stuck in it?

A

femoral hernia

31
Q

what nerve provides sensation to suprapubic region

A

iliohypogastric

32
Q

nerve with small area of sensation to medial thigh and scrotum/labia majora
Always the answer to “what nerve is that”
runs ontop of the spermatic cord

A

ilioinguinal nerve

33
Q

nerve with sensation to anterior scrotum and motor to cremasteric fibers

A

Genital branch w/ genitofemoral nerve

34
Q

sensation to anteromedial thigh

A

femoral branch for gentiofermoal

35
Q

sensation to lateral thigh

A

lateral femoral cutaneous nerve

36
Q
  • motor and sensation to the thigh
A

femoral nerve

37
Q

what are the 2 main connective tissue structures in the inguinal region

A

Inguinal/ Poupart’s Ligament

Cooper’s ligament

38
Q

most common causes of inguinal hernia

A 
increased intrabdominal pressure
peritoneal dialysis and ascites
COPD/ chronic cough
BPh
chronic constipation (colonscopy is >50) 
physical labor
39
Q

gold standard dx for inguinal hernia?

A

H and P

40
Q

best way to diagnose a inguinal hernia

A

while patient is standing and supine

examine both sides

41
Q

standard of care for hernia repair

A

mesh to reconstructe the floor of in the inguinal canal (Lichtenstein)

42
Q

only indication laparoscopic hernia repair (TEP)

A

B/L or recurrent hernia

can usually only do this once

43
Q

reasons you can’t do a laparoscopic hernia approach

A

prostate surgery
lower midline incision
C-section

44
Q

complications of inguinal hernias

A

placing the repair under tension has higher rate of occurrence
nerve entrapment (ilioinguinal nerve)
ischemic orchitis

45
Q

what type hernia is more likely to present as incarcerated

A

femoral hernias

pediatric hernias

46
Q

where are the majority of pediatric hernias

A

right side

47
Q

can you use mesh in hernias for kids

A

will be to small when the kids grows

48
Q

when should you fix an umbilical hernia

A

If less than 2 cm, wait until age 4 to close
elective repair should be done
especially fix in adults

49
Q

occur in upper abdomen and are associated with obesity and pregnancy

A

Epigastric hernia

50
Q

condition where rectus abdominus muscle pull apart and linea alba spread apart
goes from belly to sternum, never below

A

diastasis recti (not a hernia!)

51
Q

first for diastasis recti

A

tummy tuck

abdominoplasty

52
Q

2 biggest risk factors for incisional hernia

A

obesity, wound infection

53
Q

ventral hernia repair

A

Dissection of sac
Exposure of healthy facial edges
Closure of defect (primarily?) or with mesh (only don’t use mesh if smaller than the size of your finber)

54
Q

elderly emaciated females - on right and can barely feel them

A

Obturator hernia

55
Q

involve urogenital diaphragm and pass into labia majora

A

perineal hernia

56
Q

hole in messentary of intestines and another loop slips through there. often after gastric bypass.

A

internal hernias

57
Q

3 numbers for percentage pimp questions

A

15, 85, 50

58
Q

Where is an indirect hernia sac positioned?

A

anteromedially

59
Q

Where do recurrences happen?

A

pubic tubercle (because of gravity)

*OldSurgery (22 decks)

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