Hernia

Question 1

Protrusion of visceral contents through abdominal wall

Answer 1

Hernia

Question 2

2 components of a hernia

Answer 2

fascial defect

hernia sac and its contents

Question 3

what is the anatomy of the abdominal wall

Answer 3

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

Question 4

direction of external oblique fibers

Answer 4

hands into pocket

Question 5

where is a femoral inguinal ligament (rarest)

Answer 5

below inguinal ligament

Question 6

inguinal ligament start and end point

Answer 6

ASIS and public tubercle

Question 7

who are femoral hernias usually found in?

Answer 7

women, elderly and thin

Question 8

a hernia which cannot be reduced

Answer 8

incarcerated hernia

Question 9

contents of sac have a compromised blood supply

Answer 9

strangulated hernia

Question 10

a retroperitoneal organ makes up part of the sac

Answer 10

sliding hernia

Question 11

antimesenteric portion of intestine is in the sac

non-obstructive hernia with part of wall stuck in there

Answer 11

Richter’s hernia

Question 12

Any hernia near an incision is a ____ until proven otherwise

Answer 12

VIH (ventral incisional hernia)

Question 13

what in the women is analogous to the spermatic cord

Answer 13

round ligament of the ovary

Question 14

what attaches the testicle to the scrotum

Answer 14

gubernaculum

Question 15

beyond what age should an umbilical hernia be evaluated for surgery

Answer 15

3

Question 16

why should a hernia be fixed earlier

Answer 16

get bigger

more difficult to mix

Question 17

contents of the inguinal canal

Answer 17

spermatic cord
round ligament (no suspensory capacity)

Question 18

anterior border of the inguinal canal

Answer 18

external oblique aponeurosis

Question 19

superior border of the inguinal cancal

Answer 19

internal and transversus abdominal muscles

Question 20

inferior border of inguinal canal

Answer 20

inguinal lacunar ligaments (right by pubic tubercle)

Question 21

posterior border inguinal canal

Answer 21

transversalis fascia

Question 22

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

Answer 22

internal obliques

Question 23

what is Hesselbach’s triangle

Answer 23

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

Question 24

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

Answer 24

direct hernia

Question 25

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

Answer 25

indirect hernia

Question 26

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

Answer 26

pantaloon hernia

Question 27

what is the lateral border of the femoral triangle

Answer 27

femoral vein

Question 28

contents of the femoral canal

Answer 28

``` NAVEL (lateral to medial) nerve artery vein empty space lymphatics ```

Question 29

what does the vas defernes feel like?

Answer 29

iphone cord

Question 30

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

Answer 30

femoral hernia

Question 31

what nerve provides sensation to suprapubic region

Answer 31

iliohypogastric

Question 32

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

Answer 32

ilioinguinal nerve

Question 33

nerve with sensation to anterior scrotum and motor to cremasteric fibers

Answer 33

Genital branch w/ genitofemoral nerve

Question 34

sensation to anteromedial thigh

Answer 34

femoral branch for gentiofermoal

Question 35

sensation to lateral thigh

Answer 35

lateral femoral cutaneous nerve

Question 36

- motor and sensation to the thigh

Answer 36

femoral nerve

Question 37

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

Answer 37

Inguinal/ Poupart's Ligament | Cooper's ligament

Question 38

most common causes of inguinal hernia

Answer 38

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

Question 39

gold standard dx for inguinal hernia?

Answer 39

H and P

Question 40

best way to diagnose a inguinal hernia

Answer 40

while patient is standing and supine | examine both sides

Question 41

standard of care for hernia repair

Answer 41

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

Question 42

only indication laparoscopic hernia repair (TEP)

Answer 42

B/L or recurrent hernia | can usually only do this once

Question 43

reasons you can't do a laparoscopic hernia approach

Answer 43

prostate surgery lower midline incision C-section

Question 44

complications of inguinal hernias

Answer 44

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

Question 45

what type hernia is more likely to present as incarcerated

Answer 45

femoral hernias | pediatric hernias

Question 46

where are the majority of pediatric hernias

Answer 46

right side

Question 47

can you use mesh in hernias for kids

Answer 47

will be to small when the kids grows

Question 48

when should you fix an umbilical hernia

Answer 48

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

Question 49

occur in upper abdomen and are associated with obesity and pregnancy

Answer 49

Epigastric hernia

Question 50

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

Answer 50

diastasis recti (not a hernia!)

Question 51

first for diastasis recti

Answer 51

tummy tuck | abdominoplasty

Question 52

2 biggest risk factors for incisional hernia

Answer 52

obesity, wound infection

Question 53

ventral hernia repair

Answer 53

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)

Question 54

elderly emaciated females - on right and can barely feel them

Answer 54

Obturator hernia

Question 55

involve urogenital diaphragm and pass into labia majora

Answer 55

perineal hernia

Question 56

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

Answer 56

internal hernias

Question 57

3 numbers for percentage pimp questions

Answer 57

15, 85, 50

Question 58

Where is an indirect hernia sac positioned?

Answer 58

anteromedially

Question 59

Where do recurrences happen?

Answer 59

pubic tubercle (because of gravity)