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Hernia Flashcards

1
Q

Layers of abdomen

A 
Skin
Subcutaneous fat
Camper’s fascia
Scarpa’s fascia
EO
IO
TA
Transversalis fascia
Peritoneum
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2
Q

Superior to arcuate line of Douglas

A

Anterior sheath is EO and IO aponeurosis

Posterior sheath is IO and TF

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3
Q

Inferior to arcuate line, posterior sheath

A

Only transversalis fascia

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4
Q

Superficial and fatty fascia

A

Camper’s

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5
Q

Deeper and fibrous fascia

A

Scarpa’s

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6
Q

Entrance to inguinal canal

Arises from transversalis f

A

Deep internal ring

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7
Q

Exit of inguinal canal

Arising from the medial and lateral crura of EO aponeurosis

A

Superficial external ring

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8
Q

Arises from thickened portion of EO and Connects ASIS to pubic tubercle

A

Inguinal Poupart’s ligament

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9
Q

Medial fan shaped inguinal ligament joining it to pubic tubercle to pectineal line of pubis

A

Lacunar

Gimbernat’s ligament

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10
Q

Arises from inferior aspect of TF

Parallel and deep to inguinal ligament

A

Iliopubic tract

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11
Q

Thickening of fascia at pectineal line and extends from lacunar ligament

A

Cooper Pectineal ligament

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12
Q

Arises from IO and transversus abdominis aponeuroses

A

Conjoint tendon Falx inguinalis

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13
Q

Boundaries of inguinal canal

A

Anterior: EO
Posterior: TF
Roof: IO, transversus abdominis
Floor: inguinal ligament

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14
Q

Preperitoneal space behind pubic symphysis

Site of laparoscopic hernia repair

A

Space of Retzius

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15
Q

Inguinal ligament inferiorly
Rectus sheath medially
Inferior epigastric vessel superolaterally

A

Hesselbach’s triangle

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16
Q

Contents of inguinal canal

A 
Ilioinguinal nerve (superior to cord)
Spermatic cord (genital branch of genitofemoral) posteromedial aspect
Cremaster muscle
Vas deferens
Testicular artery
Pampiniform plexus
Round ligament
Lymphatic
Vessels
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17
Q

Occur at medial femoral canal

A

Femoral hernia

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18
Q

Boundaries of femoral hernia

A

Anterior: inguinal ligament
Posterior: Cooper’s ligament with pubic ramus
Medial: Lacunar ligament
Lateral: Femoral vein

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19
Q

Most common type
75% of all hernias

7x in Men on the right

A

Inguinal hernia
50% indirect
25% direct

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20
Q

hernia rf

A 
obesity
pregnancy
ascites
heavy exercise
inc intraabdominal pressure (straining, coughing)
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21
Q 
Congenital failure of obliteration of processus vaginalis 
Arises lateral to Hesselbach’s triangle
Medial to inferior epigastric vessel
Sac is anteromedial to cord 
descends to scrotum
A

Indirect hernia

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22
Q

Acquired
arise within Hesselbach’s
Weakness of transversalis fascia

A

Direct hernia

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23
Q

Ilioinguinal

A

L1

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24
Q

Iliohypogastric nerve

A

T12, L1

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25
Genitofemoral
L1, L2
26
Bilateral or recurrent hernias sx
Laparoscopic inguinal hernia repair
27
Avoid staples in
Trapezoid of doom
28
Trapezoid of doom
lateral to femoral vessel below iliopubic tract where lateral cutaneous, femoral branch of genitofemoral and femoral nerves run
29
High ligation with repair of inguinal floor Approximation of TF, conjoint tendon and shelving edge of inguinal ligament Avoid sutures in pubic tubercle to minimize osteitis pubis
Open suture based: Bassini
30
Primary repair utilizing continuous running sutures in multiple layers
Shouldice
31
Closure involves Cooper’s ligament | Both inguinal and femoral hernia repair
McVay
32
Tension-free repair for direct and indirect hernia | Avoid mesh if infection
Lichtenstein
33
Plug and patch
Stoppa repair
34
Laparoscopic repair:
transabdominal preperitoneal totally extraperitoneal not for strangulated hernia less post op pain, earlier return to work
35
Most common early complication of repair
Urinary retention others: wound infection, ischemic orchitis, testicular atrophy (vessel disruption and thromobosis of vessels), nerve injury, pain, recurrence
36
Loss of cremasteric reflex sensation to ipsilateral penis, scrotum and medial thigh
Ilioinguinal injury
37
Loss of sensation to lower abdominal wall and inguinal region
Iliohypogastric injury
38
Loss of sensation to upper lateral thigh (femoral) or loss of scrotal sensation and cremasteric motor function (genital branch)?
Genitofemoral injury
39
Urinary retention post op:
spinal>general>local
40
5% of hernias 15% bilateral More common in women
Femoral hernia
41
Most common hernia in women
Inguinal
42
Greater incidence of incarceration due to narrow neck
Femoral hernia
43
Inferior to inguinal ligament | Repair requires approximation with Cooper’s
Femoral hernias
44
Protrusion at upper medial thigh | Inferior to inguinal ligament
Femoral hernia
45
Most commonly injured nerve during hernia repair | On top of cord
Ilioinguinal nerve
46
Tx for femoral hernia
operative repair | 45% risk of strangulation by 2 years
47
10-20% of patients who undergo abdominal surgery Ischemia, advanced age, infection, malnutrition, obesity, ascites, tobacco use, corticosteroid, repair in emergent setting, poor surgical technique, aortic aneurysm, immunosupression
Incisional ventral hernia
48
Associated with greater recurrence rate compared to mesh repair
Primary repair
49
Complication of incisional hernia repair
``` Recurrence (greatest primary) Wound infection Seroma Hematoma Visceral damage ```
50
Repair of small <1cm childhood umbilical hernia is delayed until
4 bec of high rate of spontaneous closure adult rarely close
51
Fascial defect at linea alba at umbilicus | Umbilical hernia
Umbilical hernia
52
Indications for expeditious repair of umbilical hernia
Incarceration Strangulation Ascites
53
85, F Intermittent crampy abdominal pain Hemodynamically stable Mildly distended abdomen Medial thigh pain exacerbated with Abd, IR, Ext Diagnosis?
Obturator hernia + Howship-Romberg sign
54
Medial thigh pain upon leg abduction, internal rotation, extension
Howship-Romberg sign
55
Obturator hernia dx
CT scan
56
Hernia through linea semilunaris (lateral to posterior rectus sheath to medial aspect of transversus abdominis) where line of Douglas intersects linea semilunaris Up to 20% incarceration
Spigelian
57
Hernia through inferior lumbar triangle | posterior edge of EO, lats dorsi, iliac crest
Petit hernia at lumbar area
58
Hernia through superior lumbar triangle (12th rib, serratus, IO, quad lumborum, erector spinae)
Grynfeltt’s at lumbar area
59
Midline hernia through muscular aponeurosis that forms linea alba, area extending from xiphoid to umbilicus
Epigastric hernia
60
``` Hernia though obturator foramen Anteromedial to obturator nerve and vessel Elderly women Bowel obstruction Palpable medial thigh Howship-Romberg sign Operative repair ```
Obturator hernia
61
Hernia on wall of bowel Cause ischemia and strangulation Perforation without associated obstruction
Richter’s hernia
62
Hernia of meckel’s diverticulum
Littre’s hernia
63
Indirect and direct inguinal hernia straddles the inferior epigastric vessel
Pantaloon hernia
64
Most common cause of urinary retention post hernia repair
General anesthesia | Excessive IV fluid administration
65
Testicular atrophy after indirect hernia repair?
Ischemic orchitis due to venous congestion with venous thrombosis Indirect hernia repair
66
23, M Incarcerated inguinal hernia Next step?
If no strangulation, reduce while sedated on Trendelenburg Repair in 2-3 days If unsuccessful, urgent operative
67
Sliding indirect hernia in female. | Organs involved?
Ovary, fallopian tubes, cecum (right), sigmoid (left), bladder
68
Bleeding due to McVay repair?
Aberrant obturator artery
69
45, M Dull groin ache Painful ejaculation after hernia repair therapy
Vasectomy Dysejaculation syndrome likely by partial obstruction of vas deferens after inguinal hernia repair

Surgery (17 decks)

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