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Surgery > Hernia > Flashcards

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
Q

Genitofemoral

A

L1, L2

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26
Q

Bilateral or recurrent hernias sx

A

Laparoscopic inguinal hernia repair

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27
Q

Avoid staples in

A

Trapezoid of doom

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28
Q

Trapezoid of doom

A

lateral to femoral vessel
below iliopubic tract

where lateral cutaneous, femoral branch of genitofemoral and femoral nerves run

29
Q

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

A

Open suture based: Bassini

30
Q

Primary repair utilizing continuous running sutures in multiple layers

A

Shouldice

31
Q

Closure involves Cooper’s ligament

Both inguinal and femoral hernia repair

A

McVay

32
Q

Tension-free repair for direct and indirect hernia

Avoid mesh if infection

A

Lichtenstein

33
Q

Plug and patch

A

Stoppa repair

34
Q

Laparoscopic repair:

A

transabdominal preperitoneal
totally extraperitoneal

not for strangulated hernia
less post op pain, earlier return to work

35
Q

Most common early complication of repair

A

Urinary retention

others: wound infection, ischemic orchitis, testicular atrophy (vessel disruption and thromobosis of vessels), nerve injury, pain, recurrence

36
Q

Loss of cremasteric reflex sensation to ipsilateral penis, scrotum and medial thigh

A

Ilioinguinal injury

37
Q

Loss of sensation to lower abdominal wall and inguinal region

A

Iliohypogastric injury

38
Q

Loss of sensation to upper lateral thigh (femoral) or loss of scrotal sensation and cremasteric motor function (genital branch)?

A

Genitofemoral injury

39
Q

Urinary retention post op:

A

spinal>general>local

40
Q

5% of hernias
15% bilateral

More common in women

A

Femoral hernia

41
Q

Most common hernia in women

A

Inguinal

42
Q

Greater incidence of incarceration due to narrow neck

A

Femoral hernia

43
Q

Inferior to inguinal ligament

Repair requires approximation with Cooper’s

A

Femoral hernias

44
Q

Protrusion at upper medial thigh

Inferior to inguinal ligament

A

Femoral hernia

45
Q

Most commonly injured nerve during hernia repair

On top of cord

A

Ilioinguinal nerve

46
Q

Tx for femoral hernia

A

operative repair

45% risk of strangulation by 2 years

47
Q

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

A

Incisional ventral hernia

48
Q

Associated with greater recurrence rate compared to mesh repair

A

Primary repair

49
Q

Complication of incisional hernia repair

A 
Recurrence (greatest primary)
Wound infection
Seroma
Hematoma
Visceral damage
50
Q

Repair of small <1cm childhood umbilical hernia is delayed until

A

4

bec of high rate of spontaneous closure

adult rarely close

51
Q

Fascial defect at linea alba at umbilicus

Umbilical hernia

A

Umbilical hernia

52
Q

Indications for expeditious repair of umbilical hernia

A

Incarceration
Strangulation
Ascites

53
Q

85, F
Intermittent crampy abdominal pain
Hemodynamically stable
Mildly distended abdomen

Medial thigh pain exacerbated with Abd, IR, Ext

Diagnosis?

A

Obturator hernia

+ Howship-Romberg sign

54
Q

Medial thigh pain upon leg abduction, internal rotation, extension

A

Howship-Romberg sign

55
Q

Obturator hernia dx

A

CT scan

56
Q

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

A

Spigelian

57
Q

Hernia through inferior lumbar triangle

posterior edge of EO, lats dorsi, iliac crest

A

Petit hernia at lumbar area

58
Q

Hernia through superior lumbar triangle (12th rib, serratus, IO, quad lumborum, erector spinae)

A

Grynfeltt’s at lumbar area

59
Q

Midline hernia through muscular aponeurosis that forms linea alba, area extending from xiphoid to umbilicus

A

Epigastric hernia

60
Q 
Hernia though obturator foramen
Anteromedial to obturator nerve and vessel 
Elderly women 
Bowel obstruction
Palpable medial thigh
Howship-Romberg sign
Operative repair
A

Obturator hernia

61
Q

Hernia on wall of bowel
Cause ischemia and strangulation
Perforation without associated obstruction

A

Richter’s hernia

62
Q

Hernia of meckel’s diverticulum

A

Littre’s hernia

63
Q

Indirect and direct inguinal hernia straddles the inferior epigastric vessel

A

Pantaloon hernia

64
Q

Most common cause of urinary retention post hernia repair

A

General anesthesia

Excessive IV fluid administration

65
Q

Testicular atrophy after indirect hernia repair?

A

Ischemic orchitis due to venous congestion with venous thrombosis

Indirect hernia repair

66
Q

23, M
Incarcerated inguinal hernia

Next step?

A

If no strangulation, reduce while sedated on Trendelenburg

Repair in 2-3 days

If unsuccessful, urgent operative

67
Q

Sliding indirect hernia in female.

Organs involved?

A

Ovary, fallopian tubes, cecum (right), sigmoid (left), bladder

68
Q

Bleeding due to McVay repair?

A

Aberrant obturator artery

69
Q

45, M
Dull groin ache
Painful ejaculation after hernia repair

therapy

A

Vasectomy

Dysejaculation syndrome likely by partial obstruction of vas deferens after inguinal hernia repair

Surgery (17 decks)

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