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SURGERY > HERNIA > Flashcards

HERNIA Flashcards

1
Q

Presumed causes of groin herniation

A 
coughing
COPD
obesity
straining 
pregnancy
birthweight <1500 g
family history of hernia
Valsalva's maneuver
ascites
upright position
congenital CT disorders
defective collagen synthesis
previous RLQ incision
arterial aneurysm
cigarette smoking
heavy lifting
physical exertion
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2
Q

Reducible

A

Ability to return the displaced organ or

tissue/hernia contents to their usual anatomic site

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3
Q

Incarcerated

A

Swollen or fixed within the hernia sac (incarcerated = imprisoned)

may cause intestinal obstruction (i.e., an irreducible hernia)

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4
Q

Strangulated

A

Incarcerated hernia with resulting ischemia –> signs and symptoms of ischemia and intestinal
obstruction or bowel necrosis

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5
Q

Complete

A

Hernia sac and its contents protrude all

the way through the defect

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6
Q

Incomplete

A

Defect present without sac or contents protruding completely through it

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7
Q

Sliding Hernia

A

Hernia sac partially formed by the wall of a viscus (i.e., bladder/cecum

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8
Q

Littre’s hernia

A

Hernia involving a MECKEL’s DIVERTICULUM

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9
Q

Spigelian hernia

A

Hernia through the LINEA SEMILUNARIS (or spigelian fascia)

Also known as spontaneous lateral ventral hernia

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10
Q

Internal hernia

A

Hernia into or involving INTRA-ABDOMINAL structure

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11
Q

Petersen’s hernia

A

Seen after BARIATRIC GASTRIC BYPASS— internal herniation of small bowel through the mesenteric defect from the Roux limb

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12
Q

Obturator hernia

A

Hernia through OBTURATOR CANAL (females > males)

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13
Q

Lumbar hernia

A

Petit’s hernia or Grynfeltt’s hernia

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14
Q

Petit’s hernia

A

Rare

Hernia through Petit’s triangle (a.k.a. INFERIOR lumbar triangle)

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15
Q

Grynfeltt’s hernia

A

Hernia through Grynfeltt-Lesshaft triangle (SUPERIOR lumbar triangle)

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16
Q

Pantaloon hernia

A

Hernia sac exists as BOTH DIRECT AND INDIRECT HERNIA straddling the inferior
epigastric vessels and protruding through
the floor of the canal as well as the internal ring (two sacs separated by the inferior epigastric vessels [the pant crotch] like a pair of pantaloon pants)

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17
Q

Incisional hernia

A

Hernia through an incisional site

MC cause - wound infection

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18
Q

Ventral hernia

A

Incisional hernia in the VENTRAL ABDOMINAL WALL

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19
Q

Parastomal hernia

A

Hernia adjacent to an ostomy (e.g., colostomy)

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20
Q

Sciatal hernia

A

Hernia through the sciatic foramen

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21
Q

Richter’s hernia

A

Incarcerated or strangulated hernia
involving only ONE SIDEWALL OF THE BOWEL which can spontaneously reduce
–> gangrenous bowel and perforation within the abdomen without signs of obstruction

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22
Q

Epigastric hernia

A

Hernia through the LINEA ALBA ABOVE the UMBILICUS

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23
Q

Intraparietal hernia

A

Hernia through the umbilical ring, in adults associated with ascites, pregnancy, and obesity

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24
Q

Femoral hernia

A

Hernia MEDIAL TO FEMORAL VESSELS (under inguinal ligament)

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25
Q

Hesselbach’s hernia

A

Hernia UNDER INGUINAL LIGAMENT LATERAL to femoral vessels

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26
Q

Bochdalek’s hernia

A

Hernia through the posterior DIAPHRAGM

usually on the LEFT

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27
Q

Morgagni’s hernia

A

ANTERIOR PARASTERNAL DIAPHRAGMATIC

hernia

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28
Q

Properitoneal hernia

A

Intraparietal hernia between the peritoneum and transversalis fascia

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29
Q

Cooper’s hernia

A

Hernia through the FEMORAL CANAL

and tracking into the scrotum or labia majus

30
Q

Indirect hernia

A

Inguinal hernia LATERAL l to Hesselbach’s triangle

31
Q

Direct hernia

A

Inguinal hernia WITHIN Hesselbach’s triangle

32
Q

Hiatal hernia

A

Hernia through ESOPHAGEAL HIATUS

33
Q

Amyand’s hernia

A

Hernia sac containing a RUPTURED APPENDIX

34
Q

Boundaries of Hesselbach Triangle

A

Inferior epigastric vessels

Inguinal ligament (Poupart’s)

Lateral border of the rectus sheath

Floor consists of internal oblique and the
transversus abdominis muscle

35
Q

Ilioinguinal nerve

A

Nerve that runs with the

spermatic cord in the inguinal canal

36
Q

Bassini

A

SUTURES approximate reflection of INGUINAL ligament (Poupart’s) to the transversus abdominis aponeurosis/ conjoint tendon

37
Q

McVay

A

COOPER’s ligament sutured to transversus

abdominis aponeurosis/conjoint tendon

38
Q

Lichtenstein

A

“Tension-free repair” using mesh

39
Q

Shouldice

A

Imbrication of the floor of the inguinal canal (a.k.a. “Canadian repair”)

40
Q

Plug and Patch

A

Placing a plug of mesh in hernia defect and then overlaying a patch of mesh over inguinal floor (requires few if any sutures in mesh!)

41
Q

TAPP procedure

A

TransAbdominal PrePeritoneal inguinal

hernia repair

42
Q

TEPA procedure

A

Totally ExtraPeritoneal Approach

43
Q

Superficial epigastric vein

A

name of the subcutaneous vein that is ligated

44
Q

ilioinguinal nerve is cut

A

Numbness of inner thigh or lateral scrotum; usually goes away in 6 months

45
Q

Cremaster muscle is derived from

A

Internal Oblique Muscle

46
Q

abdominal muscle layer from which inguinal ligament (a.k.a. Poupart’s ligament) is derived

A

External oblique muscle aponeurosis

47
Q

Attachment of inguinal (Poupart’s) ligament

A

ASIS to the pubic tuburcle

48
Q

Nerve that travels on the spermatic cord

A

Ilioinguinal nerve

49
Q

Spermatic Cord Contents

A

3 fasciae - external, cremasteric, internal spermatic fascia

3 arteries - testicular, cremasteric, artery of vas deferens

3 veins - pampiniform plexus or tesiticular veins, cremasteric vein, deferential vein

50
Q

Attaches the testicle to

the scrotum

A

Gubernaculum

51
Q

MC organ in an inguinal hernia sac in men

A

small intestine

52
Q

MC organ in an inguinal hernia sac in women

A

ovary/fallopian tube

53
Q

Lies in the inguinal

canal in the female instead of the VAS

A

round ligament

54
Q

Preperitoneal fat on the cord structures (pushed in by the hernia sac); not a real lipoma; remove surgically, if feasible

A

cord lipoma

55
Q

nerve is found on top of the spermatic cord

A

ilioinguinal nerve

56
Q

nerve travels within the spermatic cord

A

Genital branch of the genitofemoral nerve

57
Q

Aponeurotic attachments of the “conjoining” of the internal oblique and
transversus abdominis to the pubic tubercle

A

Conjoint tendon

58
Q

Femoral hernia

A

Hernia traveling beneath the inguinal
ligament down the femoral canal medial
to the femoral vessels

59
Q

Repair of a femoral hernia

A

McVay (Cooper’s ligament repair), mesh plug repair

60
Q

How can an incarcerated hernia be reduced in the ER

A
  1. Apply ice to incarcerated hernia
  2. Sedate
  3. Use the Trendelenburg position for inguinal hernias
  4. Apply steady gentle manual pressure
  5. Admit and observe for signs of necrotic bowel after reduction
  6. Perform surgical herniorrhaphy
    ASAP
61
Q

Howship-Romberg sign

A

Pain along the MEDIAL aspect of the PROXIMAL THIGH from nerve compression caused by an OBTURATOR HERNIA

62
Q

Silk glove sign

A

Inguinal hernia sac in an infant/toddler feels like a finger of a silk glove when rolled under the examining finger

63
Q

Sliding Esophageal Hiatal Hernia (Type I)

A

Both the stomach and GE junction herniate into the thorax via the esophageal hiatus

64
Q

Diagnosis of Hiatal Hernia

A

UGI series, manometry,

esophagogastroduodenoscopy (EGD) with biopsy for esophagitis

65
Q

Complications of Hiatal Hernia

A

Reflux –> esophagitis –> Barrett’s esophagus
S cancer and stricture formation

aspiration pneumonia

can also result in UGI bleeding from esophageal ulcerations

66
Q

Treatment of Hiatal Hernia

A

85% of cases treated medically with
antacids, H2 blockers/PPIs, head elevation after meals, small meals, and no
food prior to sleeping

15% of cases require surgery for persistent symptoms
despite adequate medical treatment

67
Q

Surgical Treatment of Hiatal Hernia

A

Laparoscopic Nissen fundoplication (LAP NISSEN) involves wrapping the fundus around the LES and suturing it in place

68
Q

Paraesophageal Hiatal Hernia (Type II)

A

Herniation of all or part of the stomach through the esophageal hiatus into the thorax without displacement of the GEJ

69
Q

Symptoms of Paraesophageal Hiatal Hernia (Type II)

A

dysphagia, stasis gastric ulcer, and strangulation

many cases are asymptomatic and not associated with reflux because of a relatively normal position of the GE junction

70
Q

Complications of Paraesophageal Hiatal Hernia (Type II)

A

Hemorrhage, incarceration, obstruction, and strangulation

71
Q

Type III Hiatal hernia

A

Combined type I and type II

72
Q

Type IV Hiatal hernia

A

Organ (e.g., colon or spleen) +/- stomach in the chest cavity

SURGERY (27 decks)

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