HERNIA ABDOMINAL WALL SPLEEN

Question 1

A hydrocele result of

and what is presentation

Answer 1

patent processus vaginalis

and leads to an accumulation of serous fluid around the testicle.

This fluid filled structure can be differentiated from an inguinal hernia in that it is generally asymptomatic and transilluminates with a light on physical exam.

Another important distinction is that an examiner is able to get his / her fingers above a hydrocele on palpation of the scrotum and cord structures.

This is not possible with an inguinal hernia as the contents are a protrusion from the abdominal cavity.

Question 2

symptomatic, nonparasitic cysts Tx

Answer 2

small:

may be excised with splenic preservation,

large:

symptomatic nonparasitic cysts may be unroofed

Both of these operations may be performed laparoscopically.

Question 3

tumor that most commonly spreads to the spleen.

Answer 3

Lung cancer

Question 4

The most common primary tumor of the spleen is

Answer 4

sarcoma.

‘spleen is kind of stomal muscular tissue’

Question 5

A Richter’s hernia

Answer 5

involves only the antimesenteric border of the intestine and strangulation is likely to occur

WITHOUT the presence of obstruction.

Question 6

ITP autoantibodies source

Answer 6

The spleen is believed to be the source of these antibodies

Question 7

at risk for injury with manipulation below the iliopubic tract during lap hernia

Answer 7

BOTH

genitofemoral

lateral femoral cutaneous nerves

Placing staples beyond the external iliac artery in this region will most likely injure either of these structures.

This will result in sensation deficits to the upper, lateral, and anterior thigh.

Question 8

Lap that aids in the workup of hereditery spherocytosis

Answer 8

A NEGATIVE Coombs test can aid in diagnosis.

Question 9

femoral canal,

Answer 9

Femoral hernias are found here

under the inguinal ligament.

lateral aspect of the pubic tubercle. I

inguinal ligament anteriorly,

pectineal ligament posteriorly,

lacunar ligament medially,

femoral vein laterally

Question 10

ITP patient require no treatment as long as:

Answer 10

platelet counts are greater than 50,000 /mm3

asymptomati

Question 11

first line tx of ITP

Answer 11

glucocorticoids (prednisone 1 mg/kg)

If a patient fails to respond or is unable to tolerate prednison:
surgical intervention.

Question 12

ITP response rate to splenectomy

Answer 12

75% to 85% long term response rate.

Question 13

utility of platelet transfusion for ITP patient undergoing splenectomy and platelet count less than 20,000

Answer 13

Even in the face of marked thrombocytopenia, administration is indicated only for significant bleeding events

 An alternative preoperative preparation for those patients whose platelet counts are less than 20,000 /mm3 is the administration of 
IV immunoglobulin (1 g/kg for 2 days).

Transfusions that are required during splenectomy are ideally held until after arterial inflow to the spleen has been ligated

This practice prevents exposure of the administered platelets to antibody opsonization and clearance by the offending organ.

Bottom Line: Administration of platelets to patients with ITP undergoing splenectomy is indicated only for significant bleeding events.

Question 14

Umbilical hernias require intervention in children if:

Answer 14

defect is greater than 2 cm
or
symptomatic

Umbilical hernias less than 2 cm in size will often close spontaneously without intervention.

The risk of incarceration of an umbilical hernia in children is very low and treatment should be delayed until after the age of 5.

Question 15

percent kids born with Umbilical hernias and what ethnic group has highest risk

Answer 15

Higher incidence in African Americans

Occur in up to 20% of live births

Question 16

indirect inguinal hernia is primarily caused by

Answer 16

a patent processus vaginalis

defect is result of the passage of the testis from its abdominal origin into the scrotum through the muscular layers of the abdominal wall.

processus is obliterated during the first few months of life.

Persistence of any or all of the processus vaginalis results in a spectrum of disorders ranging from a scrotal hydrocele to an indirect inguinal hernia.

Question 17

can lead to a direct inguinal hernia

Answer 17

A weakness of the conjoint tendon

which forms the posterior wall of the inguinal canal

Question 18

A diastasis

Answer 18

a separation of the rectus muscles

at the linea alba

resulting in a cosmetic defect that generally does not demand surgical attention.