Hernia & General Flashcards
What technique should be used for femoral hernia repair
McVay/Cooper because it closes the femoral canal defect without incorporating mesh
Management of dialysis-related peritonitis
Give empiric intraperitoneal antibiotics; if sepsis, give IV (catheter removal only indicated if no response after 5d or relapsing peritonitis)
Patient with PD catheter presenting with dialysate retention and watery diarrhea
Bowel wall erosion
Operative repair of rectus diastasis
Plicate the broad midline aponeurosis
Absolute contraindications to laparoscopic hernia repair
Active infection, strangulated hernia, and inability to tolerate pnemoperitoneum
Most common trimester for appendicitis in pregnancy
2nd trimester
Risk of fetal loss with appendicitis in pregnancy
Non-perforated: 2%
Complicated: 6%
Most common hernia in males and females
Indirect Inguinal hernia
Richter hernia
Contains antimesenteric border of bowel (usually distal ileum)
Littre hernia
Contains meckels diverticulum
Cause of direct Inguinal hernia
Weakness in floor of Inguinal canal (transversalis fascia)
Most commonly injured nerves in laparoscopic Inguinal hernia repair
Genitofemoral and lateral femoral cutaneous
Borders of triangle of doom
Vas deferens, spermatic vessels
Borders of hernia triangle of pain
Spermatic vessels, iliopubic tract, and peritoneal fold
Symptoms and physical exam in obturator hernia
Pain from Inguinal crease to anterimedial aspect of thigh, exacerbated by medial rotation of thigh
Loss of adductor reflex, positive patellar reflex
Region for spigelian hernia
At the level of the arcuate line, between semilunar line and lateral border of rectus abdominis
Grynfeltt hernia
Superior lumbar hernia: between latissmus Dorsi, serratus posterior, and posterior border of internal oblique
Hernia of petit
Inferior lumbar hernia: latismuss dorsi, iliac crest, and posterior border of external oblique
Management of parastomal hernia
Transabdominal repair with mesh underlay (primary repair has high recurrence rates)
Most common etiology of a mesenteric cystic mass
Cystic lymphangioma
Management of Chylothorax
If low output (<1L/d) conservative management
If >1L/d or refractory: thoracic duct ligation or embolization
Most common cause of chylous ascites in West
Lymphoma (TB in developing countries)
SAAG for portal hypertension
> 1.1
(Serum albumin-ascites albumin)
Desmoid tumor genetic syndromes
FAP and Gardner syndrome
Management of desmoid tumor
If >7cm and symptomatic: wide local excision with frozen section
Effect of pneumoperitoneum on urine output
Decreased due to decreased renal perfusion and increase in ADH
Effect of pneumoperitoneum on brain
Increased cerebral blood flow and MAP
Effect of pneumoperitoneum on lungs
Decreased pulmonary compliance
How to assess celiac lymph node basin intraop
Place US probe on left lobe of liver or on hepatoduodenal ligament
Types of rectus sheath hematomas
1: small, does not cross midline or dissect fascia planes
2: confined to rectus but crosses midline/fascial planes
3: below actuate line, large, blood in prevesical space
