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BTK Book Review > Hernias > Flashcards

Hernias Flashcards

1
Q

What is the most common cause of recurrent hernia?

A

wound infection

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2
Q

What are the two most common causes of SBO?

A

adhesive disease followed by hernias

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3
Q

Why is the arcuate line anatomically important?

A

because it is the line below which the posterior rectus sheath disappears

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4
Q

What are the layers of the abdominal wall just off midline?

A
  • skin
  • subcutaneous fat
  • Scarpa’s fascia
  • anterior rectus sheath
  • rectus muscle
  • posterior rectus sheath
  • preperitoneal fat
  • peritoneum
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5
Q

What are the layers of the abdominal wall lateral to the rectus?

A
  • skin
  • subcutaneous fat
  • Scarpa’s fascia
  • external oblique
  • internal oblique
  • transversus abdominis
  • transversals fascia
  • preperitoneal fat
  • peritoneum
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6
Q

Where is the arcuate line?

A

a third of the distance down from the umbilicus to the pubis symphysis

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7
Q

What is the blood supply to the rectus?

A

inferior and superior epigastrics

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8
Q

What is hesselbach’s triangle?

A
  • it is the pace through which a direct hernia protrudes

- medial border is the rectus, inferior border is the inguinal ligament, and lateral border is the epigastrics

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9
Q

What is the inguinal ligament composed of?

A

it is an extension of the external oblique fascia

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10
Q

The median and medial umbilical ligaments are remnants of what embryonic structures?

A
  • median: urachus

- medial: umbilical arteries

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11
Q

What embryonic structure gives rise to a Meckel’s diverticulum?

A

the vitelline duct

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12
Q

What embryonic structure gives rise to the round ligament of the liver?

A

the obliterated umbilical vein

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13
Q

What structures do the umbilical vein and umbilical arteries give rise to?

A
  • the vein becomes the round ligament of the liver

- the arteries become the medial umbilical ligaments

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14
Q

When does the midgut herniate during embryonic development? When does it return to the abdominal cavity?

A
  • herniates around week 6

- returns around week 10

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15
Q

Where does an omphalocele herniate through? What about a gastroschisis?

A
  • omphaloceles come through the umbilical stalk

- gastroschisis comes inferior and to the right of the umbilicus

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16
Q

What is the most common contents of an umbilical hernia?

A

preperitoneal fat

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17
Q

Which umbilical hernias can be primarily repaired?

A

those that are less than 1 cm or that are in pediatric patients

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18
Q

At what age are pediatric umbilical hernias repaired?

A

at age five because they are likely to close spontaneously before that

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19
Q

What differentiates an indirect from direct hernia anatomically?

A

indirect arise lateral to the inferior epigastrics while direct are medial to these

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20
Q

What is the etiology of an indirect inguinal hernia?

A

a patent processus vaginalis

21
Q

What are risk factors for a direct inguinal hernia?

A
  • obesity
  • smoking
  • poor nutrition
  • ascites
  • anything that increases intra-abdominal pressure
22
Q

What are the contents of the spermatic cord?

A
  • cremasteric muscles
  • testicular artery and pampiniform plexus
  • vas deferens
  • ilioinguinal nerve
  • genital branch of the genitofemoral nerve
23
Q

What forms the cremaster muscles?

A

an extension of the internal oblique muscle fibers

24
Q

What is the most common nerve injured during open inguinal hernia repair?

A

the ilioinguinal which usually occurs when opening the external oblique

25
Q

What are the three key nerves to identify during an inguinal hernia repair?

A
  • ilioinguinal
  • iliohypogastric
  • genital branch of the genitofemoral
26
Q

What is the most common nerve injured during laparoscopic inguinal hernia repair?

A

the lateral femoral cutaneous due to improperly placed lateral tacks

27
Q

What is a Bassini repair?

A
  • the floor of the canal is opened by cutting the transversalis fascia from the internal ring to the pubic tubercle, exposing preperitoneal fat
  • then the conjoint tendon (composed of transversus and internal oblique fascia) is sutured to the inguinal ligament
28
Q

What is a Shouldice hernia repair?

A

the same as a bassini, except that the layers are closed in two separate layers

29
Q

What is a Lichtenstein hernia repair?

A

a repair with mesh in which the inguinal ligament is sewn to the conjoined tendon

30
Q

How is a pediatric inguinal hernia repaired?

A

with high ligation of the sac

31
Q

What is the main structure for fixation of the mesh in a laparoscopic inguinal hernia repair?

A

Cooper’s ligament

32
Q

What is the triangle of doom?

A
  • it is the medial triangle with an apex at the iliopubic tract and bounded by the vas medially and the spermatic vessels laterally
  • it contains the iliac vessels and is a potential area for vascular injury
33
Q

What and where is the triangle of pain?

A
  • it is the more lateral triangle with an inferior apex
  • contains the nerve structures
  • bounded medially by the spermatic vessels and superiorly by the iliopubic tract
34
Q

Where is a femoral hernia found?

A

below the inguinal ligament and medial to the femoral vein

35
Q

How is a femoral hernia repaired?

A

a McVay repair whereby the inguinal floor is opened and the femoral space is closed by suturing the conjoint tendon to cooper’s ligament

36
Q

What are your options for repairing a strangulated hernia?

A

biologic mesh or primary repair

37
Q

Does onlay, inlay, or underlay ventral hernia repair have the highest recurrence rate?

A

inlay

38
Q

What layer of the abdominal wall is incised for each of the following:

  • anterior component separation
  • transversus abdominis repair
  • posterior component separation
A
  • anterior: incise the external oblique lateral to the rectus sheath
  • transversus abdominis repair: incise the transversus abdominis fascia lateral to the rectus sheath
  • posterior: incise the posterior rectus sheath
39
Q

What is the optimal method for closing fascia?

A

use of a smaller, absorbable suture while taking 5-7 mm bites

40
Q

What is a spigelian hernia?

A

an intramuscular hernia at the junction of the semilunaris and arcuate line

41
Q

What is an amyand hernia?

A

one in which the appendix is found in the inguinal hernia sac

42
Q

What is a Littre’s hernia?

A

one in which a meckel’s diverticulum is found in the inguinal hernia sac

43
Q

What is a pantaloon hernia?

A

an inguinal hernia with an indirect and direct component

44
Q

What is a sliding hernia?

A

one in which a retroperitoneal structure makes up a portion of the hernia sac

45
Q

What is a Richter’s hernia?

A

one in which a part of the wall of the bowel is present in the hernia sac; therefore, giving strangulation without obstruction

46
Q

What is the next step if you’re doing an inguinal hernia repair and skeletonize the cord but still can’t find the hernia?

A

must open the floor and look for a femoral hernia

47
Q

What is the next step for a cirrhotic with massive ascites and an umbilical hernia with intermittent obstructive symptoms?

A

TIPS to first control the ascites

48
Q

What should you do if you damage the femoral vein during an inguinal hernia repair?

A

pull out the suture and hold pressure

49
Q

What should you do if you are doing an inguinal hernia repair and can’t reduce the sac?

A
  • ligate the proximal portion that will reduce into the abdominal cavity
  • keep the distal portion open to reduce the chances of a hydrocele

BTK Book Review (13 decks)

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