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BTK Review 2024 > Hernias > Flashcards

Hernias Flashcards

1
Q

What is the most common cause of hernia recurrence following repair?

A

wound infection

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2
Q

Name 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
  • pre peritoneal fat
  • peritoneum
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3
Q

Where does the posterior sheath end?

A

at the arcuate line, one third of the distance below the umbilicus to the pubic symphysis

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4
Q

What is the blood supply to the rectus?

A

inferior and superior epigastrics

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5
Q

What are the boundaries of Hasselbach’s triangle? What is the significance of this space?

A

the space of a direct inguinal hernia
- medial: rectus
- lateral: inferior epigastrics
- inferior: inguinal hernia

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6
Q

A meckel’s diverticulum is derived from what embryonic structure?

A

the omphalomesenteric (or vitelline) duct

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7
Q

The urachus gives rise to what adult structure?

A

the median umbilical ligament

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8
Q

The obliterated umbilical vein and arteries give rise to what adult structures?

A
  • vein: ligamentum teres, the round ligament of the liver
  • artery: the medial umbilical ligaments
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9
Q

When does the midgut herniate from and return to the embryonic abdomen?

A
  • herniates at 6 weeks
  • returns at 10 weeks
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10
Q

What is the difference in location of the defect in a gastroschisis versus omphalocele?

A
  • gastroschisis is inferior and right of the umbilicus
  • omphalocele is at the umbilicus
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11
Q

What should generally be your go-to mesh for hernia repair?

A

a light-to-medium weight, microporous, polypropylene or polyester mesh

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12
Q

Which umbilical hernias should be repaired primarily?

A

those < 1cm and those in the pediatric population

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13
Q

When should you repair a pediatric umbilical hernia?

A

repair if persistent after 5 years of age, prior to starting school

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14
Q

How should you manage a cirrhotic with an umbilical hernia that has skin breakdown and is leaking fluid?

A
  • resuscitate and start antibiotics
  • repair urgently, avoiding mesh
  • be aggressive about post-operative control of ascites
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15
Q

What is the anatomic relationship between direct and indirect inguinal hernias?

A

direct are medial to the epigastrics

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16
Q

What are the contents of the spermatic cord?

A
  • cremasteric muscles
  • testicular artery
  • pampiniform plexus
  • vas deferens
  • ilioinguinal nerve
  • genital branch of the genitofemoral nerve
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17
Q

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

A

the ilioinguinal nerve, which usually occurs when opening the external oblique

18
Q

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

A
  • ilioinguinal (MC injured)
  • genital branch of the genitofemoral
  • iliohypogastric
19
Q

What nerve is most commonly injured during a MIS approach to inguinal hernia repair?

A

the cutaneous branch of the lateral femoral, usually due to a misplaced tack, laterally

20
Q

Describe a Bassini repair for inguinal hernia.

A

the conjoint tendon (transversalis and internal oblique) to the inguinal ligament

21
Q

Describe a Shouldice repair for inguinal hernia?

A

a bassini repair (conjoint tendon to inguinal ligament) but in four layers

22
Q

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

A

Cooper’s ligament

23
Q

What is the triangle of doom?

A
  • an area of concern in laparoscopic inguinal hernia repair where bleeding is likely if tacks/suture are placed due to the underlying iliacs
  • defined by the vas deferens medially and the spermatic vessels laterally with the apex at the inguinal ligament
24
Q

What tissue repair is appropriate for a femoral hernia?

A

McVay repair

25
Q

Describe a McVay repair.

A

the conjoint tendon is sutured to Cooper’s ligament, closing the femoral space

26
Q

How does an obturator hernia usually present?

A
  • as a bowel obstruction in a thin, elderly patient
  • will have Howship-Romberg sign on exam (groin/thigh pain with internal hip rotation)
27
Q

What are the three types of component separation?

A
  • anterior: incise the external oblique
  • posterior: incise the posterior rectus sheath
  • transversus abdominis release
28
Q

What is a spigelian hernia?

A

an intramuscular hernia which occurs at the junction of the semilunaris and arcuate lines

29
Q

How should a spigelian hernia be managed?

A

they are at high risk for incarceration and should therefore be repaired

30
Q

What do you call an inguinal hernia containing the appendix?

A

an Amyand hernia

31
Q

What do you call a hernia containing a meckel’s diverticulum?

A

a Littre’s hernia

32
Q

What is a Richter’s hernia?

A

one containing bowel wall potentially leading to strangulation without obstruction

33
Q

What is the most common type of hernia in females?

A

indirect inguinal

34
Q

Cirrhotic with massive ascites and an umbilical hernia with intermittent obstructive symptoms. What is the next step?

A

medical management with diuretics and TIPS to control ascites before attempting repair

35
Q

Laparoscopic inguinal hernia repair and you tack mesh to Cooper’s ligament but then get large arterial bleeding. What happened?

A

you put a tack in the corona mortis, branch between obturator and external iliac arteries

36
Q

When should you repair an umbilical hernia noticed during pregnancy?

A

after all planned pregnancies have been completed

37
Q

What should you do if you encounter an inguinal hernia but can’t fully reduce the sac?

A

ligate the proximal portion, reduce it into the abdominal cavity, and then keep the distal portion open to reduce the risk of hydrocele

38
Q

How can you avoid issues with an ICD while operating?

A
  • place the dispersive electrode so that the path from the energy device to the electrode avoids the ICD
  • use lower energy devices (ultrasonic or bipolar)
  • avoid draping the cord near the ICD or its pathway to the heart
39
Q

Pneumoperitoneum has what cardiac effects?

A
  • increased CVP
  • decreased venous return and cardiac output
  • increased SVR
  • increased MAP
  • increased HR
  • increased pulmonary artery pressure
  • decreased organ perfusion 2/2 splanchnic vessel compression
40
Q

Pneumoperitoneum has what pulmonary effects?

A
  • increased mean airway and peak inspiratory pressures
  • decreased functional residual capacity
  • increased EtCO2
41
Q

Pneumoperitoneum has what renal effects?

A
  • decreased renal perfusion
  • increased renin and ADH production
  • decreased UOP
42
Q

What vagal response does the body have to pneumoperitoneum?

A

bradycardia

BTK Review 2024 (19 decks)

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