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surgery oral stuff > Hernias > Flashcards

Hernias Flashcards

1
Q

indirect inguinal hernia

A
  • hernia through the internal ring of the inguinal canal

- travels down the external ring

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2
Q

which nerve travels on the spermatic cord?

A

ilioinguinal nerve

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3
Q

what happens if you cut the ilioinguinal nerve?

A

numbness of inner thigh or lateral scrotum

goes away w/in 6 mo (typically)

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4
Q

what is the conjoint tendon made of?

A

aponeurosis of the transversus abdominus + internal oblique

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5
Q

what is the floor of the inguinal canal?

A

inguinal ligament / poupart’s

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6
Q

what are the 3 nerves of the groin?

A

iliohypogastric
genital branch of the genitofemoral nerve
ilioinguinal nerve

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7
Q

what is the roof of the inguinal canal?

A

conjoint tendon

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8
Q

where do you find the ilioinguinal nerve?

A

between the internal/external oblique

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9
Q

What is the surface marking of the deep inguinal ring?

A

midpoint of the inguinal ligament - between the ASIS / pubic tubercle

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10
Q

What is the surface marking of the deep inguinal ring? midpoint of the inguinal ligament

A

between the ASIS / pubic tubercle

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11
Q

what is the anterior wall of the inguinal canal?

A

external oblique aponeurosis

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12
Q

what is the posterior wall of the inguinal canal?

A

transversalis fascia

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13
Q

what is the length of the inguinal canal?

A

pubic tubercle to ASIS

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14
Q

what is in the spermatic cord (6)?

A

1) cremasteric muscle fibers
2) vas deferens
3) testicular artery
4) testicular pampiniform venous plexus
5) genital branch of the genitofemoral nerve
6) +/- hernia sac

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15
Q

what is the hernia sac made of?

A

peritoneum (direct)

patent processus vaginalis (indirect)

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16
Q

what is ddx of inguinal hernia?

A 
lymphadenopathy
psoas abscess
ectopic testis
hydrocele of the cord
saphenous varix
lipoma
varicocele
testicular torsion
femoral artery aneurysm
abscess
17
Q

what is the difference b/w herniorrhaphy vs. herniotomy vs. hernioplasty?

A

Herniotomy: removal of sac only

herniorrhaphy: removal of sac plus repair of posterior wall of inguinal canal
hernioplasty: removal of sac + reinforcement of posterior wall of inguinal canal with mesh

18
Q

what are the borders of the hesselbach’s triangle?

A 
epigastric vessels (superior-lateral)
inguinal ligament (inferior)
lateral border of the rectus (medial)
19
Q

what nerve is in found on top of the spermatic cord?

A

ilioinguinal nerve

20
Q

what attaches the testicle to the scrotum?

A

gubernaculum

21
Q

what is the most common organ in an inguinal hernia sac in men vs. women?

A 
men = small intestine
women = ovary/fallopian tube
22
Q

from what abdominal muscle layer is the cremaster muscle derived?

A

internal oblique muscle

23
Q

from what abdominal layer is the inguinal ligament

A

external oblique muscle aponeurosis

24
Q

what lies in the inguinal canal in the female instead of the VAS?

A

round ligament

25
Q

where in the inguinal canal does the hernia sac lie in relation to the other structures?

A

anteromedially

26
Q

what is a cord lipoma?

A 
preperitoneal fat on the cord structures (pushed in by the hernia sac)
not a real lipoma
remove surgically (if feasible)
27
Q

internal ring

A

transversalis fascia

28
Q

external ring

A

external oblique aponeurosis

29
Q

what percentage of the strength of the floor repair does the external oblique aponeurosis represent

A

ZERO

30
Q

what are the boundaries of the femoral canal?

A

1) cooper’s ligament posteriorly
2) inguinal ligament anteriorly
3) femoral vein laterally
4) lacunar ligament medially

31
Q

what factors are assoc. w/ femoral hernia?

A

women, pregnancy, and exertion

32
Q

what is a femoral hernia?

A

hernia traveling beneath the inguinal ligament down the femoral canal medial to the femoral vessels (FM radio)

33
Q

what is the howship-romberg sign?

A

pain along the medial aspect of the proximal thigh from nerve compression - caused by obturator hernia

34
Q

what must you do before leaving the OR after an inguinal hernia repair?

A

pull the testicle back down to the scrotum

35
Q

how can an incarcerated hernia be reduced in the ER?

A

1) apply ice
2) sedate
3) use the trendelenburg for inguinal hernias
4) apply steady gentle manual pressure
5) admit & observe for signs of necrotic bowel after reduction
6) perform surgical herniorrhaphy ASAP

36
Q

what is the floor of hasselbach’s triangle?

A

external oblique aponeurosis, internal oblique, transversus abdominis muscles

surgery oral stuff (4 decks)

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