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Gastrointestinal > Hernias > Flashcards

Hernias Flashcards

1
Q

Is omentum/fat in a hernia concerning?

A

No, but can be painful

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2
Q

Is an organ stuck in a hernia concerning?

A

Yes

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3
Q

What is the most common type of hernias? What is the men:women ratio?

A

Inguinal hernias

90% men, 10% women

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4
Q

What are the abdominal wall layers in the inguinal canal? (4)

A

Peritoneum + fat
Transversalis fascia
Transversus abdominis
Internal/external oblique

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5
Q

Which muscle is not found in the inguinal canal?

A

transversus abdominus

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6
Q

What are the vessels within the inguinal canal? (3)

A

Testicular artery
Cremasteric artery
Artery to the vas deferens

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7
Q

What are the nerves that run within the inguinal canal? Alongside it?

A

Genital branch of the genitofemoral nerve

Ilioinguinal nerve runs alongside

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8
Q

What are the 3 fascial layers that run through the inguinal canal?

A

External spermatic
Cremasteric
Internal spermatic

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9
Q

What are direct inguinal hernias?

A

Passing through Hesselbach’s triangle

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10
Q

What are the sides of Hesselbach’s triangle?

A

Rectus abdominus
Inguinal ligament
Inferior epigastric artery

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11
Q

What are femoral hernias?

A

Pass through the femoral space, with the inguinal ligament above, cooper’s ligament below

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12
Q

Where are the femoral vessels relative to a femoral hernia?

A

Laterally (VAN)

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13
Q

What is the ligament below femoral hernias? Above?

A 
Below = Cooper's
Above = inguinal
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14
Q

What is the Bassini repair?

A

Single layer reconstruction of the inguinal floor

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15
Q

What is the Shouldice repair?

A

Four-layer reconstruction of the inguinal floor

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16
Q

What is the McVay repair? What is significant about this method of repair?

A

Inguinal floor brought to cooper’s ligament

Closes the femoral space

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17
Q

True or false: all tissue repairs are without prosthetic reinforcement

A

True

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18
Q

Why would you perform a tissue repair, without mesh?

A

Infection risk

Cheaper if without

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19
Q

What is a Lichtenstein Mesh repair?

A

Mesh reconstruction of the inguinal floor

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20
Q

What is the standard for hernia repair?

A

Lichtenstein mesh repair

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21
Q

Mesh reconstruction of the inguinal floor = ?

A

Lichtenstein Mesh repair

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22
Q

What is a pre-peritoneal mesh repair?

A

Placing mesh beneath the fascia to allow for pressure of abdominal contents to better hold the mesh

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23
Q

What are the benefits of a pre-peritoneal mesh repair?

A

Mechanically more sound

Eliminates the need to reconstruct the internal ring

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24
Q

What is a transabdominal preperitoneal laparoscopic inguinal hernia repair (TAP)?

A

Lap + incision into peritoneum + placement of mesh

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25
Q

What is a total extraperitoneal preperitoneal lap inguinal hernia repair? (TEP)

A

Entry into rectus sheath, and dissection of preperitoneal space (no entry into the peritoneum)

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26
Q

What are the three indications for laparoscopic repair?

A
  • Bilateral inguinal hernias

- Comorbid umbilical hernias

27
Q

What are the indications for watchful waiting of inguinal hernias?

A

If pt has CV or pulmonary comorbidities, or lifts a lot for work

28
Q

When is open tissue repair indicated?

A

If infected field

29
Q

Where is the transversus abdominis muscle?

A

Deep to the internal oblique

30
Q

What happens to the posterior rectus abdominis sheath as you go inferiorly?

A

Disappears

31
Q

What are the four types of abdominal wall hernias?

A

Umbilical
Incisional
Epigastric
Spigelian

32
Q

Where do umbilical hernias occur?

A

Umbilical stalk

33
Q

What is the prognosis for congenital umbilical hernias in infants? Acquire in Adults?

A 
Children = will regress
Adults = progress and enlarge
34
Q

What are incisional hernias?

A

Failure of fascial healing

35
Q

What are the risk factors for incisional hernias?

A

Lifting and straining (6 weeks (2 weeks is weakest time)

36
Q

Why are epigastric hernias repaired much more often than other types?

A

These are usually painful

37
Q

Why do you need to mark epigastric hernias when pts are awake?

A

Pt will be too relaxed and it will be hard to find

38
Q

What are Spigelian hernias?

A

Hernias at vascular perforation of the inferior semilunar line

39
Q

What is the semilunar zone?

A

Area where there is no longer fascia behind the rectus abdominus

40
Q

What is a primary repair of an abdominal wall hernia? When are these appropriate (2)?

A

Suture repair of defect.

Good for small hernias and/or contaminated fields

41
Q

What is the problem with primary hernia repairs?

A

high recurrence rate

42
Q

When are mesh reinforced repair contraindicated?

A

Contaminated fields

43
Q

What part of the body do you want to scar over the mesh?

A

Abdominal fascia

44
Q

What is an inlay mesh?

A

Between borders of herniation

45
Q

What is an overlay mesh?

A

Lay over the hernia

46
Q

What is an underlay mesh?

A

Intraperitoneal–behind the hernia

47
Q

What is a retrorectus mesh lay?

A

Between rectus abdominus and its sheath

48
Q

What is the gold standard for mesh laying?

A

Retrorectus lay

49
Q

What are the three characteristics of an ideal hernia repair?

A
  1. Prevent recurrence
  2. Resist infection
  3. Resist intra-peritoneal adhesion
50
Q

What is Diastasis recti? Treatment?

A

Attenuation and widening of the linea alba

Reassure and strengthen

51
Q

What is the appropriate way to reduce the hernia?

A

Push from sides–not on top

52
Q

True or false: incarcerated hernias are not necessarily a surgical emergency

A

True, but should be fixed

53
Q

What are strangulated hernias?

A

Hernias with compromised blood flow

54
Q

What are incarcerated hernias?

A

Hernias that cannot be reduced

55
Q

What are the ssx of strangulated hernias?

A

Redness, warmth, TTP

56
Q

True or false: hernias rarely occur through mesh

A

True

57
Q

When should a BMP be ordered with a hernia? CBC? CT?

A 
BMP = If suspect obstruction
CBC = infx
CT = large or recurrent defects
58
Q

What makes up the superior wall of the inguinal canal?

A

2M
Internal oblique
Transverse abdominus muscle

59
Q

What makes up the anterior wall of the inguinal canal?

A

2A

Aponeurosis of external oblique and internal oblique

60
Q

What makes up the floor of the inguinal canal?

A

2L
Inguinal ligament
Lacunar ligament

61
Q

What makes up the posterior wall of the inguinal canal?

A

2Ts
Transversalis fascia
Conjoint Tendon

62
Q

What is the transverse line that separates where there is and is not a sheath behind the rectus abdominus?

A

Arcuate line

63
Q

What are the layers of the spermatic cord fascia? List them in order of deep to superficial. (3)

A

Internal spermatic fascia
Cremasteric fascia
External spermatic fascia

64
Q

From what structures are the:

  • Internal spermatic fascia
  • Cremasteric fascia
  • External spermatic fascia

derived from?

A

Internal spermatic fascia-Transversalis fascia
Cremasteric fascia - Internal oblique
External spermatic fascia - External oblique

Gastrointestinal (42 decks)

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