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Surgery > Hernias > Flashcards

Hernias Flashcards

1
Q

Superficial and fatty fascial layer

A

Camper’s

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2
Q

Deep and membranous fascial layer

A

Scarpa’s

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3
Q

Superior to the arcuate line of Douglas, the anterior sheath is composed of the

A

EO and IO aponeuroses

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4
Q

Superior to the arcuate line of Douglas, the posterior sheath is composed of the

A

IO aponeurosis and transversalis fascia

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5
Q

Inferior to the arcuate line, the posterior sheath is composed only of

A

transversalis fascia

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6
Q

Deep inguinal ring arises from

A

Transversalis fascia

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7
Q

Superficial inguinal ring arises from

A

External oblique aponeurosis

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8
Q

Arises from thickened portion of EO and connects the anterior superior iliac spine to the pubic tubercle.

A

Inguinal (Poupart’s) ligament

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9
Q

Medial, fan-shaped aspect of inguinal ligament that joins inguinal ligament at the pubic tubercle to the pectineal line of pubis.

A

Lacunar (Gimbernat’s) ligament

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10
Q

Arises from the inferior aspect of transversalis fascia, parallel and deep to the inguinal ligament.

A

Iliopubic tract

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11
Q

Arises from a thickening of the fascia at the pectineal line and appears to extend from the lacunar ligament.

A

Cooper’s (pectineal) ligament

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12
Q

Arises from IO and transversus abdominus aponeuroses.

A

Conjoint tendon (falx inguinalis)

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13
Q

Preperitoneal space behind pubic symphysis. Site of laparoscopic hernia repairs.

A

Space of Retzius

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14
Q

Bordered by the inguinal ligament inferiorly, lateral border of the rectus sheath medially, and the inferior epigastric vessels superiolaterally.

A

Hesselbach’s triangle

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15
Q

Femoral hernias occur at what aspect of femoral canal

A

Medial

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16
Q

Inguinal hernias are more common on what side

A

Right

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17
Q

Location of indirect hernial sac relative to the cord

A

Anteromedial

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18
Q

Weakness in what fascia results to direct inguinal hernia

A

Transversalis fascia

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19
Q

Boundaries of the inguinal canal

A

Anterior: EO
Posterior: Transversalis fascia
Roof: IO, transversus abdominus
Floor: Inguinal ligament

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20
Q

Direct vs indirect hernia: reduce with supine position

A

Direct

21
Q

High ligation with repair of inguinal floor. Involves approximation of transversalis fascia, conjoint tendon, and shelving edge of inguinal ligament.

A

Bassini

Avoid sutures in the pubic tubercle to minimize incidence of osteitis pubis.

22
Q

Primary repair utilizing continuous running sutures in multiple layers.

A

Shouldice

23
Q

Closure involves Cooper’s ligament. Used for both inguinal and femoral hernia repairs.

A

McVay

24
Q

Tension-free repair that is used for direct and indirect hernias.

A

Lichtenstein

Avoid a mesh repair if infection is present.

25
Q

“Plug and Patch” hernia repair

A

Stoppa repair

26
Q

In hernia repair, staples must be avoided in this area lateral to femoral vessels and below iliopubic tract

A

trapezoid of doom

27
Q

Structures in the trapezoid of doom

A

Lateral cutaneous, femoral branch of genitofemoral, and femoral nerves

28
Q

Most common early complication of hernial repair

A

Urinary retention

29
Q

Loss of cremasteric reflex and sensation to ipsilateral penis, scrotum, and medial thigh is an injury to

A

Ilioinguinal injury

30
Q

Loss of sensation to the lower abdominal wall and inguinal region is an injury to

A

Iliohypogastric injury

31
Q

Loss of sensation to the upper lateral thigh or loss of scrotal sensation and cremasteric motor function is injury to

A

Genitofemoral injury

32
Q

Inguinal vs femoral hernia: greater incidence of incarceration and strangulation due to narrow neck.

A

Femoral

33
Q

Repair for femoral hernia

A

McVay

34
Q

The most commonly injured nerve during hernia repair.

A

ilioinguinal nerve

Superior to the cord

35
Q

Umbilical hernia arises from facial defect in

A

Linea alba

36
Q

Repair of small, childhood umbilical hernias (

A

4

37
Q

Hernia through the linea semilunaris, particularly where the line of Douglas intersects the linea semilunaris.

A

Spigelian

38
Q

Hernia through the inferior lumbar triangle (boundaries: posterior edge of the EO, latissimus dorsi, and iliac crest).

A

Petit’s

39
Q

Hernia through the superior lumbar triangle (boundaries: 12th rib, serratus, IO, quadratus lumborum, and erector spinae).

A

Grynfeltt’s

40
Q

Midline hernia through muscular aponeuroses that form the linea alba, in an area extending from xiphoid to umbilicus.

A

Epigastric

41
Q

Hernia through the obturator foramen in pelvis; lie anteromedial to obturator nerve and vessels; most common in elderly women.

A

Obturator

Howship-Romberg sign

42
Q

Hernia involving one wall of bowel. Can cause ischemia and strangulation, leading to perforation without associated obstruction.

A

Richter’s

43
Q

Hernia involving a Meckel’s diverticulum.

A

Littre’s

44
Q

Combination of indirect and direct inguinal hernias that straddle the inferior epigastric vessels.

A

Pantaloon

45
Q

Sliding indirect hernia involves what organs?

A

Ovary, fallopian tube, cecum, sigmoid colon, bladder

46
Q

During a McVay repair, bleeding is encountered. What is a possible source?

A

Aberrant obturator artery

47
Q

An 80 year old has a medial thigh pain with leg abduction, internal rotation, or extension. Diagnosis?

A

Obturator hernia

Operative procedure

48
Q

A 45 year old man has a dull groin ache and painful ejaculation after an inguinal hernia repair. What therapy will cure his symptoms?

A

Vasectomy

Dysejaculation syndrome (partial obstruction of the vas deferens

Surgery (10 decks)

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