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Surgery > Hernias > Flashcards

Hernias Flashcards

1
Q

Where is a femoral hernia

A

Medial to femoral vessels, under the inguinal ligament

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2
Q

What does TEPA procedure stand for

A

Totally ExtraPeritoneal Approach

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3
Q

To what does the inguinal ligament attach?

A

ASIS to the pubic tubercle

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4
Q

What are the borders of hesselbach’s triangle

A

Epigastric vessels

Inguinal ligament

Lateral border of the rectus

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5
Q

What is the most common organ in an inguinal hernia sac in women

A

Ovary/fallopian tube

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6
Q

Risk of strangulation in groin hernias from most likely to least

A

Femoral

Indirect

Direct

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7
Q

Medial border of femoral canal

A

Lacunar ligament

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8
Q

What lies in the inguinal canal in females instead of the VAS?

A

Round ligament

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9
Q

What does TAPP procedure stand for

A

TransAbdominal PrePeritoneal inguinal hernia repair

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10
Q

What is the difference between complete and incomplete hernia

A

Incompete = defect present without sac or contents protruding completely through it

Complete = hernia sac and its contents protrude all the way through the defect

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11
Q

A hernia is a protrusion of a _______ through a ______

A

Peritoneal sac

Musculoaponuerotic barrier

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12
Q

What is an umbilical hernia

A

Hernia through the umbilical RING

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13
Q

What is an umbilical hernia associated with in adults

A

Ascites, pregnancy, and obesity

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14
Q

Which is more dangerous: a small or large hernia defect

A

Small

Tight defect = more likely to strangulate if incarcerated

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15
Q

Most common hernia in women

A

Indirect

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16
Q

What is the repair of a femoral hernia?

A

McVay, mesh plug repair

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17
Q

Risk factors associated with femoral hernia

A

Women

Preggos

Exertion

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18
Q

Where is a hiatal hernia

A

Hernia through esophageal hiatus

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19
Q

What is in the spermatic cord

A
  1. Cremasteric muscle fibers
  2. Vas deferens
  3. Testicular artery
  4. Testicular pampiniform venous plexus
  5. +/- hernia sac
  6. Genital branch of the genitofemoral nerve
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20
Q

Name the layers of the abdominal wall from superficial to deep

A

Skin ➡️ subcuntaneous fat ➡️ Scarpa’s fascia ➡️ External oblique ➡️ Internal oblique ➡️ Transversus abdominus ➡️ Transversalis fascia ➡️ Preperitoneal fat ➡️ Peritoneum

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21
Q

What is a ventral hernia

A

Primary hernias with no associated prior incision and are located anywhere along the midline above or below the umbilicus

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22
Q

What is a Richter’s hernia?

A

Incarcerated or strangulated hernia involving only one sidewall of the bowel, which can spontaneously reduce, resulting in gangrenous bowel and perforation within the abdomen without signs of obstruction

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23
Q

What is the most common cause of incisional hernia

A

Wound infection

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24
Q

What is Peterson’s hernia

A

Seen after bariatric gastric bypass-internal herniation of small bowel through the mesenteric defect from the Roux limb

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25
Q

What is a “cord lipoma”

A

Preperitoneal fat on the cord structures (pushed in by the hernia sac); not a real lipoma

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26
Q

What is an obturator hernia

A

Hernia through obturator canal

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27
Q

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

A

Anteromedially

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28
Q

What nerve runs with the spermatic cord in the inguinal canal?

A

Ilioinguinal nerve

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29
Q

What is a conjoint tendon?

A

Aponeurotic attachments of the “conjoining” of the internal oblique and transversus abdominis to the pubic tubercle

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30
Q

What is a pantaloon hernia

A

Hernia sac exists as both a direct and indirect hernia straddling the inferior epigastric vessels and prodtruding through the floor of the canal as well as the internal ring

(Two sacs separated by the inferior epigastric artery)

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31
Q

What is the first identifiable subcutaneous named layer?

A

Scarpa’s fascia

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32
Q

Describe McVay procedure

A

Cooper’s ligament sutured to transversus abdominis aponeurosis

33
Q

Posterior border of femoral canal

A

Cooper’s ligament

34
Q

What is a small outpouching of testicular tissue off the testicle?

A

Testicular appendage

35
Q

How tight should the nre internal inguinal ring be?

A

Should allow entrance of the tip of a kelly clamp but not a finger

36
Q

What are the indications for laparoscopic inguinal hernia repair

A
  1. Bilateral inguinal hernias
  2. Recurring hernia
  3. Need to resume full activity as soon as possible
37
Q

Why do we repair hernias

A

To avoid complications of incarceration/strangulation, bowel necrosis, SBO, pain

38
Q

What is an internal hernia

A

Hernia in or involving intra-abdominal structure

39
Q

From what abdominal muscle layer is the inguinal ligament derived?

A

External oblique muscle aponeurosis

40
Q

What is a “relaxing incision”

A

Incisions in the rectus sheath to relax the conjoint tendon so that it can be approximated to the reflection of the inguinal liagment without tension

41
Q

Symptoms that the hernia is strangulated

A 
Intractable nausea/vomiting
Severe pain
Tachycardia
Fever
Focal peritonitis
Leukocytosis
Acidosis
Obstruction on imaging
42
Q

What nerve travels within the spermatic cord

A

Genital branch of the genitofemoral nerve

43
Q

What is the differential diagnosis of an inguinal hernia?

A

Lymphadenopathy

Psoas abscess

Ectopic testis

Hydrocele of the cord

Saphenous varix

Lipoma

Baricocele

Testicular torsion

Femoral artery aneurysm

Abscess

44
Q

How often do femoral hernias incarcerate?

A

1/3

45
Q

What is Littre’s hernia

A

Hernia involving a Meckel’s diverticulum

46
Q

What is a sliding hernia

A

Hernia sac partially formed by the wall of a viscus (bladder, cecum)

47
Q

Describe the Lichtenstein procedure

A

“Tension-free repair” using mesh

48
Q

Lateral border of femoral canal

A

Femoral vein

49
Q

Most common hernia in men

A

Indirect inguinal

50
Q

What is an epigastric hernia (location specifically)

A

Hernia through the linea alba above the umbilicus

51
Q

Why do some surgeons deliverately cut the ilioinguinal nerve?

A

To remove the risk of entrapment and postoperative pain

52
Q

What are the boundaries of Hasselbach’s triangle

A

Inferior epigastric vessels

Inguinal ligament (Poupart’s)

Lateral border of the rectus sheath

Floor consists of internal oblique and the transversus abdominis muscle

53
Q

What attaches the testicle to the scrotum

A

Gubernaculum

54
Q

What happens if you cut the ilioinguinal nerve

A

Numbness of inner thigh or lateral scrotum, usually goes away in 6 months

55
Q

What percentage of patients with a femoral hernia are female?

A

85%

56
Q

Which nerve travels on the spermatic cord

A

Ilioinguinal nerve

57
Q

Non-reducible hernia =

A

Incarcerated

58
Q

What action should be taken if a suture is placed through the femoral artery or vein during an inguinal herniorrhaphy?

A

Remove the suture ASAP and apply pressure

59
Q

What is a femoral hernia

A

Hernia traveling beneath the inguinal ligament down the femoral canal medial to the femoral vessels

60
Q

What is the name of the surgery for hernia repair

A

Herniorrhaphy

61
Q

Incarcerated hernia with resulting ischemia =

A

Strangulated

62
Q

Describe High ligation

A

Ligation and transection of indirect hernia sacwithout repair of inguinal floor (used only in children)

63
Q

Describe the Bassini procedure

A

Sutures approximate reflection of inguinal ligament to the transversus abdominis aponeurosis

64
Q

Where is a direct hernia

A

Inguinal hernia within Hasselbach’s triangle

65
Q

What is the hernia sac made of

A

Peritoneum (direct)

Patent processus vaginalis (indirect)

66
Q

What is the name of the subcutaneous vein that is ligated?

A

Superficial epigastric vein

67
Q

What is a spigelian hernia

A

Hernia through the linea semilunaris

Also known as spontaneous lateral ventral hernia

68
Q

Describe “plug and patch” procedure

A

Placing a plug of mesh in hernia defect and then overlaying a patch of mesh over inguinal floor

69
Q

Anterior border of femoral canal

A

Inguinal liagment

70
Q

What is the nerve found on top of the spermatic cord

A

Ilioinguinal nerve

71
Q

What is a hernia adjacent to an -ostomy called?

A

Parastromal hernia

72
Q

What are the boundaries of the femoral canal?

A
  1. Cooper’s ligament - posterior
  2. Inguinal ligament - anterior
  3. Femoral vein - lateral
  4. Lacunar ligament - medial
73
Q

What is a ventral hernia

A

Incisional hernia in the ventral abdominal wall

74
Q

Where is an indirect hernia

A

Inguinal hernia lateral to hasselbach’s triangle

75
Q

From what abdominal muscle layer is the cremaster muscle derived?

A

Internal oblique muscle

76
Q

Precipitating factors for hernia

A

Increased intra-abdominal pressure:

Straining at defecation/urination, obesity, pregnancy, ascites, valsavagenic COPD, abnormal congenital anatomic route

77
Q

What is reducing a hernia “en masse”

A

Reducing the hernia contents and hernia sac

78
Q

What is the most common organ in an inguinal hernia sac in men

A

Small intenstin

Surgery (5 decks)

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