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General Surgery > Hernias, Abdomen, and Surgical Technology > Flashcards

Hernias, Abdomen, and Surgical Technology Flashcards

1
Q

_____ forms the inguinal ligament (shelving edge and roof) at the inferior portion of the inguinal canal

A

External abdominal oblique fascia

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2
Q

Forms cremasteric muscles

A

Internal oblique fascia

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3
Q

_______ and ______ form the inguinal canal floor

A

Transversalis muscle and conjoined tendon

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4
Q

The conjoined tendon is composed of _____ and _____.

A

Aponeurosis of the internal abdominal oblique and transversalis fascia

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5
Q

The inguinal ligament runs from the _____ to the _____. It is _______ to the femoral vessels

A
  • Anterior superior iliac spine to the pubis
  • Anterior

Inguinal ligament = Poupart’s ligament

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6
Q

What is the lacunar ligament?

A

Where the inguinal ligament splays out to insert onto the pubis

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7
Q

Cooper’s ligament is _____ to the femoral vessels.

A
  • Posterior

Cooper’s ligament = Pectinal ligament
- Lies against bone

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8
Q

The vas deferens runs ____ to the cord structures

A

Medial

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9
Q

Hesselbach’s Triangle borders

A
  • Rectus muscle
  • Inferior inguinal ligament
  • Inferior epigastrics
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10
Q

Direct hernias are ______ to the epigastric vessels

A

Inferior/medial

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11
Q

Indirect hernias are ______ to the epigastric vessels

A

Superior/lateral

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12
Q

Which is more common, direct or indirect hernias?

A

Indirect

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13
Q

Cause of indirect hernias

A

Persistently patent processus vaginalis

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14
Q

Direct hernias have a _____ (higher/lower) risk of incarceration and ______ (higher/lower) recurrence rate compared to indirect hernias

A
  • Lower risk of incarceration

- Higher recurrence risk

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15
Q

A _____ hernia contains components of both direct and indirect hernias.

A

Pantaloon hernia

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16
Q

Risk factors for inguinal hernias in adults (9)

A
  • Age
  • Obesity
  • Heavy lifting
  • COPD (coughing)
  • Chronic constipation
  • Straining (BPH)
  • Ascites
  • Pregnancy
  • Peritoneal dialysis
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17
Q

Part of the hernia sac in sliding hernias is made up of a ______.

A
  • Retroperitoneal organ
  • Most common organ in women: Ovaries or fallopian tube
  • Most common organ in men: Cecum or sigmoid colon
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18
Q

What to do if an ovary is found within the inguinal canal

A
  • Ligate the round ligament (found within the inguinal canal in women)
  • Return the ovary to the peritoneum
  • Perform biopsy of ovary if looks abnormal
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19
Q

How to repair inguinal hernia in infants and children

A
  • Perform high ligation (nearly always indirect hernias)

- Open sac prior to ligation

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20
Q

Lichtenstein repair

A
  • Uses mesh

- Recurrence decreased with use of mesh as this reduces tension

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21
Q

Bassini repair

A
  • Approximation of the conjoined tendon to the free edge of the inguinal ligament (shelving edge, inferior)
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22
Q

Cooper’s ligament repair

A

Approximation of the conjoined tendon to Cooper’s ligament (pectineal ligament, inferior)

  • Needs relaxing incision to the external oblique fascia
  • Can be used for femoral hernia repair
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23
Q

Indications for laparoscopic inguinal hernia repair

A
  • Bilateral inguinal hernias

- Recurrent inguinal hernia

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24
Q

Most common complication following hernia repair

A

Urinary retention

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25
Q

Wound infection rate following inguinal hernia repair

A

1%

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26
Q

Recurrence rate following inguinal hernia repair

A

2%

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27
Q

Testicular atrophy following inguinal hernia repair is usually caused by _____.

A

Dissection of the distal component of the hernia sac causing vessel disruption

  • Thrombosis of the spermatic cord vessels
  • Usually occurs with indirect hernias
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28
Q

Pain after inguinal hernia repair is usually caused by _____.

  • Treatment:
A
  • Compression of the ilioinguinal nerve

- Tx: Local infiltration near anterior superior iliac spine (can be diagnostic and therapeutic)

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29
Q

Symptoms of ilioinguinal nerve injury and where is it most commonly injured

A
  • Loss of cremasteric reflex
  • Numbness of ipsilateral penis, scrotum and thigh

Usually injured at the external ring as the nerve runs on top of the cord (anterior)

30
Q

Genitofemoral nerve

  • Genital branch function:
  • Femoral branch function:
A
  • Genital branch function: Cremaster (motor), scrotum (sensory)
  • Femoral branch function: Upper lateral thigh (sensory)
  • Usually injured with laparoscopic hernia repair
31
Q

Cord lipomas _____ (should/should not) be removed if found.

A

Should be removed if found

32
Q

Femoral canal boundaries

A
  • Cooper’s ligament (pectineal, posterior)
  • Inguinal ligament (anterior)
  • Femoral vein (lateral)
  • Lacunar ligament (medial)
33
Q

Femoral hernia is _____ to the femoral vein and _____ to the lymphatics.

A
  • Medial to the femoral vein

- Lateral to the lymphatics

34
Q

Femoral hernias pass underneath the ________

A

Inguinal ligament

35
Q

Characteristic physical exam finding of a femoral hernia

A

Bulge on the anterior-medial thigh below the ligament

36
Q

Femoral hernias are usually repaired through an ______ approach with a _________ repair

A
  • Inguinal approach

- Cooper’s ligament repair

37
Q

Umbilical hernia repairs are delayed until age ___

A

Age 5

*Risk of incarceration in adults, not children

38
Q

Spigelian hernia occurs between the ________ and _______.

A

Between the muscle fibers of the internal oblique muscle and insertion of the external oblique aponeurosis into the rectus sheath

39
Q

Spigelian hernias are found at the lateral border of the _____, adjacent to the _______.

A
  • Lateral border of rectus muscle
  • Adjacent to the linea semilunaris

*Almost always inferior to the semicircularis

40
Q

Obturator hernia can present as a _____ or ______

A
  • Tender medial thigh mass
  • SBO

*Found in anterior pelvis

41
Q

What is Howship-Romberg sign? What type of hernia is it seen in?

A
  • Inner thigh pain with internal rotation

- Obturator hernia

42
Q

Treatment of an obturator hernia

A

Tx: operative reduction, may need mesh, check other side for similar defect

43
Q

Sciatic hernia is caused by herniation through the ______.

A
  • Through the greater sciatic foramen

* Found in posterior pelvis. High rate of strangulation

44
Q

Most common cause of incisional hernias

A

Inadequate closure

45
Q

Posterior rectus sheath is absent below the ______.

A

Semicircularis (absent below umbilicus)

*The posterior aponeurosis of the internal oblique and transversalis moves anterior below the umbilicus

46
Q

Most common cause of rectus sheath hematoma

A

Trauma - epigastric vessel injury

47
Q

Rectus sheath hematomas usually present as a _______.

Treatment:

A
  • Painful abdominal wall mass

- Tx: usually non-operative, surgery if expanding

48
Q

What is Fothergill’s sign?

A

Abdominal wall mass is more prominent and painful with flexion of the rectus muscle. Seen in rectus sheath hematoma

49
Q

Desmoid tumor usually present as _______. Can be seen in _____ syndrome.

A
  • Painless mass
  • Gardner’s syndrome
  • More common in women
  • Usually benign, but locally invasive
50
Q

Treatment of desmoid tumors

A

Tx: Wide local excision if possible

  • If involving significant small bowel mesentery, excision may not be indicated as often it is not completely resectable

Medical Tx: Sulindac and Tamoxifen

51
Q

Most sensitive test for retroperitoneal fibrosis

A
  • IVP (intravenous pyelogram): shows constricted ureters

* retroperitoneal fibrosis can occur with hypersensitivity to methysergide

52
Q

Symptoms and treatment of retroperitoneal fibrosis

A
  • Symptoms: usually related to trapped ureters and lymphatic obstruction
  • Tx: Steriods, nephrostomy if infection is present, surgery if renal function becomes compromised (free up ureters and wrap in omentum)
53
Q

Mesenteric tumors

  • Tumors closer to the root are more likely to be _____ (malignant/benign)
  • More peripheral tumors are more likely to be ______ (malignant/benign)
A
  • Tumors closer to the root are more likely to be malignant

- More peripheral tumors are more likely to be benign

54
Q

Most common malignant mesenteric tumor

A

Liposarcoma

55
Q

Diagnosis and treatment of mesenteric tumors

A

Dx: Abdominal CT
Tx: Resection

56
Q

Most common malignant retroperitoneal tumor

A
  • Lymphoma

* 2nd most common: liposarcoma

57
Q

Retroperitoneal sarcoma

  • ___% resectable
  • ___% recurrence rate
  • ___% 5-year survival rate
A
  • < 25 % resectable
  • 40 % recurrence rate
  • 10 % 5-year survival rate
  • Mets go to the lungs
  • Tumors have pseudocapsule, but can’t shell out because this would leave residual tumor
58
Q

Most common omental solid tumor

A

Metastatic disease

*Primary solid omental tumors are rare, 1/3 are malignant

59
Q

Omental cyst symptoms

A

Usually asymptomatic, but can undergo torsion

60
Q

Omental tumor diagnosis and treatment

A

Dx: No biopsy, can have significant bleeding
Tx: Resection

61
Q

Blood is absorbed through _______ in the peritoneum

A

Fenestrated lymphatic channels

62
Q

Removed during peritoneal dialysis (4)

A

NH3, Ca, Fe, and lead are removed

*most drugs are not removed

63
Q

Mechanism of peritoneal dialysis: movement of fluid into the peritoneal cavity can occur with administration of _______.

A

Hypertonic intra-peritoneal saline load

*can cause hypotension

64
Q

Cardiopulmonary dysfunction can occur with intra-abdominal pressure > ____

A

> 20

65
Q

Increased intra-abdominal pressure causes increased (8)

A
  • MAP
  • PA pressure
  • HR
  • SVR
  • CVP
  • Mean airway pressure
  • Peak inspiratory pressure
  • CO2
66
Q

Increased intra-abdominal pressure causes decreased (4)

A
  • pH
  • Venous return (IVC compression)
  • Cardiac output
  • Renal flow secondary to decreased cardiac output
67
Q

CO2 embolus presentation and treatment

A
  • Sudden rise in ETCO2, followed by a drop then hypotension

- Tx: Head down, turn patient on left, can try to aspirate CO2 through CVL, prolonged CPR

68
Q

Harmonic scalpel mechanism of action

A

Disrupts protein H bonds causing coagulation

69
Q

Ultrasound

  • Lower frequencies show ____ (superficial/deep) structures
  • Higher frequencies show ____ (superficial/deep) structures
A
  • Lower frequencies show deep structures

- Higher frequencies show superficial structures

70
Q

Argon beam causes ____ (deep/superficial) coagulation

A

Superficial coagulation

*Is non-contact, so good for hemostasis of the liver and spleen

71
Q

Fibroblast ingrowth can be seen in ______ (Gore-Tex / Dacron)

A

Gore-Tex (PTFE) cannot get fibroblast ingrowth

Dacron (polypropylene) allows fibroblast ingrowth

72
Q

Incidence of vascular or bowel injury with Veress needle or trocar

A

0.1 %

General Surgery (14 decks)

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