Hernias,Abdomen, Surgical technology Flashcards
indirect hernia
patent processus vaginalis
most common
superior and lateral to epigastric muscles
runs medial to cord structures
vas deferens
forms external abdominal oblique fascia and shelving edge
external abdominal oblique
forms cremasteric muscles
internal abdominal oblique
forms inguinal canal floor
transversalis muscle
lacunar ligamnet
where inguinal ligament splays out to insert in the pubis
below inguinal ligament , from transversalis
ileopubic tract
composed of aponeurosis of the internal abdominal oblique and transversus abdomins muscles
conjoined tendon
hasselbachs traiangle
medial - rectus muscle
inferior - inguinal ligament
superior - inferior epigastric
direct hernias
lower risk of incarceration
rare in females
inferior/medial to epigastric vessels
lichtenstein repair
decreases reccurence of hernia by using mesh
decreases tension
bassini repair
approximation of the conjoined tendon and transversalis fascia (superior) to the free edge of the inguinal ligament (inferior)
Mcvay repair
approximation of the conjoined tendon and transversalis fascia to coopers ligament
needs a relaxing incsions in the external abdominal oblique fascia
most common early complication following hernia repair
urinary retention
testicular atrophy after hernia repair
secondary to dissection of the distal component of the hernia sac causing vessel disruption
thrombosis of spermatic cord veins
usually with indirect hernia repair
pain after hernia repair
ilioinuinal nerve compression
TX: local infiltration can be diagnostic and therapeutic
ilioinguinal nerve injury
loss of cremasteric reflex, numbness on ipsilateral penis,scrotum, thigh
usually injured at external ring, nerve runs on top of cord
genitofemoral nerve injury
genital branch -
motor cremaster/ scrotum sensory
femoral - sensory upper lateral thigh
cord lipomas
remove
trapezoid of doom
laparoscopic hernia repair- femoral branch of genitfemoral nerve, lateral cutaneous nerve, femoral artery
dissect lateral to vessels stay along inguinal ligament
femoral hernia
medial to femoral vein and lateral to the lymphatics
boundaries:
coopers ligament, inguinal ligament, femoral vein
TX use a Mcvay or bassni repair
spigelian hernia
lateral border of rectus muscle throug linea semilunaris and usually inferior to semicicrularis
richters hernia
noncircumfrential incarceration of thre nonmesenteric bowel wall
littres hernia
incarcerated meckels
Petis hernia
inferior lumbar hernia
boarders: external abdominal oblique
latissimus dorsi
ilia crest
grynfelts hernia
superior lumbar hernia
boarders: internal abdominal oblique, lumbrodorsal aponeurosis, 12 th rib
sciatic hernia
herniation through the greater sciatic foramen, high rate of strangulation
obturator hernia
howship romberg sign - inner thigh pain with internal rotation
elderly women, previous pregnancy, bowel gas below superior pubic ramus
TX: operative reduction
CO2 pneumoperitoneum
increased pulmonary artery pressure, HR, systemic vascular resistance, CVP, mean airway pressure, peak inspiratory pressure, and CO2
decreased venous return (IVC compression), pH, renal flow , CO
PEEP has additive effect–> increased P –> decreased renal blood flow and increases renin production
Co2 embolus
head down, turn patient to left
sudden rise in ETCO and hypotension during laprascopy
CO2 embolus
harmonic scalpel
disrupts H bonds, causes coagulation
