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Chirurgie > Hernii > Flashcards

Hernii Flashcards

1
Q

Herniile de perete abd. posterior:

A

-lombare: Petit, Greenfield
-ischiatice

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2
Q

Frecventa herniilor:

A

6% din interventiile chirurgicale
Raport B/F: 5/1

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3
Q

Etiologia herniilor: modern

A
  1. “Shutter mechanism”: deplasarea in contractie a arcului aponevrotic al m transvers peste o.i.p
  2. “Sphincter mechanism”: tractiunea in contractie a fasciei transversalis superior si lateral, inchide o.i.p
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4
Q

Hernii. Factori determinanti:

A
  • efortul fizic
  • fumatul
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5
Q

Factori fav., comorb. care slabesc peretele abd.

A
  • Bronho-pneumopatii acute/cronice
  • Malnutritie
  • Hipotiroidii
  • Obezitate
  • Boli neoplazice
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6
Q

Factori fav. Comorb care cresc pres abdominala:

A
  • Constipatie
  • Tuse
  • Ascita
  • Adenom periuretral
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7
Q

Factori fav: profesii

A
  • Suflatori
  • Hamali
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8
Q

Factori fav: congenitali

A
  • Persistenta de canal peritoneo-vaginal
  • Inel ombilical
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9
Q

Durerea in hernii:

A

Durere la formarea herniei, la aparitia complicatiilor (strangulare), accentuata la efort.

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10
Q

Examen clinic: inspectie

A
  • Reductibilitatea in clinostatism
  • Expansiunea la tuse, trecere in ortostatism
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11
Q

Examen clinic: palparea

A
  • Orificiu: diametru, margini, rapoarte anatomice
  • Reductibilitatea la taxis cu/fara zg hidroaerice
  • Impulsiune la tuse
  • Consistenta: elastica, pastoasa, dura.
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12
Q

Examen clinic: percutie

A
  • Matitate: epiploon
  • Sonoritate: tub digestiv
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13
Q

Hernii: Imagistica

A
  • Eco: - pt diagnosticul diferential
    - pt depistarea comirbiditatilor: h.b.p, ascita, ciroza, tumori
  • CT, RX: - pt hernii cu continut hidroaeric ireducribil
    - pt ocluzie intestinala
    - pt depistarea comorb: h.b.p, stenoze colon
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14
Q

Diagnostic pozitiv:

A
  1. Formatiune pseudotumorala
  2. In zona slaba a peretelui
  3. Reductibila in forma necomplicata.
  4. Expansioneza si impulsioneaza la tuse.
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15
Q

Forme de hernii strangulate

A
  1. Supraacut: durere vie, voma, alterarea starii generale
  2. Subacut: hernii mari, pot retroceda, subocluzie
  3. Varstnici care nu stiu de existenta herniei
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16
Q

Forme hernii strangulate:

A
  1. Strangulare Richter: ciupire lat.
  2. Strangulare Omega
  3. Strangulare W
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17
Q

Flegmonul piostercoral al peretelui:

A

Asocierea semnelor inflamatorii de la nivelul sacului:durere, edem, eritem cu peritonita generalizata: aparare, contractura, ileus

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18
Q

Indicatie orteze de contentie:

A
  • Hernii ombilicale sugari
  • Hernii congenitale pana la 6 ani
  • Contraind trat chir.
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19
Q

Cerintele herniorafiei corecte:

A
  1. Rata recidiva redusa
  2. Reluarea precoce a activ.
  3. Complicatii postop minime (durere, supuratie, af testiculara)
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20
Q

Pasi Abord Clasic

A
  1. Anestezia
  2. Disectia si descchiderea sacului
  3. Tratarea continutului
  4. Refacerea peretelui
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21
Q

Continut canal inghinal:

A
  • nervii genitofemural, ilioinghinal, iliohipogastric
  • funiculul spermatic/ligamentul rotund
22
Q

Zona delimitata medial de traca m drepti, lateral de v epig inf si inf de lig inghinal se numeste?

A

Triunghiul Hesselbach

23
Q

Clasificarea Nyhus

A

Tip I : oblica externa cu o.i.p normal
Tip II : oblica externa cu o.i.p largit si planseu inghinal normal
Tip IIIa : directa
Tip IIIb : mixta
Tip IIIc : femurala
Tip IV : recidivata

24
Q

Forme anatomo-clinice hernii oblice externe

A
  • Punct herniar
  • Inghino - interstitiala
  • Bubonocel
  • Inghino-funiculara
  • Inghino-scrotala
25
Q

Forme anatomo-clinice hernii directe

A
  • Inghino-properotoneala
  • Inghino-interstitiala
  • Inghino-superficiala
26
Q

Diagnostic diferential hernii inghinale:

A
  • Adenopatie inghinala
  • Chist de cordon (Nuck la femei)
  • Persistenta canal pv
  • Dilatatie crosa safena mare
  • Hidrocel inchistat/comunicant
  • Testicol ectopic
  • Varicocel voluminos
  • Tumori testiculare
  • Lipom
  • Hernii femurale (sub linia Malgaigne)
27
Q

Manevra Astley-Cooper

A

Observarea herniilor abd in raport cu linia Malgaigne

28
Q

Avantaj abord laparoscopic

A

Permite acoperirea cu material protetic a intregii regiuni inghino-femurale

29
Q

Anatomie inel femural:

A

Ant: lig inghinal
Post: creasta pectineala
Lat: vena femurala
Med: lig Gimbernat

Contine gg Cloquet

30
Q

Evolutie hernie femurala in traiect

A
  • Punct herniar: trecut de in fem
  • Interstitiala: sub fascia cribiforma
  • Completa: dincolo de fascia cribiforma
31
Q

Cele 2 simptome frecv ale herniei femurale

A

Durere si tulb digestive

32
Q

Inspectia herniei femurale

A

Formatiune pseudotumorala in partea interna a triunghiului Scarpa, sub linia Malgaigne

33
Q

Limite regiune ombilicala

A

Superior/inf 2cm de la cicatrice
Lat delim de marginile interne ale dreptilor
Coresp L4

34
Q

Stratigrafie reg ombilicala

A
  1. Piele
  2. Tesut subcutanat
  3. Aponevroza cu inelul ombilical cu diam de 2 cm
  4. Fascia Richet(ombilicala): fibre transv pe fata int a liniei albe
  5. Peritoneu
35
Q

Canal Richet

A

Format de fascia ombilicala Richet si fata int a liniei albe

36
Q

Diagnostic diferential hernie ombilicala

A
  • Extrofie de vezica urinara
  • Granulom dupa ligatura cordonului ombilical
  • Tumora chistica de uraca
37
Q

Tratament hernie ombilicala copil mic

A

Ortopedic pana la 3 ani, dupa 3 ani chirurgical in caz de strangulare

38
Q

Tratament hernii ombilicale congenitale

A

Chirurgical din a 2 a zi de viata
Contraind: aplazii parietale extinse, prematuri

39
Q

Hernia ombilicala la cirotic: f. fav, complicatii specifice, pregatire preop, tratament

A

F. fav: denutritie, hipoprot, presiune intrabd crescuta

Complicatii specifice: strangulare, erodarea tegument, fistula

Pregatire: reducere ascita, corect tulb coag, corect hipoprot

Trat chrurgical riscant, morbid si mortalitate crescuta

40
Q

Linia Spiegel

A

-Limita intre portiunea musculara si cea tendinoasa a m. transvers
-La 2 cm lateral de spina pubelui, la varful coastei 11

41
Q

Locul de formare a herniei Spiegel

A

Locul unde linia Spiegel intretaie marginea inf. a arcadei Douglas

42
Q

Diagnostic diferential hernie Spiegel:

A
  • Tumori
  • Hematom parietal
  • H. Inghinala
43
Q

Limite canal obturator:

A

Superior: jgheabul osos subpubian
Inferior: muschii obturatori

44
Q

Hernii obturatorii

A

Interstitial: sac in canalul obt
Antepectineala: sac intre m. pectineu si m. add mic

45
Q

Semnul Howship-Romberg

A

Dureri pe fata antero-interna a coapsei

46
Q

Manevra hernie obturatorie voluminoasa

A

Durere la extensia, abductia si rotatia extrena a coapsei

47
Q

Semnul Rene:

A

Imagine hidroaerica rotunda in canalul obturator la rx

48
Q

Trigonul J.L Petit:

A
  • Marele dorsal
  • Oblic extern
  • Creasta iliaca
49
Q

Patrulaterul GrynFeld

A
  • Coasta XII
  • Micul dintat postero inf
  • Patratul lombelor
  • Micul oblic (oblic intern)
50
Q

Fosete peritoneale: hernii interne

A
  • Paraduodenal
  • Pericecal
  • Juxtasigmoidian
  • Hiatus Winslow

Chirurgie (16 decks)

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