Hulka: Clinical hernia lecture

Question 1

What are the benefits of making a midline incision through the linea alba?

Answer 1

It is the strongest area to close and causes minimal nerve injury

Question 2

What layers of muscle does a transverse incision go through?

Answer 2

External and internal obliques, transversus abdominus, and possibly rectus muscles.

Question 3

3 things to worry about if deciding to perform a laparoscopic surgery

Answer 3

prior abdominal surgery, emergency situation (too time consuming), and advanced pregnancy

Question 4

What are the benefits of laparoscopic surgery?

Answer 4

Minimalist approach, small incisions, less change of hernias, quicker recovery

Question 5

A weakness in the muscle allows an organ to bulge through it

Answer 5

Hernia

Question 6

T/F: Hernias can be congenital or acquired

Answer 6

True

Question 7

What is the most common type of hernia?

Answer 7

Inguinal (75%)

Question 8

Does a hernia always need to be fixed?

Answer 8

In children, yes. In adults, can watch and wait a bit.

Question 9

At what age do umbilical hernias usually close?

Answer 9

Age 2

Question 10

Inferior aspect of the abdominal wall, above the fold of the leg

Answer 10

inguinal canal

Question 11

A direct hernia goes through the (blank) portion of the inguinal canal, (blank) to the inferior epigastric artery, and through Hesselbach’s Triangle

Answer 11

medial; medial

Question 12

An indirect hernia goes through the (blank) portion of the inguinal canal, usually through a patent processus vaginalis. These usually follow the descent of the testis.

Answer 12

lateral

Question 13

The testes develop intra-abdominally while the fetus is in utero. They are referred to as (blank)

Answer 13

retroperitoneal

Question 14

The testes descend thru the deep ring down the inguinal canal to the (blank)

Answer 14

scrotum

Question 15

The testicle drags with it the (blank) which forms the tunica vaginalis

Answer 15

peritoneum

Question 16

What is the communication between the abdomen and the scrotum? What does this become after birth?

Answer 16

Processus vaginalis; tunica vaginalis

Question 17

The weak area created by the arching fibers of the inner abdominal muscles and their tendons is (blank) to the deep ring and found in the inguinal triangle.

Answer 17

medial

Question 18

Three ways to fix inguinal hernias

Answer 18

Suture the muscles together
Mesh repair
Laparoscopic repair

Question 19

When would an open repair be preferred over a laparoscopic repair?

Answer 19

Unilateral hernia, first time hernia, prior lower abdominal surgery

Question 20

Where do femoral hernias occur?

Answer 20

Inferior to the inguinal ligament

Question 21

What three ligaments border a femoral hernia?

Answer 21

inguinal; lacunar; pectineal

Question 22

What two things can develop when the muscles do not fuse after the bowel extrudes from the abdomen during week 6-8 of gestation?

Answer 22

Gastroschisis or omphaloceles

Question 23

What are abdominal wall defects caused by?

Answer 23

Who knows! Maybe the obliteration of the right umbilical artery…