Hulka Clinical Hernia Lecture

Question 1

(blank) is the resection, repair ulcer disease, anti-reflux surgery

Answer 1

gastric surgery

Question 2

(blank) is a cholecystectomy, liver resection

Answer 2

biliary surgery

Question 3

(blank) is a small bowel or colonic resection, appendectomy

Answer 3

intestinal surgery

Question 4

(blank) is a hysterectomy, oophorectomy

Answer 4

gynecologic surgery

Question 5

What is a midline incision?

Whats unique about it?

Answer 5

1)goes through the linea alba
2)Strongest area to close
Minimal nerve injury

Question 6

What is a transverse incision?

Whats unique about it?

Answer 6

1) goes through external & internal obliques, transversus and possibly rectus muscles
2) Minimizes nerve injury
May be a weaker incision

Question 7

What is a muscle sparing incision?

Answer 7

cut along the line of the external oblique

Question 8

What fascia is stronger, the rectus and midline or the obliques and transvers?

Answer 8

the rectus and midline

Question 9

What kind of surgery is this:
Allows for minimalist approach to abdominal cavity
Small incisions – less chance of hernias, recover quicker
Contraindications – prior abdominal surgeries, emergency, advanced pregnancy

Answer 9

laparoscopic surgery

Question 10

what is this:
Where a weakness in the muscle allows a organ to bulge through it
Can be developmental or acquired

Answer 10

hernia

Question 11

who are more likely to have inguinal hernias, male or females?

Answer 11

males 25% only 2% of females

Question 12

What is the most common hernia?

Answer 12

inguinal

Question 13

Should you fix and inguinal hernia in an adult? in a child?

Answer 13

asymptomatic doesnt need

children need surgery

Question 14

What is incarceration?

Answer 14

when something gets stuck, you cant push it back in and it is not reducible

Question 15

What is strangulation?

Answer 15

something has been stuck too long and the blood supply dies and now that stuck piece is starting to decay

Question 16

Should you fix umbilical hernias in adults? in Kids?

Answer 16

Yes

only if it isnt closed by age 2 or if it is symptomatic yes

Question 17

What muscles of the anterior abdominal wall contribute to the inguinal canal?

Answer 17

all muscles

Question 18

Inguinal canal is the inferior aspect of the abdominal wall above the the fold of the leg. It is divided into the right and left by the (blank)

Answer 18

linea alba

Question 19

What are the two types of hernias?

Answer 19

direct and indirect

Question 20

What type of hernia is this?

through medial portion of inguinal canal - medial to inferior epigastric artery. This is through Hesselbach’s Triangle

Answer 20

direct

Question 21

What type of hernia is this?
through lateral portion of inguinal canal - usually through patent processus vaginalis. This follows the descent of the testis

Answer 21

Indirect

Question 22

Testes develop (blank) while fetus is in utero. and they develop retroperitoneal.

Answer 22

intra abdominally

Question 23

Tests will descend through the (blank) down the inguinal canal to the scrotum

Answer 23

deep ring

Question 24

When testes descent through the deep ring, what do they bring with them and what do they form?

Answer 24

they bring with them the peritoneum which forms the tunica vaginalis

Question 25

The communication between the abdomen and scrotum is the (Blank). THis obliterates after (blank) and turns into the tunica vaginalis.

Answer 25

processus vaginalis

birth

Question 26

processus vaginalis turns into the (Blank)

Answer 26

tunica vaginalis

Question 27

What muscle is the deep ring located in?

Answer 27

the transversus

Question 28

What is the common type of hernia in:
Males?
Females?
elderly females?

Answer 28

direct
indirect
femoral

Question 29

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

Answer 29

medial

Question 30

HOw do you check for inguinal hernia in male?

In female?

Answer 30

In male, can be done by invaginating the skin between the scrotum and penis into the inguinal canal by going through the superficial inguinal ring
In female, placing hand over inguinal canal and having them increase abdominal pressure

Question 31

In children, are hernias indirect or direct?

Answer 31

In children, hernias are indirect because they are developmental
High ligation of sac

Question 32

How do you fix inguinal hernias?

Answer 32

sutures, mesh repairs, laparoscopic repairs

Question 33

When do you uses open repair versus laproscopic repair for inguinal hernias?

Answer 33

Open for unilateral, first time hernia repairs, pts with prior lower abdominal surgery
Laparoscopic for bilateral or recurrent hernias

Question 34

Femoral hernias occur inferior to the (blank). They are bordered by the (blank) ligament medially, the (blank) ligament superiorly, and the (blank) ligament inferiorly.

Answer 34

inguinal ligament.
lacunar ligament
inguingal ligament
pectineal ligament

Question 35

How do you fix a femoral hernia?

Answer 35

mesh repair either below the inguinal ligament or above

Question 36

(blank) or (blank) develop when the muscles do not fuse after the bowel extrudes from the abdomen during the 6-8th week of gestation.
What side does the defect occur?

Answer 36

Gastroschisis or omphaloceles

Right

Question 37

Name that defect:

Bowel is open to the amniotic fluid

Answer 37

gastroschisis

Question 38

Name that defect:

Bowel has a covering but is protruding from the umbilical ring

Answer 38

omphalocele

Question 39

Etiology of abdominal defects?

Answer 39

most likely due to obliteration of right umbilical artery