Hulka Hernias

Question 1

What’s good about a midline incision?

Answer 1

goes thru the linea alba
strongest area to close
this allows for minimal nerve injury

Question 2

What’s the deal w/ a transverse incision?

Answer 2

this goes thru external & internal obliques & transversus muscles & rectus abdominis muscles
minimizes nerve injury
a weaker incision

Question 3

What are the contraindications for laparoscopic surgery?

Answer 3

prior abdominal surgeries
emergency
advanced pregnancy

Question 4

What is a hernia?

Answer 4

a weakness in a muscle that allows an organ to bulge thru

**can be developmental or acquired

Question 5

What is the difference b/w incarceration & strangulation?

Answer 5

Incarceration: a piece of bowel gets stuck
Strangulation: the bowel is stuck so long that its blood supply is cut off & it starts to die

Question 6

When do umbilical hernias in children usu close by?

Answer 6

by 2 years of age

Question 7

Describe the inguinal canal.

Answer 7

all of the muscles of the anterior abdominal wall contribute to the inguinal canal
it is the inferior aspect of the ab wall above the fold of the leg
it is divided into R & L by the linea alba

Question 8

What is a direct hernia?

Answer 8

inguinal hernia
thru the medial portion of the inguinal canal
medial to inferior epigastric artery
thru the Hasselbach’s triangle

Question 9

Describe an indirect hernia.

Answer 9

inguinal hernia
thru the lateral portion of the inguinal canal
thru patent processus vaginalis
follows the descent of the testis

Question 10

Which is acquired & which is congenital? Direct & Indirect inguinal hernias.

Answer 10

Direct Inguinal Hernia: Acquired

Indirect Inguinal Hernia: Congenital

Question 11

Describe the descent of the testis.

Answer 11

testes develop intrabdominally
they descend thru the deep ring & down the inguinal canal to the scrotum
bring peritoneum w/i it that forms the tunica vaginalis

Question 12

What is the tunica vaginalis?

Answer 12

this is the covering for the testicle
the peritoneum that the testicle dragged with it on its way down…
used to be the processus vaginalis

Question 13

What is the inferior epigastric artery a branch of?

Answer 13

the internal iliac artery

Question 14

What is the cremaster?

Answer 14

it is a muscle over the spermatic cord

a continuation of the internal oblique

Question 15

What’s the most common type of hernia in a man?

Answer 15

a direct hernia

Question 16

What’s the most common type of hernia in a woman?

Answer 16

an indirect hernia

Question 17

What’s the most common type of hernia in an elderly woman?

Answer 17

a femoral hernia

Question 18

Which 2 muscles make up the weak area of the triangle?

Answer 18

transversus abdominis

internal oblique

Question 19

Which 2 muscles contribute stuff to the conjoint tendon?

Answer 19

transversus abdominis

internal oblique

Question 20

What goes thru the superficial inguinal ring?

Answer 20

spermatic cord

Question 21

Describe the borders of where a femoral hernia occurs.

Answer 21

Superior: Inguinal Ligament
Mediall: lacunal ligament
Inferior: Pectineal ligament

Question 22

When do gastroschisis or omphaloceles occur?

Answer 22

when the muscles don’t fuse after the bowel extrudes from the abdomen during the 6th-8th week of gestation…

Question 23

What causes abdominal wall defects?

Answer 23

likely due to an obliteration of the right umbilical artery, causing a wall defect

Question 24

How do you treat gastroschisis?

Answer 24

used to shove the GI back in, but it created too much abdominal pressure & made it hard for the lungs to breathe…
So instead you put them in a hygienic bag for 5-7 days & then shove it back in.