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SURGERY > INGUINAL HERNIAS > Flashcards

INGUINAL HERNIAS Flashcards

1
Q

Indirect Hernia

A

protrude LATERAL to the inferior epigastric vessels, through the deep inguinal ring

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2
Q

Direct Hernia

A

protrude MEDIAL to the inferior epigastric vessels, within Hesselbach’s triangle

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3
Q

Hesselbach’s triangle

A

BORDERS OF THE TRIANGLE

INFERIOR - inguinal ligament
MEDIAL - lateral edge of rectus sheath
SUPEROLATERALLY - inferior epigastric vessels

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4
Q

Femoral Hernia

A

protrude through the small and inflexible femoral ring

traverse the empty space between the femoral vein and the lymphatic channels

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5
Q

Femoral Ring

A 
BORDERS OF THE FEMORAL RING
•	ANTERIOR - iliopubic tract and inguinal ligament
•	POSTERIOR - Cooper’s ligament
•	MEDIAL – lacunar ligament
•	LATERAL – femoral vein
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6
Q

Nerve which runs with the spermatic cord in the

inguinal canal

A

Ilioinguinal nerve

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7
Q

Risk of strangulation

A

Higher with INDIRECT than direct inguinal hernia, but highest in FEMORAL hernias

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8
Q

Nyhus Classification System

A

Type I - Indirect Hernia w/ normal internal abdominal ring

Type II - Indirect Hernia; enlarged internal ring w/o impingement on the floor of inguinal canal; does not extend into scrotum

Type IIIA - direct hernia

Type IIIB - indirect hernia large enough to intrude the posterior inguinal floor
- SLIDING, SCROTAL and PANTALOON hernia

Type IV - recurrent hernia

  • A - recurrent direct
  • B - recurrent indirect
  • C - recurrent femoral
  • D - recurrent combination
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9
Q

Triangle of Doom

A

BORDERS

MEDIAL: ductus deferens
LATERAL: gonadal vessels
POSTERIOR: peritoneal edge

CONTENTS

external iliac artery and vein
deep circumflex iliac vein
femoral nerve
genital branch of the genitofemoral nerve

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10
Q

Triangle of Pain

A

BORDERS

SUPEROMEDIAL: gonadal vessels
INFEROLATERAL: iliopubic tract
LATERAL: reflected peritoneum

CONTENTS

lateral femoral cutaneous nerve
femoral branch of the genitofemoral nerve
femoral nerve

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11
Q

An abnormal protrusion of an organ or tissue through a defect in its surrounding walls

A

Hernia

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12
Q

MC symptom of inguinal hernia

A

groin mass that protrudes while standing, coughing, or straining

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13
Q

3-Finger test or Zieman technique

A

with patient standing the fingers are positioned as follows:

INDEX finger: placed at the DEEP (internal) inguinal ring
MIDDLE finger: placed at the SUPERFICIAL (external) inguinal ring
RING finger: placed at the SAPHENOUS opening (over femoral canal)

patient is asked to cough or strain:

INDIRECT HERNIA: impulse felt at DEEP (internal) inguinal ring
DIRECT HERNIA: impulse felt at SUPERFICIAL (external) inguinal ring
FEMORAL HERNIA: felt at SAPHENOUS opening

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14
Q

Signs of strangulated hernia

A
  • tenderness
  • fever
  • leukocytosis
  • hemodynamic instability

hernia bulge is usually warm and tender
overlying skin may be erythematous or discolored

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15
Q

Incidence of inguinal hernias in men has a bimodal distribution, which peaks

A

before 1st year of life and after age 40

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16
Q

2 types of collagen found to exist in a decreased

ratio of the skin of inguinal hernia

A

types I and III

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17
Q

Should be attempted or incarcerated hernias W/O sequelae of strangulation

A

Taxis

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18
Q

Emergent herniorrhaphy

A

Indicated if strangulation is suspected or acute

incarceration is present

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19
Q

Elective herniorrhaphy

A

Indicated to prevent the chance of incarceration/strangulation

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20
Q

Indications for Tissue Repair

A

o operative field contamination
o emergency surgery
o when the viability of hernia contents is uncertain

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21
Q

Sutures approximate reflection of inguinal ligament (Poupart’s) to the transversus abdominis aponeurosis/
conjoint tendon

A

Bassini

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22
Q

Cooper’s ligament sutured to transversus abdominis aponeurosis/conjoint tendon

A

McVay

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23
Q

Tension-free repair” using mesh

A

Lichtenstein

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24
Q

Imbrication of the floor of the inguinal

canal (a.k.a. “Canadian repair”)

A

Shouldice

25
Q

Placing a plug of mesh in hernia defect
and then overlaying a patch of mesh over
inguinal floor

A

Plug and Patch

26
Q

Ligation and transection of indirect
hernia sac without repair of inguinal floor
(used only in children)

A

High Ligation

27
Q

Indications for laparoscopic inguinal hernia

repair

A

Bilateral inguinal hernias
Recurring hernia
Need to resume full activity as soon as possible

28
Q

Addresses both inguinal and femoral ring defects

Indicated for femoral hernias and in cases where the use of prosthetic material is contraindicated

A

McVay

29
Q

Consists of a mesh-free repair utilizing a strip of external oblique aponeurosis

A

Desarda

30
Q

MC Complications of Inguinal Hernia Repair

A 
bleeding
infection
seroma
urinary retention
ileus
injury to adjacent structures
31
Q

This is considered when pain, bulging, or a mass at the site of an inguinal hernia repair are present as well as clinical entities such as seroma, persistent cord lipoma

A

Recurrent hernia

32
Q

Common medical issues associated with recurrence

A 
malnutrition
immunosuppression
diabetes
steroid use
smoking
33
Q

Usually a result of ligamentous or muscular trauma and inflammation – reproduced with abdominal muscle contraction

A

Nociceptive pain

34
Q

The MC cause of urinary retention after hernia repair

A

general anesthesia

35
Q

Injury to the LATERAL FEMORAL CUTANEOUS nerve

A

Meralgia paresthetica

36
Q

Mimic acute neuropathic pain, and they occur with a dermatomal distribution

A

Local nerve Entrapment

37
Q

Occurs as a result of direct nerve damage or entrapment

A

Neuropathic pain

38
Q

Occurs as a result of direct nerve damage or entrapment

A

Visceral pain

39
Q

A debilitating chronic complication of inguinal hernia repair

A

postherniorrhaphy inguinodynia

40
Q

hernia repair method associated with the LOWEST RECURRENT RATE

A

Lichtenstein

41
Q

Change in bowel habits or urinary symptoms

A

sliding hernia - w/ intestinal contents or involvement

of the bladder within the hernia sac

42
Q

Contents of spermatic cord

A
  1. Cremasteric muscle fibers
  2. Vas deferens
  3. Testicular artery
  4. Testicular pampiniform venous plexus
  5. +/- hernia sac
  6. Genital branch of the genitofemoral
    nerve
43
Q

Attaches the testicle to the scrotum

A

Gubernaculum

44
Q

Hernia traveling beneath the inguinal ligament down the femoral canal medial to the femoral vessels

A

Femoral Hernia

45
Q

Boundaries of the femoral canal

A
  1. Cooper’s ligament posteriorly
  2. Inguinal ligament anteriorly
  3. Femoral vein laterally
  4. Lacunar ligament medially
46
Q

Defect of LINEA ALBA anywhere from xiphoid to umbilicus

A

Epigastric (Ventral) Hernia

47
Q

Incomplete closure of early natural umbilical defect

A

Umbilical Hernia

48
Q

Herniation of intraperitoneal viscera into open umbilical ring

A

Omphalocele

49
Q

Defect of anterior abdominal wall to right or left of the midline

A

Gastroschisis

50
Q

Herniation along the the LINEA SEMILUNARIS anywhere above level of umbilicus lateral to the symphysis pubis

A

Spigelian

51
Q

Herniation through SUPERIOR LUMBAR triangle

A

Grynfelt (Superior Lumbar)

52
Q

Herniation through INFERIOR LUMBAR triangle

A

Petit (Inferior Lumbar)

53
Q

Herniation through greater sciatic foramen ABOVE piriformis muscle

A

Suprapiriformic hernia

54
Q

Herniation through greater sciatic foramen BELOW piriformis muscle

A

Infrapiriformic hernia

55
Q

Herniation through lesser sciatic foramen

A

Subspinous hernia

56
Q

Herniation through the LUMBOCOSTAL TRIGONE (above and lateral to left lateral lumbocostal arch)

A

Congenital Diaphragmatic: Bochdalek hernia (posterolateral)

57
Q

Herniation through the STERNOCOSTAL TRIANGLE (foramina of Morgagni, space of Larrey)

A

Congenital Diaphragmatic: Bochdalek hernia (posterolateral)

58
Q

MCC of URINARY RETENTION after hernia repair

A

General Anesthesia

SURGERY (27 decks)

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