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Surgery 2 > Inguinal Hernias, Abdominal Wall, Omentum, Mesentery, & Retroperitoneum > Flashcards

Inguinal Hernias, Abdominal Wall, Omentum, Mesentery, & Retroperitoneum Flashcards

1
Q

What are the important boundaries of the inguinal canal?

A

Anterior: external oblique aponeourosis
Posterior: transversalis fascia & transcersus abdominis
Lateral: internal oblique muscle
Inferior: inguinal ligament (Poupart’s ligament)
Sperior: internal oblique & transversus abdominis muscle

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2
Q

What are the structures in the inguinal canal that should be protected to avoid complications?

A

Three arteries
Three veins
2 nerves
Pampiniform venou plexus
Vas deferens
Enveloped by 3 layers of spermatic fascia

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3
Q

What is the difference betw the indirect and direct hernia

A

Direct = medial to the inferior epigastric vessels within the HEsselbach’s triangle

Indirect = protrudes lateral to the inferior epigastric vessels through the deep inguinal ring

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4
Q

What are the boundaries of the Hesselbach’s triangle?

A

Inferior: inguinal ligament
Medial: lateral edge of the rectus sheath
Lateral: inferior epigastric vessels

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5
Q

What is the location of fermoral henia?

A

Seen BELOW the inguinal ligament

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6
Q

What is the landmark used to differentiate direct from indeirect inguinal hernia?

A

Inferior epigastric vessels

Direct inguinal hernia = MEDIAL to the inferior epigastric vessels

Indirect inguinal hernia = LATERAL to the inferior epigastric vessels

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7
Q

What are the points of reference in inguinal hernia?

A

5 peritoneal folds
Bladder
Inferior epigastric vessels
Psoas muscle
Space of Bogros (preperitoneal space)

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8
Q

What artery supplies the rectus abdominis muscle?

A

Inferior epigastric artery

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9
Q

What are the nerves of interest in the inguinal canal?

A

Ilioinguinal nerve
Iliohypogastric nerve
Genitofemoral nerve
Lateral femoral cutaneounerve

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10
Q

What are the important areas of interest of the Preperitoneal anatomy?

A

Triangle of Doom
Triangle of pain
Circle of death

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11
Q

What are the sides of triangle of doom?

A

Medial: vas deferens
Lateral: vessels of the spermatic cord
External iliac vessels & deep circumflex iliac vein

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12
Q

What are the vessels inside the circle of death?

A

Common iliac
Internal iliac
Obturator
Inferior epigastric
External iliac vessels

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13
Q

What is the cause of inguinal hernia in pediatric px?

A

Failure of the processus vaginalis to close

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14
Q

How do you differentiate through physical exam indirect & direct inguinal hernia?

A

Indirect = herniating organ is felt pushng on the tip of the finger

Direct = felt at the dorsal aspect

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15
Q

What is the definitive treatment of inguinal hernia?

A

Surgical repair: open approach

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16
Q

What are indications for urgent repair of inguinal hernia?

A

Incarceration
Strangulation

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17
Q

What is inarceration in inguinal hernia?

A

Failure to reduce the herniating organ

Happens in indirect inguinal hernia & femoral hernia

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18
Q

What is attempted for incarcerate hernias without sequelae of strangulation?

A

Taxis

19
Q

What are clinical signs of strangulation?

A

Tenderness
Fever
Leukocytosis
Hemodynamic instability

20
Q

What is the most comonly performed type of hernia operation and its types?

A

Open inguinal hernia repair
= mesh repair (more common) & tissue repair (px with infected fields)

21
Q

What are the types of tissure repair used in open approach of ingiunal hernias?

A

Bassini repair
SHouldice repair
Mcvay cooper’s ligament repair
Desarda repair

22
Q

What is the gold standard of prosthetic repairs in inguinal hernia?

A

Lichenstein tension-free repair

23
Q

What is the significance of laparascopic approach in inguinal hernia?

A

Reinforce the abdominal wall ia posterior approach

NOT ADVISED in px who cannot undergo general anesthesia

24
Q

What is the useful prosthetic repair for bilateral hernias, large hernias, or scarring from previous lower abdominal surgery?

A

Tapp repair

25
Q

What is the advantage of TEP repair?

A

Access to the preperitoneal space without intraperitoneal infiltration

26
Q

What are the most common complications of inguinal hernia repair?

A

Bleeding
Infeciton
Seroma
Urinary retention
Ileus
Injury to adjacent structures

27
Q

What presents as pain, bulging, or a mass at the site of repair?

A

Hernia recurrence

28
Q

What aer the 3 mechanisms of pain assoc with hernia?

A

Nociceptive (somatic) pain = most common
Neuropathic pain = direct nerve damage or entrapment
Visceral pain = poorly localized

29
Q

What nerves are at great risk of entrapment?

A

Ilioinguinal & iliohypogastric nerves = anterior repairs

Genitofemoral and lateral femoral cutaneous nerves = endoscopic repairs

30
Q

What is the most common injury to the paminiform plexus?

A

Ischemic orchitis

31
Q

What are the commonly injured vessels in hernia?

A

Inferior epigastrics and external iliac arteries

32
Q

What are the nin elayers of the abdominal wall?

A

Skin
SQ tissue
Superficial fascia: campers & scarpas
External oblique m
Intenral oblieuq m
Transversus abdominis
Transversalis fascia
Preperitoneal adipose tissue
Peritoneum

33
Q

What are the congenital abnormalities of the abdominal walls?

A

Omphalocele
Gastroschisis
Vitelling duct abnormalities
Urachus

34
Q

What are the diff acquired abnormaltiies of the abdominal wall?

A

Abdominal wall hernias:
- non-incisional hernias (umbilical hernias, spigelian hernias, epigastric hernias)
- incisional hernias (simple suture repair, open mesh repair)
- rectus abdominis diastasis
- rectus sheath hematoma

35
Q

What is a Fothergill’s sign?

A

Palpatioon of a mass that does not change during contrction of the rectus muscle

36
Q

What are the different acquired disorders of the omentum?

A

Omental infarction
Omental cysts

37
Q

What is the type of cancer most comonly seen to have omental involvement?

A

Ovarian cancer

38
Q

What are the diff conditions in the mesentery?

A

Sclerosing mesenteritis
Mesenteric cyst
Mesenteric tumors

39
Q

What are the 2 types of sclerosing mesenteritis?

A

Localized = Mesenteric lipodystrophy
Diffuse = mesenteric panniculitis

40
Q

What are the confirmatory signs of Sclerosing Mesenteritis in abdominal CT with IV contrast?

A

Tumor pseudocapsule
Fat ring sign

41
Q

What is a confirmatory sign of Mesenteric cyst?

A

Tillaux’s sign = mass that is only mobile laterally

42
Q

What are the boundaries of Retroperitneum?

A

Anterior: peritoneum
Posterior: iliopsoas & lumbar muscles
Superior: diaphragm
Inferior: levator ani

43
Q

what are the important spaces in retroperitoneum?

A

Anterior pararenal spacec
Perirenal space
Posterior pararenal space

Surgery 2 (2 decks)

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