surgery? Flashcards
what are risk factors for abdominal hernias
obesity // ascites // age // surgery
features of abdo hernias
lump // cough impluse // pain // obstruction // strangulation
what is the most common abdo wall hernia
inguinal
who usually gets inguinal hernias
men
where do inguinal hernias usually occur + what are symptoms
superior and medial to pubic tubercle // discomfort worse on activity
when is surgery indicated for inguinal hernias
all patients even if asymptomatic
surgery for inguinal hernias
unilteral = open // bilateral or recurring = lap
when can you return to work after inguinal hernias
open repair (2-3 weeks) // lap (1-2) weeks
what is a direct vs indirect inguinal hernia
direct is a bulge in posterior wall of bowel that protrudes into the superficial ring // indirect is herniation down the deep inguinal ring
what is an incarcerated hernia and what does it increase risk of
non-reducible // risk of strangulation
what is a strangulated inguinal hernia
blood supply to tissue cut off –> ischaemia –> bowel perforation
symptoms strangulated inguinal hernia
pain in perviously aysmptomatic hernia // fever // increased size // peritonitis // bowel obstuction // bloody stool
bloods in strangulated hernia
raised lactate // raised WCC (leukocytosis)
should you reduce a strangulated inguinal hernia
no –> can increase peritonitis
what hernia is common in children
inguinal hernias (males)
what passage to femoral hernias form
through femoral ring –> femoral canal
anatomy of femoral hernia
inferolateral to pubic tubercle
symptoms femoral hernia
mildy painful // non reducable // no cough impulse // multiparous women
complications femoral hernia
straungulation // bowel obstruction// bowel ischaemia
mx femoral hernia
surgery - lapaopscopically or open
how do direct inguinal hernias form
weakness in hesselbach traingle
how do indirect hernias form
failure of processus vaginalis to close
o/e how would you differentiate direct vs indirect hernia
reduce –> cover deep inguinal canal –> cough –> reappears = direct // does not reappear = indirect
where do epigastric hernias form
midline between umbilicus and xiphisternum
rf for epigastric hernias
teenage boys // exercise // coughing
where do umbilical hernias appear and who gets them
symmetrically under umbilicus - newborns
where do para-umbilical hernias appear and who gets them
asymmetric above or below umbilicus - obesity and ascites
when would Hartmann’s procedure be indictaed
emergency eg bowel obstruction or perforation
indication proctocolectomy UC
dysplastic transformation
mx emergency colitis
sub total colectomy + end ileostomy
restorative option UC
ileoanal pouch (only if rectim in situ)
surgical mx chrons
small bowe; resections // ileocacel resection
4 types of fistulas
Enterocutaneous (skin to intestine) // enter colic (large or small intestine) // enterovaginal // enterovesicular (to bladder)
invx fistulas
barium + CT
location + appearance ileostomy
RIF, spouted, liquids
location + appearance colostomy
usually left side, flushed, solids
indication loop ileostomy
definitioning colon eg rectal cancer to PROTECT for an anastomosis
function end ileostomy
following complete colon excision with NO plan for anastomosis
indication loop colostomy
definition single section of colon in obstructing cancer // may be anastomosed later
what is abdominal wound dehiscence
all layers of abdo closure fail and viscera protrudes externally
superficial vs compelete abdominal wound dehiscence
superficial = skin // complete = all layers
RF abdominal wound dehiscence
malnutrition // jaundice // steroids // wound contamination
mx abdominal wound dehiscence
cover wound with saline gauze, IV broad spec abx, analgesia, IV fluids
absolute contraindications laparoscopic surgery
haeodynamically unstable // raised ICP // acute intestinal obstruction, bowel loops >4cm // coagulopathy
complications lap surgery
anaesthetic // bradycardia // surgical emphysema // GI tract or vessel injury
common hormone imbalance after brain surgery
SIADH –> hypoNa
common complication + mx following GI surgery
ileus –> NG tube
what is a anastaotpic leak
sepsis –> mediastinitis or peritonitis