Week 1 Flashcards
Describe longitudinal incisions
midline and paramedian incisions good exposure and access to the viscera
Describe median incisions
avoid cutting muscle, major blood vessels, and nerves made along the lines alba which means that there are only small vessels and nerves that are present
Describe paramedian incisions
lateral to the median plane; sagittal plane Open the anterior sheath, push the rectus muscles aside laterally and enter the peritoneum
Describe an oblique incision
Cut is related to the muscle fiber orientation
Describe Gridiron incisions
Used in appendectomy muscle splitting
Describe the oblique McBurney incision
Made at mcBurneys point, 2.5 cm superomedial to the ASIS careful to preserve the iliohypogastric nerve that runs deep to the internal oblique
Describe a suprapubic incision
made at the pubic hairline horizontal incisions gyn/OB surgeries linea alba and anterior layers of the rectus sheaths are transected and resected superiorly; rectus muscles are retracted iliohypogastric nerves and ilioinguinal nerves are identified and preserved
Describe subcostal incisions
provide access to the gallbladder and biliary ducts on the right side and spleen on the left 2.5 cm inferior to the costal margin to AVOID the 7th and 8th T spine nerves
What are the high risk incisions?
Pararectus and inguinal
Why are pararectus incisions high risk?
They are along the lateral border of the rectus sheath, can cut off the nerve supply to the rectus abdomens
Why are inguinal incisions high risk?
may injure the olio-inguinal nerve
If there is an infection or cancer that is ABOVE the umbilicus what lymph nodes will it travel to?
Axillary lymph nodes
If there is an infection or cancer that is BELOW The umbilicus, what lymph nodes will the infection and cancer mets to?
Superficial inguinal lymph nodes
If there is an infection in the deep veins or a cancer surrounding, what lymph nodes and veins will it travel to?
Deep lymph vessels External and internal iliac veins
What is the site for the direct inguinal hernia?
The medial inguinal fossa
What is the site of the indirect inguinal hernia?
Lateral inguinal fossa
If you have a patient come in with RLQ pain, fever, positive heel strike, and positive Rovsigns test, what incision would you expect to be made should the patient need surgery?
Gridiron
If you have a patient come in with a positive murphys sign, which incision would you expect to be used?
Subcostal
If you have a patient in which you need to have a good vantage point of the entire abdomen, which incision would you use?
Longitudinal
If there is cancer or infection in the scrotum, which lymph nodes does it spread to?
Scrotum drains into the superficial inguinal lymph then goes to the iliac and lumbar lymph nodes
If there is cancer or an infection in the testes, where will it spread?
Lumbar and pre-aortic lymph nodes
Describe a direct inguinal hernia
Medial to the inferior epigastric ligament occurs in the peritoneum alongside the spermatic cord
An _______ ________ ________ enters the deep ring and occurs within the sprematic cord and is able to go into the balls
indirect inguinal hernia