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Anatomy of the Trunk > Week 9 - Abdominal Incision & Hernia > Flashcards

Week 9 - Abdominal Incision & Hernia Flashcards

* Describe the types and discuss the basis of abdominal herniae * Explain the causes of abdominal herniae * Differentiate between various types of abdominal herniae * Discuss the complications of abdominal herniae

1
Q

What are the 9 abdominal wall regions?

A
  • Right hypochondrium
  • Epigastric
  • Left hypochondrium
  • Right flank
  • Umbilical
  • Left flank
  • Right Groin (inguinal)
  • Pubic
  • Left groin (inguinal)

These regions are used for anatomical reference and surgical procedures.

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2
Q

What is the subcostal plane?

A

Level of the 10th costal margin, level of L3

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3
Q

What is the intertubercular plane?

A

Imaginary line between the 2 iliac tubercles, level of L5

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4
Q

Name the types of abdominal incisions.

A
  • Vertical incisions
  • Oblique abdominal incisions
  • Transverse abdominal incisions
  • Thoracolumbar incision

Each type is chosen based on the specific surgical requirements.

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5
Q

What is a laparotomy?

A

A surgical incision into the abdominal cavity for diagnostic purposes.

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6
Q

What factors influence the choice of abdominal incision type?

A
  • Organ to be removed
  • Patient’s obesity
  • Previous abdominal incisions and scars
  • Type of surgery
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7
Q

What complications can arise from abdominal wound closure?

A
  • Burst abdomen
  • Incisional hernia
  • Persistent sinuses
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8
Q

What is an abdominal hernia?

A

A piece of the intestine or other organ protruding through an opening in the abdominal wall.

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9
Q

What are common causes of abdominal hernias?

A
  • Normal weak sites in anatomy
  • Abnormal weakness of the anterior abdominal wall
  • Increased intraabdominal pressure
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10
Q

What are the types of hernias?

A
  • Inguinal Hernia
  • Femoral Hernia
  • Umbilical and para-umbilical hernias
  • Incisional and recurrent hernias
  • Epigastric Hernia
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11
Q

Where is the inguinal canal located?

A

Between the deep inguinal ring and superficial inguinal ring.

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12
Q

What structures pass through the deep inguinal ring?

A
  • Spermatic cord in males
  • Round ligament of the uterus in females
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13
Q

Where is the Hesselbach triangle?

A
  • Medial: Rectus abdominis muscle,
  • Inferior: Inguinal ligament,
  • Lateral: Inferior epigastric artery
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14
Q

What is the difference between indirect and direct inguinal hernia?

A
  • Indirect: Passes through both deep and superficial inguinal rings
  • Direct: Passes through weakness in abdominal wall
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15
Q

What is a hiatal hernia?

A

Occurs when part of the stomach protrudes through the diaphragm into the chest cavity.

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16
Q

What are the two main types of hiatal hernias?

A
  • Sliding hiatal hernia
  • Paraesophageal hernia
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17
Q

What symptoms are associated with hiatal hernias?

A
  • Heartburn
  • Sudden regurgitation
  • Pain on swallowing hot fluids
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18
Q

True or False: Inguinal hernias occur more frequently in women than men.

A

False

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19
Q

What are the compartments of the femoral sheath?

A
  • Lateral compartment: Femoral artery
  • Intermediate compartment: Femoral vein
  • Medial compartment: Femoral canal
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20
Q

What is an umbilical hernia?

A

A protrusion at the bellybutton due to failure of the abdominal muscles to close completely.

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21
Q

What are predisposing factors for incisional hernia?

A
  • Infection
  • Bowel obstruction
  • Obesity
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22
Q

What is an obturator hernia?

A

An extremely rare abdominal hernia that protrudes through the obturator foramen.

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23
Q

What is an epigastric hernia?

A

Occurs between the navel and the lower part of the rib cage, often painless and made up of fatty tissue.

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24
Q

What is the location of the subcostal plane?

A

At the level of the 10th costal margin, level of L3

The subcostal plane is an important anatomical reference point in abdominal surgery.

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25
What are the two imaginary planes that define the abdominal regions?
- Midclavicular plane - Intertubercular plane ## Footnote The midclavicular planes run vertically through the midpoint of the clavicle, while the intertubercular plane is horizontal at the level of L5.
26
Fill in the blank: The intertubercular plane is at the level of _______.
L5
27
List the regions of the abdomen.
* Epigastric region * Umbilical region * Pubic region * Hypogastric region * Right hypochondrium * Left hypochondrium * Right flank * Left flank * Right groin * Left groin * Right inguinal region or iliac fossa * Left lumbar region
28
True or False: The right inguinal region is also known as the iliac fossa.
True
29
What is the anatomical significance of the right hypochondrium?
It is a specific region of the abdomen located under the right rib cage ## Footnote This region can be relevant in diagnosing certain medical conditions affecting the liver and gallbladder.
30
What is the level of the umbilical region?
At the level of L3 ## Footnote The umbilical region is central and important for various surgical approaches.
31
Name the 9 abdominal regions.
* Right hypochondrium * Epigastric * Left hypochondrium * Right flank * Umbilicus * Left flank * Right iliac fossa * Suprapubic * Left groin/iliac fossa ## Footnote The abdominal regions are used for clinical assessment and surgical procedures.
32
What is the most common abdominal incision which is used in many different procedures?
Midline incision ## Footnote This type of incision is commonly used for various abdominal surgeries.
33
Fill in the blank: The _______ region is located at the center of the abdomen.
Umbilicus ## Footnote The umbilicus region is significant for its anatomical landmarks.
34
True or False: The left flank region is also known as the left iliac fossa.
False ## Footnote The left flank and left iliac fossa are distinct regions.
35
What are the components of the right lower quadrant in abdominal anatomy?
* Right iliac fossa * Suprapubic * Right flank ## Footnote Understanding the quadrants aids in locating organs and diagnosing conditions.
36
What is the significance of the epigastric region?
It contains important organs such as the stomach and part of the liver. ## Footnote The epigastric region is crucial in diagnosing gastrointestinal issues.
37
Fill in the blank: The _______ region is situated beneath the right hypochondrium.
Right flank ## Footnote This region is important for examining potential pathologies.
38
Name two types of abdominal incisions.
* Midline incision * Paramedian incision ## Footnote Different incisions serve various surgical purposes.
39
What is the purpose of identifying abdominal regions in clinical practice?
To facilitate diagnosis and surgical procedures. ## Footnote Knowledge of these regions helps in understanding anatomy and planning interventions.
40
True or False: The left hypochondrium is located on the right side of the abdomen.
False ## Footnote The left hypochondrium is on the left side, opposite the right hypochondrium.
41
What is an oblique incision?
A type of abdominal incision made at an angle ## Footnote Oblique incisions can be used in various surgical procedures.
42
What is a subcostal or Kocher's incision?
An abdominal incision made below the rib cage ## Footnote This incision is often used for access to the gallbladder.
43
What is the Rutherford Morison incision primarily used for?
Kidney transplant procedures ## Footnote This incision allows access to the renal area.
44
What is a McBurney incision?
An incision used for appendectomy ## Footnote It is located in the right lower quadrant of the abdomen.
45
List the types of vertical incisions.
* Midline * Paramedian * Transverse ## Footnote Vertical incisions are often used for various abdominal surgeries.
46
What is a Pfannenstiel incision?
A suprapubic incision used in gynecological surgeries ## Footnote This incision is often used for cesarean sections.
47
What is the Lanz incision used for?
Appendectomy procedures ## Footnote It is a modification of the McBurney incision.
48
What is a thoracolumbar incision?
An incision made in the thoracic or lumbar region ## Footnote This incision is often used for spinal surgeries.
49
Fill in the blank: The _______ incision is used for access to the gallbladder.
Subcostal or Kocher's incision
50
True or False: The McBurney incision is used for kidney transplant procedures.
False ## Footnote The McBurney incision is specifically used for appendectomies.
51
What does an incision usually refer to?
A surgical cut in a patient's skin by scalpel
52
Name a type of vertical incision.
Midline incision
53
What is a paramedian incision?
A type of vertical incision located beside the midline
54
Identify an oblique abdominal incision.
Subcostal or Kocher's incision
55
What is the Rutherford Morrison incision used for?
Kidney transplant (right or left)
56
Name a transverse abdominal incision.
Pfannenstiel incision
57
What is the purpose of a midline laparotomy?
Intra-abdominal access
58
Fill in the blank: The _______ incision is used for open cholecystectomy.
Subcostal or Kocher’s
59
What is the 'Mercedes Benz' incision used for?
Liver transplant
60
What is the gridiron incision primarily used for?
Open appendectomy
61
Fill in the blank: The _______ incision is often used in gynaecological and obstetric surgeries.
Pfannenstiel
62
What does the term 'stoma closure/formation' refer to in relation to incisions?
Transverse incision
63
True or False: The McBurney incision is a type of transverse abdominal incision.
False
64
What is the significance of the Lanz incision?
Used for appendectomy
65
Name a type of incision that provides intra-abdominal access.
Midline laparotomy or paramedian incision
66
What is a median or midline incision?
A surgical incision made along the midline of the abdomen ## Footnote Commonly used for abdominal surgeries.
67
What is a left paramedian incision?
An incision made to the left of the midline of the abdomen ## Footnote Often used when access to the left side of the abdomen is needed.
68
What is a Gridiron (muscle-splitting) incision?
An incision that splits the muscle fibers of the abdominal wall ## Footnote Typically used for appendectomies.
69
What is a transverse (abdominal) incision?
An incision made horizontally across the abdomen ## Footnote Used in various surgical approaches.
70
What is a suprapubic (Pfannenstiel) incision?
A horizontal incision made just above the pubic bone ## Footnote Commonly used in gynecological surgeries.
71
What is a subcostal incision?
An incision made just below the rib cage ## Footnote Often used for access to the liver or gallbladder.
72
Where is McBurney point located?
The usual location of the appendix ## Footnote Found in the right lower quadrant of the abdomen.
73
What is a laparotomy?
A surgical procedure involving an incision into the abdominal cavity ## Footnote Used for diagnosis and treatment of abdominal conditions.
74
What factors affect the type of abdominal incision used?
* Organ being removed * Obesity * Previous incisions or scars * Type of surgery ## Footnote Each factor influences the choice of incision for optimal results.
75
What are complications of an abdominal wound closure?
* Burst abdomen * Incisional hernia * Persistent sinuses * Leave a neat scar ## Footnote These complications can affect recovery and surgical outcomes.
76
Define a hernia.
A condition where an organ pushes through an opening in the muscle or tissue that holds it in place ## Footnote Common types include inguinal, femoral, and umbilical hernias.
77
What is an abdominal hernia?
A piece of the intestine or other organ protruding through an opening in the abdominal wall.
78
What causes hernias?
- Increased intraabdominal pressure due to persistent constipation - persistent cough - strain - ascites
79
List some conditions that lead to increasing pressure on the abdominal cavity.
* Obesity * Lifting heavy objects * Chronic lung disease (chronic coughing)
80
What can cause abnormal weakness of the anterior abdominal wall?
Congenital abnormality or acquired as a result of trauma or diseases.
81
Where are the normal sites of weakness in the abdominal wall related to?
Anatomy of the area, such as the location of superficial and deep inguinal ring, or areas with only scar tissue.
82
What is the inguinal canal?
A slit-like passage extending downward and medial between the deep and superficial inguinal ring.
83
What are the contents of the inguinal canal?
* Ilioinguinal nerve
84
True or False: Hernias can only occur due to congenital abnormalities.
False
85
Fill in the blank: Hernias occur where the abdominal wall is _______ or where a previous opening has occurred during abdominal surgery.
[weakened]
86
What is the spermatic cord?
A structure that passes through the inguinal canal containing blood vessels, nerves, and the vas deferens. ## Footnote The spermatic cord is crucial for male reproductive anatomy.
87
What is the round ligament of the uterus?
A ligament that helps support the uterus and passes through the inguinal canal. ## Footnote The round ligament is significant in female reproductive anatomy.
88
Where is the deep inguinal ring located?
1/2 inch above the mid-inguinal point, midway between ASIS and pubic symphysis. ## Footnote The deep inguinal ring is an important anatomical landmark in hernia surgery.
89
What structures pass through the deep inguinal ring?
Spermatic cord and round ligament of the uterus. ## Footnote These structures are crucial for understanding inguinal hernias.
90
What is the superficial inguinal ring?
An opening in the external oblique aponeurosis. ## Footnote The superficial inguinal ring is the exit point of the inguinal canal.
91
Where is the superficial inguinal ring located?
Above and lateral to the pubic tubercle. ## Footnote This location is significant for surgical approaches to the inguinal region.
92
What structures pass through the superficial inguinal ring?
- Spermatic cord - Round ligament - Ilioinguinal nerve. ## Footnote The ilioinguinal nerve provides sensory innervation to the skin of the groin.
93
What is the ASIS of the pelvis?
Anterior Superior Iliac Spine
94
What anatomical landmark is located at the midpoint of the inguinal ligament?
Mid-inguinal point
95
What is the significance of the pubic symphysis?
It is a cartilaginous joint between the left and right pubic bones
96
What is the pubic tubercle?
A bony prominence on the superior part of the pubis
97
Fill in the blank: The midpoint of the inguinal ligament is known as the _______.
Mid-inguinal point
98
True or False: The ASIS is a landmark on the posterior aspect of the pelvis.
False
99
List the key anatomical landmarks of the pelvis:
* ASIS of the pelvis * Mid-inguinal point * Midpoint of the inguinal ligament * Pubic symphysis * Pubic tubercle
100
What does the abbreviation ASIS stand for?
Anterior Superior Iliac Spine
101
What is the layer of tissue that lines the abdominal cavity?
Peritoneum
102
Which muscle lies below the peritoneum and above the fascia transversalis?
Transversus abdominis muscle
103
What is the role of the internal oblique muscle in relation to the inguinal canal?
Reinforces the anterior wall of the inguinal canal
104
Which vessels are located in the inguinal region and include the external iliac vessels?
Inferior epigastric vessels
105
What anatomical structure is referred to as the deep inguinal ring?
Entry point into the inguinal canal
106
Fill in the blank: The _______ is the outermost muscle layer of the abdominal wall.
External oblique muscle
107
What is the function of the inguinal ligament?
Supports the inguinal canal
108
Which vessels are found in the femoral region?
Femoral vessels
109
True or False: The superficial inguinal ring is a reinforced structure.
True
110
The anterior wall of the inguinal canal is primarily formed by which structure?
External oblique aponeurosis
111
What are the walls of the inguinal canal?
- **Anterior** - External oblique aponeurosis, internal oblique aponeurosis, superficial inguinal ring - **Posterior** - Transversalis fascia, conjoint tendon, Deep inguinal ring - **Roof** - Medial crus of the external oblique aponeurosis, musculoaponeurotic arches of the internal oblique & transverse abdominal muscles, transversalis fascia - **Floor** - inguinal ligament, Lacunar ligament, iliopubic tract
112
Which muscle provides the strongest reinforcement opposite the deep inguinal ring?
Internal oblique muscle
113
What are the components of the posterior wall of the inguinal canal?
* Conjoint tendon (medially) * Fascia transversalis (laterally) ## Footnote The posterior wall is crucial for the structural integrity of the inguinal canal.
114
Which structure is behind the superficial inguinal ring?
Conjoint tendon ## Footnote The conjoint tendon provides support and stability to the inguinal canal
115
What forms the roof of the inguinal canal?
Arching lowest fibers of internal oblique and transversus abdominis ## Footnote These muscles help to form a protective layer over the canal.
116
What constitutes the floor of the inguinal canal?
- Inguinal ligament - Lacunar ligament (medially) ## Footnote These ligaments provide support and boundaries to the canal.
117
True or False: The lacunar ligament is part of the floor of the inguinal canal.
True ## Footnote The lacunar ligament plays a role in the anatomy of the inguinal region.
118
Fill in the blank: The strongest structure opposite the superficial ring is the _______.
conjoint tendon ## Footnote This tendon is vital for preventing hernias in the inguinal region.
119
What is the significance of the fascia transversalis in the inguinal canal?
It forms the lateral part of the posterior wall ## Footnote This fascia is important for supporting the structures within the canal.
120
What is the main function of the inguinal ligament?
Forms the floor of the inguinal canal and supports structures ## Footnote This ligament is crucial for maintaining the integrity of the inguinal region.
121
What is the linea alba?
A fibrous structure that runs down the midline of the abdomen.
122
What does the femoral sheath contain?
Femoral artery, femoral vein, and lymphatic vessels.
123
Which nerve innervates the area around the inguinal region?
Ilioinguinal nerve.
124
Where is the pubic tubercle located?
On the superior aspect of the pubic bone.
125
What does the spermatic cord contain?
- Ductus deferens - Testicular artery, and nerves.
126
What is the function of the cremaster muscle?
Regulates the temperature of the testes.
127
What does the superficial inguinal ring refer to?
The opening in the external oblique aponeurosis.
128
What anatomical landmark is known as the symphysis pubis?
The joint where the left and right pubic bones meet.
129
What is the significance of the inferior epigastric artery?
It supplies blood to the lower abdominal wall.
130
Fill in the blank: The _______ is a fibrous band that serves as the midline of the abdomen.
linea alba
131
True or False: The deep inguinal ring is an opening in the transversalis fascia.
True
132
What is the pectineal line?
A ridge on the superior pubic ramus.
133
What does the term 'pubic crest' refer to?
The anterior border of the pubic bone.
134
What is the conjoint tendon?
The fusion of the internal oblique and transversus abdominis aponeuroses.
135
What is the role of the iliohypogastric nerve?
It provides sensory innervation to the skin of the lower abdomen.
136
Fill in the blank: The _______ is a structure that encases the spermatic cord.
femoral sheath
137
What is the medial boundary of Hesselbach's triangle?
Rectus abdominis muscle ## Footnote Hesselbach's triangle is important in understanding the anatomy related to hernias.
138
What is the inferior boundary of Hesselbach's triangle?
Inguinal ligament ## Footnote The inguinal ligament forms the lower margin of Hesselbach's triangle.
139
What is the lateral boundary of Hesselbach's triangle?
Inferior epigastric artery ## Footnote This artery plays a crucial role in the vascular supply to the abdominal wall and is relevant in hernia surgery.
140
Where do the inferior epigastric vessels lie in relation to direct and indirect hernias?
- Indirect hernia passes lateral to inferior epigastric vessels - Direct hernia passes medial to inferior epigastric vessels ## Footnote Understanding the relationship between hernias and inferior epigastric vessels is essential for surgical approaches.
141
Which nerves traverse the inguinal canal?
- Ilioinguinal nerve - Genital branch of genitofemoral nerve ## Footnote These nerves are important in the innervation of the groin area and can be affected during hernia repair.
142
True or False: An indirect hernia passes medial to the inferior epigastric vessels.
False ## Footnote Indirect hernias pass lateral to inferior epigastric vessels, while direct hernias pass medial.
143
Fill in the blank: An indirect hernia passes ______ to the inferior epigastric vessels.
lateral ## Footnote This distinction is critical for surgical identification of hernia types.
144
Fill in the blank: A direct hernia passes ______ to the inferior epigastric vessels.
medial ## Footnote Recognizing this relationship aids in understanding hernia formation.
145
What are the two main types of inguinal hernias?
Indirect (Congenital) and Direct (Acquired) ## Footnote Indirect hernias follow the path of the processus vaginalis through the inguinal canal, while direct hernias occur through a weakness in the abdominal wall.
146
Where does an indirect inguinal hernia pass through?
Both deep and superficial inguinal rings ## Footnote It follows the path of the processus vaginalis.
147
In which anatomical location is a distended mass typically found in an indirect inguinal hernia?
In the spermatic cord, often found in the scrotum/labia ## Footnote The mass is associated with the spermatic cord.
148
How does a direct inguinal hernia differ in its passage compared to an indirect hernia?
Not through the inguinal canal ## Footnote It passes through a weakness in the abdominal wall.
149
Where is the mass located in a direct inguinal hernia?
Adjacent to the spermatic cord ## Footnote It rarely enters the scrotum or labia.
150
How does the location of the mass in a direct inguinal hernia relate to the inferior epigastric artery?
Medial to inferior epigastric artery ## Footnote This is in contrast to indirect hernias, which are lateral to the inferior epigastric artery.
151
Which gender is more commonly affected by inguinal hernias?
Males ## Footnote Inguinal hernias are 20 times more common in males.
152
What is the peritoneum?
A serous membrane that forms the lining of the abdominal cavity ## Footnote The peritoneum supports the abdominal organs and serves as a conduit for their blood vessels, lymphatics, and nerves.
153
What are the layers involved in an inguinal hernia?
• Peritoneum • Transversalis fascia • Transversus abdominis muscle • Internal oblique muscle • External oblique muscle ## Footnote These layers are crucial for understanding the anatomy involved in hernia formation.
154
In an indirect inguinal hernia, where does the herniating bowel pass the inferior epigastric vessels?
LATERAL to inferior epigastric vessels to enter deep inguinal ring ## Footnote This is in contrast to direct inguinal hernias where the bowel passes MEDIAL to these vessels.
155
What structures are involved in a direct inguinal hernia?
Herniating bowel passes MEDIAL to inferior epigastric vessels ## Footnote The bowel pushes through the peritoneum and transversalis fascia in the inguinal triangle.
156
List the types of hernias.
• Inguinal • Femoral • Umbilical or paraumbilical • Incisional and recurrent • Epigastric ## Footnote Understanding the types of hernias is essential for diagnosis and treatment.
157
What is the inguinal falx?
Conjoint tendon ## Footnote It is formed by the fusion of the internal oblique and transversus abdominis muscles.
158
What is the role of the spermatic cord in hernias?
It contains the hernial sac in indirect hernias ## Footnote The hernial sac parallels the spermatic cord in males.
159
True or False: The deep inguinal ring is the entry point for direct inguinal hernias.
False ## Footnote The deep inguinal ring is the entry point for indirect inguinal hernias.
160
Fill in the blank: Herniating bowel in a direct inguinal hernia passes ______ to inferior epigastric vessels.
MEDIAL
161
Fill in the blank: Herniating bowel in an indirect inguinal hernia passes ______ to inferior epigastric vessels.
LATERAL
162
What are the two types of inguinal hernias?
Indirect and direct ## Footnote Indirect inguinal hernia passes via the deep inguinal ring, while direct inguinal hernia passes through the posterior wall of the canal.
163
Describe the path of an indirect inguinal hernia.
Passes via the deep inguinal ring along the canal and emerges through the superficial ring, descending into the scrotum ## Footnote This type of hernia goes through the inguinal tunnel.
164
What characterizes a direct inguinal hernia?
Rarely protrudes into the scrotum and bursts through the posterior wall ## Footnote This type is associated with weakness in the abdominal wall, often due to aging.
165
At what age is a direct inguinal hernia most likely to occur?
Almost always in middle-aged or elderly individuals ## Footnote Aging contributes to wall weakness leading to hernias.
166
What are the two types of hiatal hernia?
Sliding hiatus hernia and paraesophageal hiatus hernia ## Footnote These types are classified based on their anatomical characteristics and involvement of the diaphragm.
167
What is a characteristic feature of a sliding hiatus hernia?
Weak diaphragm and oesophageal sphincter ## Footnote This type of hernia allows the stomach to slide up into the chest through the diaphragm.
168
What symptoms are associated with hiatal hernia?
* Heartburn * Sudden regurgitation * Gastroesophageal reflux * Pain on swallowing hot liquids ## Footnote These symptoms can vary in severity and frequency among individuals.
169
What diagnostic methods are used for hiatal hernia?
* Barium meal x-rays * Gastroscopy ## Footnote These methods help visualize the hernia and assess its impact on surrounding structures.
170
True or False: The oesophageal sphincter is involved in both types of hiatal hernia.
True ## Footnote The involvement of the oesophageal sphincter is a key factor in the development of sliding and paraesophageal hernias.
171
Fill in the blank: A hiatal hernia can occur due to a _______ diaphragm.
Weak ## Footnote A weak diaphragm contributes to the displacement of the stomach into the thoracic cavity.
172
What is the role of the pyloric sphincter in the digestive system?
Regulates the passage of food from the stomach to the duodenum ## Footnote This sphincter helps control gastric emptying and prevents backflow.
173
What is the relationship between the diaphragm and the oesophagus in the context of hiatal hernia?
The diaphragm surrounds the oesophagus and can become weak, allowing herniation ## Footnote This anatomical relationship is crucial for understanding how hiatal hernias develop.
174
What is gastroesophageal reflux?
The backflow of stomach contents into the oesophagus ## Footnote This condition is often associated with hiatal hernias and can lead to heartburn and discomfort.
175
What is a sliding hiatus hernia?
A condition where the stomach and part of the esophagus slide up into the chest through the hiatus. ## Footnote More common than paraesophageal hernias.
176
What is a paraesophageal hernia?
A less common type of hernia where part of the stomach squeezes up through the hiatus next to the esophagus, with the esophagus and stomach remaining in normal locations. ## Footnote More cause for concern due to the risk of strangulation and loss of blood supply.
177
What are the main risk factors for a femoral hernia?
Rare incidence, usually occurs in females. ## Footnote Femoral hernias are generally less common than inguinal hernias.
178
Where is a femoral hernia located?
Below and lateral to the pubic tubercle. ## Footnote This location is important for diagnosis and surgical intervention.
179
What are the contents of a femoral sheath?
The femoral sheath, which includes: - Lateral compartment: femoral artery - Intermediate compartment: femoral vein - Medial compartment: femoral canal ## Footnote The femoral canal contains efferent lymphatic vessels and lymph nodes.
180
What happens if abdominal contents enter the femoral canal?
If the canal becomes large enough, abdominal contents, usually intestine, can bulge below the inguinal crease. ## Footnote This can lead to complications if not addressed.
181
True or False: A sliding hiatus hernia is more common than a paraesophageal hernia.
True ## Footnote Sliding hiatus hernias occur more frequently in the general population.
182
Fill in the blank: A paraesophageal hernia is characterized by the stomach squeezing up through the hiatus _______ the oesophagus.
next to ## Footnote This positioning differentiates it from sliding hiatus hernias.
183
What is a risk associated with hernias?
Becoming irreducible and strangulated ## Footnote Strangulation can lead to tissue necrosis and requires immediate medical intervention.
184
What are the three compartments of the femoral sheath?
- Lateral compartment - Intermediate compartment - Medial compartment ## Footnote Each compartment contains specific vessels: the lateral contains the femoral artery, the intermediate contains the femoral vein, and the medial contains the femoral canal.
185
What does the medial compartment of the femoral sheath contain?
Femoral canal ## Footnote The femoral canal contains efferent lymphatic vessels and lymph nodes.
186
Fill in the blank: The lateral compartment of the femoral sheath contains the _______.
Femoral artery
187
Fill in the blank: The intermediate compartment of the femoral sheath contains the _______.
Femoral vein
188
What is the sac of a femoral hernia?
A protrusion in the femoral canal ## Footnote Femoral hernias are more common in females due to pelvic anatomy.
189
What is an indirect inguinal hernia?
A hernia that occurs through the inguinal ring ## Footnote It often occurs in males and can be congenital.
190
What percentage of hernias are umbilical hernias?
10-30% ## Footnote Umbilical hernias are often noted after birth.
191
What causes umbilical hernias in babies?
Failure of abdominal muscle near navel to close completely after birth
192
What can cause umbilical hernias in adults?
Excessive pressure on abdomen ## Footnote Factors contributing to this pressure include obesity and previous surgery.
193
What are the risk factors for developing an umbilical hernia?
- Obesity - Surgery - Multiple pregnancies - Fluid build up ## Footnote Other factors may include chronic cough, heavy lifting, and pregnancy.
194
What type of hernia is more common in adults?
Paraumbilical hernias ## Footnote Paraumbilical hernias are more prevalent than umbilical hernias in adults.
195
Through what structure do paraumbilical hernias herniate?
Linea alba ## Footnote They do not herniate directly through the umbilicus.
196
What percentage of abdominal surgeries result in incisional hernias?
2-10% ## Footnote Incisional hernias occur after surgical procedures.
197
What is the recurrence rate of incisional hernias after surgical repair?
20-45% ## Footnote This indicates a significant risk of hernia recurrence.
198
List some risk factors associated with hernias.
* Infection * Bowel obstruction * Obesity ## Footnote These factors can lead to hernia development.
199
What results from muscles and aponeurotic layers of the abdomen not healing properly?
Hernias ## Footnote Poor healing can create areas of weakness leading to hernias.
200
What does the site of incision create that contributes to hernias?
An area of weakness ## Footnote This weakness allows for potential herniation.
201
What can protrude through a surgical incision in the case of a hernia?
Omentum or organ ## Footnote This protrusion is a defining characteristic of hernias.
202
What are the risks associated with hernias increasing in size over time?
* Intestinal obstruction * Strangulation * Entero-cutaneous fistula * Chronic back/abdominal pain * Loss of abdominal domain * Poor pulmonary function ## Footnote These complications can arise as a hernia grows.
203
What is an obturator hernia?
An obturator hernia is extremely rare and mostly occurs in women, where the hernia protrudes from the pelvic cavity through the obturator foramen.
204
Does an obturator hernia appear as a bulge?
No, an obturator hernia will not appear as a bulge.
205
What symptoms can an obturator hernia cause?
An obturator hernia can act like a bowel obstruction, causing nausea and vomiting.
206
What is an epigastric hernia?
An epigastric hernia is a weak area in the abdominal wall in the epigastric region, composed mainly of fatty tissue and rarely containing intestine.
207
How is an epigastric hernia characterized when first discovered?
An epigastric hernia is painless and irreducible when first discovered.
208
What is the location of an epigastric incision?
Upper abdomen at midline ## Footnote Epigastric incisions are made in the upper part of the abdomen, typically for surgical access.
209
Where is an incisional hernia typically found?
At the site of previous surgical invasion ## Footnote Incisional hernias occur at locations where previous surgeries have taken place.
210
What characterizes a direct inguinal hernia?
Near the opening of the inguinal canal ## Footnote Direct inguinal hernias protrude through a weakness in the abdominal wall near the inguinal canal.
211
Define an indirect inguinal hernia.
At the opening of the inguinal canal ## Footnote Indirect inguinal hernias occur at the inguinal canal and can follow the path of the spermatic cord.
212
What is the location of an umbilical hernia?
At the navel ## Footnote Umbilical hernias occur around the area of the belly button.
213
Where do femoral hernias occur?
In the femoral canal ## Footnote Femoral hernias protrude through the femoral canal, which is located below the inguinal ligament.
214
What is the best direction for an incision to minimize scarring?
In the direction of the cleavage ## Footnote Incisions made along the lines of skin cleavage tend to heal better and result in less visible scarring.
215
What happens to muscle fibers when an incision is made along their line?
Fibers will fall back into position and function normally ## Footnote Making incisions along muscle fiber lines helps maintain function post-surgery.
216
Why should main nerves be avoided during an incision?
Dividing a main nerve can result in paralysis of part of the anterior abdominal musculature ## Footnote Protecting nerves is crucial to prevent loss of muscle function in the abdominal area.
217
What can weakness in the abdominal wall lead to?
Bulging forward of the abdominal wall and visceroptosis ## Footnote Weakness in the abdominal wall can cause displacement or prolapse of abdominal organs below their natural position.
218
What is the location of a Vertical Midline incision?
Sternal notch to symphysis pubis ## Footnote This incision allows primary exposure of any part of the abdominal cavity.
219
What is the primary indication for a McBurney incision?
Open appendectomy ## Footnote The incision is located at the McBurney point and extends toward the right flank.
220
What is the location of an Inguinal incision?
Pubic tubercle to anterior iliac crest ## Footnote This incision is above and parallel to the inguinal crease and may be extended for various procedures.
221
What are the indications for a Subcostal (Kocher) incision?
Open procedures of the gallbladder, biliary system, pancreas, and spleen ## Footnote This incision extends laterally and obliquely downward to just below the costal margin.
222
What is the location of a Pfannenstiel incision?
Transverse, across the lower abdomen ## Footnote This incision is typically used for gynecologic and obstetric procedures.
223
What is the indication for a Midabdominal incision?
Colectomy or colostomy ## Footnote This incision extends laterally to the lumbar region at an angle between the ribs and iliac crest.
224
What is the location of a Thoracoabdominal incision?
Midpoint between the xiphoid and umbilicus extending posteriorly across the 7th or 8th interspace ## Footnote This incision is used for surgery of the proximal stomach, distal esophagus, and anterior spine.
225
List the advantages of a Vertical Midline incision.
* Good exposure * Easy hemostasis * Fewer layers traversed * Quick and easy to close with firm closure * Less chance of postoperative herniation or disruption * Does not disrupt any major abdominal arteries ## Footnote Other advantages include good access to inguinal canal and related structures, good cosmetic results, and minimal nerve damage.
226
What are the disadvantages of a McBurney incision?
* Postoperative hernias above the umbilicus common * Midline crossover vasculature is permanently altered * Dehiscence and evisceration common * Exposure is limited and difficult to extend * Superior epigastric artery may be sacrificed * Painful due to size and exposure required for procedure ## Footnote This incision also interrupts lateral blood supply and innervation to the rectus muscle.
227
True or False: A Subcostal (Kocher) incision alters the blood supply to the abdominal wall.
False ## Footnote It does not alter blood supply to the abdominal wall if the deep inferior epigastric artery is left intact.
228
Fill in the blank: The Pfannenstiel incision is typically used for _______.
[gynecologic and obstetric procedures]
229
What is a common issue associated with a Vertical Midline incision?
Postoperative hernias ## Footnote This issue is particularly common above the umbilicus.

Anatomy of the Trunk (12 decks)

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