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
What are the 9 abdominal wall regions?
- 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.
What is the subcostal plane?
Level of the 10th costal margin, level of L3
What is the intertubercular plane?
Imaginary line between the 2 iliac tubercles, level of L5
Name the types of abdominal incisions.
- Vertical incisions
- Oblique abdominal incisions
- Transverse abdominal incisions
- Thoracolumbar incision
Each type is chosen based on the specific surgical requirements.
What is a laparotomy?
A surgical incision into the abdominal cavity for diagnostic purposes.
What factors influence the choice of abdominal incision type?
- Organ to be removed
- Patient’s obesity
- Previous abdominal incisions and scars
- Type of surgery
What complications can arise from abdominal wound closure?
- Burst abdomen
- Incisional hernia
- Persistent sinuses
What is an abdominal hernia?
A piece of the intestine or other organ protruding through an opening in the abdominal wall.
What are common causes of abdominal hernias?
- Normal weak sites in anatomy
- Abnormal weakness of the anterior abdominal wall
- Increased intraabdominal pressure
What are the types of hernias?
- Inguinal Hernia
- Femoral Hernia
- Umbilical and para-umbilical hernias
- Incisional and recurrent hernias
- Epigastric Hernia
Where is the inguinal canal located?
Between the deep inguinal ring and superficial inguinal ring.
What structures pass through the deep inguinal ring?
- Spermatic cord in males
- Round ligament of the uterus in females
Where is the Hesselbach triangle?
- Medial: Rectus abdominis muscle,
- Inferior: Inguinal ligament,
- Lateral: Inferior epigastric artery
What is the difference between indirect and direct inguinal hernia?
- Indirect: Passes through both deep and superficial inguinal rings
- Direct: Passes through weakness in abdominal wall
What is a hiatal hernia?
Occurs when part of the stomach protrudes through the diaphragm into the chest cavity.
What are the two main types of hiatal hernias?
- Sliding hiatal hernia
- Paraesophageal hernia
What symptoms are associated with hiatal hernias?
- Heartburn
- Sudden regurgitation
- Pain on swallowing hot fluids
True or False: Inguinal hernias occur more frequently in women than men.
False
What are the compartments of the femoral sheath?
- Lateral compartment: Femoral artery
- Intermediate compartment: Femoral vein
- Medial compartment: Femoral canal
What is an umbilical hernia?
A protrusion at the bellybutton due to failure of the abdominal muscles to close completely.
What are predisposing factors for incisional hernia?
- Infection
- Bowel obstruction
- Obesity
What is an obturator hernia?
An extremely rare abdominal hernia that protrudes through the obturator foramen.
What is an epigastric hernia?
Occurs between the navel and the lower part of the rib cage, often painless and made up of fatty tissue.
What is the location of the subcostal plane?
At the level of the 10th costal margin, level of L3
The subcostal plane is an important anatomical reference point in abdominal surgery.
What are the two imaginary planes that define the abdominal regions?
Midclavicular planes and intertubercular plane
The midclavicular planes run vertically through the midpoint of the clavicle, while the intertubercular plane is horizontal at the level of L5.
Fill in the blank: The intertubercular plane is at the level of _______.
L5
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
True or False: The right inguinal region is also known as the iliac fossa.
True
What is the anatomical significance of the right hypochondrium?
It is a specific region of the abdomen located under the right rib cage
This region can be relevant in diagnosing certain medical conditions affecting the liver and gallbladder.
What is the level of the umbilical region?
At the level of L3
The umbilical region is central and important for various surgical approaches.
Name the 9 abdominal regions.
- Right hypochondrium
- Epigastric
- Left hypochondrium
- Right flank
- Umbilicus
- Left flank
- Right iliac fossa
- Suprapubic
- Left groin/iliac fossa
The abdominal regions are used for clinical assessment and surgical procedures.
What is the most common abdominal incision which is used in many different procedures?
Midline incision
This type of incision is commonly used for various abdominal surgeries.
Fill in the blank: The _______ region is located at the center of the abdomen.
Umbilicus
The umbilicus region is significant for its anatomical landmarks.
True or False: The left flank region is also known as the left iliac fossa.
False
The left flank and left iliac fossa are distinct regions.
What are the components of the right lower quadrant in abdominal anatomy?
- Right iliac fossa
- Suprapubic
- Right flank
Understanding the quadrants aids in locating organs and diagnosing conditions.
What is the significance of the epigastric region?
It contains important organs such as the stomach and part of the liver.
The epigastric region is crucial in diagnosing gastrointestinal issues.
Fill in the blank: The _______ region is situated beneath the right hypochondrium.
Right flank
This region is important for examining potential pathologies.
Name two types of abdominal incisions.
- Midline incision
- Paramedian incision
Different incisions serve various surgical purposes.
What is the purpose of identifying abdominal regions in clinical practice?
To facilitate diagnosis and surgical procedures.
Knowledge of these regions helps in understanding anatomy and planning interventions.
True or False: The left hypochondrium is located on the right side of the abdomen.
False
The left hypochondrium is on the left side, opposite the right hypochondrium.
What is an oblique incision?
A type of abdominal incision made at an angle
Oblique incisions can be used in various surgical procedures.
What is a subcostal or Kocher’s incision?
An abdominal incision made below the rib cage
This incision is often used for access to the gallbladder.
What is the Rutherford Morison incision primarily used for?
Kidney transplant procedures
This incision allows access to the renal area.
What is a McBurney incision?
An incision used for appendectomy
It is located in the right lower quadrant of the abdomen.
List the types of vertical incisions.
- Midline
- Paramedian
- Transverse
Vertical incisions are often used for various abdominal surgeries.
What is a Pfannenstiel incision?
A suprapubic incision used in gynecological surgeries
This incision is often used for cesarean sections.
What is the Lanz incision used for?
Appendectomy procedures
It is a modification of the McBurney incision.
What is a thoracolumbar incision?
An incision made in the thoracic or lumbar region
This incision is often used for spinal surgeries.
Fill in the blank: The _______ incision is used for access to the gallbladder.
Subcostal or Kocher’s incision
True or False: The McBurney incision is used for kidney transplant procedures.
False
The McBurney incision is specifically used for appendectomies.
What does an incision usually refer to?
A surgical cut in a patient’s skin by scalpel
Name a type of vertical incision.
Midline incision
What is a paramedian incision?
A type of vertical incision located beside the midline
Identify an oblique abdominal incision.
Subcostal or Kocher’s incision
What is the Rutherford Morrison incision used for?
Kidney transplant (right or left)
Name a transverse abdominal incision.
Pfannenstiel incision
What is the purpose of a midline laparotomy?
Intra-abdominal access
Fill in the blank: The _______ incision is used for open cholecystectomy.
Subcostal or Kocher’s
What is the ‘Mercedes Benz’ incision used for?
Liver transplant
What is the gridiron incision primarily used for?
Open appendectomy
Fill in the blank: The _______ incision is often used in gynaecological and obstetric surgeries.
Pfannenstiel
What does the term ‘stoma closure/formation’ refer to in relation to incisions?
Transverse incision
True or False: The McBurney incision is a type of transverse abdominal incision.
False
What is the significance of the Lanz incision?
Used for appendectomy
Name a type of incision that provides intra-abdominal access.
Midline laparotomy or paramedian incision
What is a median or midline incision?
A surgical incision made along the midline of the abdomen
Commonly used for abdominal surgeries.
What is a left paramedian incision?
An incision made to the left of the midline of the abdomen
Often used when access to the left side of the abdomen is needed.
What is a Gridiron (muscle-splitting) incision?
An incision that splits the muscle fibers of the abdominal wall
Typically used for appendectomies.
What is a transverse (abdominal) incision?
An incision made horizontally across the abdomen
Used in various surgical approaches.
What is a suprapubic (Pfannenstiel) incision?
A horizontal incision made just above the pubic bone
Commonly used in gynecological surgeries.
What is a subcostal incision?
An incision made just below the rib cage
Often used for access to the liver or gallbladder.
Where is McBurney point located?
The usual location of the appendix
Found in the right lower quadrant of the abdomen.
What is a laparotomy?
A surgical procedure involving an incision into the abdominal cavity
Used for diagnosis and treatment of abdominal conditions.
What factors affect the type of abdominal incision used?
- Organ being removed
- Obesity
- Previous incisions or scars
- Type of surgery
Each factor influences the choice of incision for optimal results.
What are complications of an abdominal wound closure?
- Burst abdomen
- Incisional hernia
- Persistent sinuses
- Leave a neat scar
These complications can affect recovery and surgical outcomes.
Define a hernia.
A condition where an organ pushes through an opening in the muscle or tissue that holds it in place
Common types include inguinal, femoral, and umbilical hernias.
What is an abdominal hernia?
A piece of the intestine or other organ protruding through an opening in the abdominal wall.
What causes hernias?
- Increased intraabdominal pressure due to persistent constipation
- persistent cough
- strain
- ascites
List some conditions that lead to increasing pressure on the abdominal cavity.
- Obesity
- Lifting heavy objects
- Chronic lung disease (chronic coughing)
What can cause abnormal weakness of the anterior abdominal wall?
Congenital abnormality or acquired as a result of trauma or diseases.
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.
What is the inguinal canal?
A slit-like passage extending downward and medial between the deep and superficial inguinal ring.
What are the contents of the inguinal canal?
- Ilioinguinal nerve
True or False: Hernias can only occur due to congenital abnormalities.
False
Fill in the blank: Hernias occur where the abdominal wall is _______ or where a previous opening has occurred during abdominal surgery.
[weakened]
What is the spermatic cord?
A structure that passes through the inguinal canal containing blood vessels, nerves, and the vas deferens.
The spermatic cord is crucial for male reproductive anatomy.
What is the round ligament of the uterus?
A ligament that helps support the uterus and passes through the inguinal canal.
The round ligament is significant in female reproductive anatomy.
Where is the deep inguinal ring located?
1/2 inch above the mid-inguinal point, midway between ASIS and pubic symphysis.
The deep inguinal ring is an important anatomical landmark in hernia surgery.
What structures pass through the deep inguinal ring?
Spermatic cord and round ligament of the uterus.
These structures are crucial for understanding inguinal hernias.
What is the superficial inguinal ring?
An opening in the external oblique aponeurosis.
The superficial inguinal ring is the exit point of the inguinal canal.
Where is the superficial inguinal ring located?
Above and lateral to the pubic tubercle.
This location is significant for surgical approaches to the inguinal region.
What structures pass through the superficial inguinal ring?
Spermatic cord, round ligament, and ilioinguinal nerve.
The ilioinguinal nerve provides sensory innervation to the skin of the groin.
What is the ASIS of the pelvis?
Anterior Superior Iliac Spine
What anatomical landmark is located at the midpoint of the inguinal ligament?
Mid-inguinal point
What is the significance of the pubic symphysis?
It is a cartilaginous joint between the left and right pubic bones
What is the pubic tubercle?
A bony prominence on the superior part of the pubis
Fill in the blank: The midpoint of the inguinal ligament is known as the _______.
Mid-inguinal point
True or False: The ASIS is a landmark on the posterior aspect of the pelvis.
False
List the key anatomical landmarks of the pelvis:
- ASIS of the pelvis
- Mid-inguinal point
- Midpoint of the inguinal ligament
- Pubic symphysis
- Pubic tubercle
What does the abbreviation ASIS stand for?
Anterior Superior Iliac Spine
What is the layer of tissue that lines the abdominal cavity?
Peritoneum
Which muscle lies below the peritoneum and above the fascia transversalis?
Transversus abdominis muscle
What is the role of the internal oblique muscle in relation to the inguinal canal?
Reinforces the anterior wall of the inguinal canal
Which vessels are located in the inguinal region and include the external iliac vessels?
Inferior epigastric vessels
What anatomical structure is referred to as the deep inguinal ring?
Entry point into the inguinal canal
Fill in the blank: The _______ is the outermost muscle layer of the abdominal wall.
External oblique muscle
What is the function of the inguinal ligament?
Supports the inguinal canal
Which vessels are found in the femoral region?
Femoral vessels
True or False: The superficial inguinal ring is a reinforced structure.
True
The anterior wall of the inguinal canal is primarily formed by which structure?
External oblique aponeurosis
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
Which muscle provides the strongest reinforcement opposite the deep inguinal ring?
Internal oblique muscle
What are the components of the posterior wall of the inguinal canal?
- Conjoint tendon (medially)
- Fascia transversalis (laterally)
The posterior wall is crucial for the structural integrity of the inguinal canal.
Which structure is behind the superficial inguinal ring?
Conjoint tendon
The conjoint tendon provides support and stability to the inguinal canal
What forms the roof of the inguinal canal?
Arching lowest fibers of internal oblique and transversus abdominis
These muscles help to form a protective layer over the canal.
What constitutes the floor of the inguinal canal?
Inguinal ligament and lacunar ligament medially
These ligaments provide support and boundaries to the canal.
True or False: The lacunar ligament is part of the floor of the inguinal canal.
True
The lacunar ligament plays a role in the anatomy of the inguinal region.
Fill in the blank: The strongest structure opposite the superficial ring is the _______.
conjoint tendon
This tendon is vital for preventing hernias in the inguinal region.
What is the significance of the fascia transversalis in the inguinal canal?
It forms the lateral part of the posterior wall
This fascia is important for supporting the structures within the canal.
What is the main function of the inguinal ligament?
Forms the floor of the inguinal canal and supports structures
This ligament is crucial for maintaining the integrity of the inguinal region.
What is the linea alba?
A fibrous structure that runs down the midline of the abdomen.
What does the femoral sheath contain?
Femoral artery, femoral vein, and lymphatic vessels.
Which nerve innervates the area around the inguinal region?
Ilioinguinal nerve.
Where is the pubic tubercle located?
On the superior aspect of the pubic bone.
What does the spermatic cord contain?
Ductus deferens, testicular artery, and nerves.
What is the function of the cremaster muscle?
Regulates the temperature of the testes.
What does the superficial inguinal ring refer to?
The opening in the external oblique aponeurosis.
What anatomical landmark is known as the symphysis pubis?
The joint where the left and right pubic bones meet.
What is the significance of the inferior epigastric artery?
It supplies blood to the lower abdominal wall.
Fill in the blank: The _______ is a fibrous band that serves as the midline of the abdomen.
linea alba
True or False: The deep inguinal ring is an opening in the transversalis fascia.
True
What is the pectineal line?
A ridge on the superior pubic ramus.
What does the term ‘pubic crest’ refer to?
The anterior border of the pubic bone.
What is the conjoint tendon?
The fusion of the internal oblique and transversus abdominis aponeuroses.
What is the role of the iliohypogastric nerve?
It provides sensory innervation to the skin of the lower abdomen.
Fill in the blank: The _______ is a structure that encases the spermatic cord.
femoral sheath
What is the medial boundary of Hesselbach’s triangle?
Rectus abdominis muscle
Hesselbach’s triangle is important in understanding the anatomy related to hernias.
What is the inferior boundary of Hesselbach’s triangle?
Inguinal ligament
The inguinal ligament forms the lower margin of Hesselbach’s triangle.
What is the lateral boundary of Hesselbach’s triangle?
Inferior epigastric artery
This artery plays a crucial role in the vascular supply to the abdominal wall and is relevant in hernia surgery.
Where do the inferior epigastric vessels lie in relation to direct and indirect hernias?
Indirect hernia passes lateral; direct hernia passes medial to inferior epigastric vessels
Understanding the relationship between hernias and inferior epigastric vessels is essential for surgical approaches.
Which nerves traverse the inguinal canal?
Ilioinguinal nerve and genital branch of genitofemoral nerve
These nerves are important in the innervation of the groin area and can be affected during hernia repair.
True or False: An indirect hernia passes medial to the inferior epigastric vessels.
False
Indirect hernias pass lateral to inferior epigastric vessels, while direct hernias pass medial.
Fill in the blank: An indirect hernia passes ______ to the inferior epigastric vessels.
lateral
This distinction is critical for surgical identification of hernia types.
Fill in the blank: A direct hernia passes ______ to the inferior epigastric vessels.
medial
Recognizing this relationship aids in understanding hernia formation.
What are the two main types of inguinal hernias?
Indirect (Congenital) and Direct (Acquired)
Indirect hernias follow the path of the processus vaginalis through the inguinal canal, while direct hernias occur through a weakness in the abdominal wall.
Where does an indirect inguinal hernia pass through?
Both deep and superficial inguinal rings
It follows the path of the processus vaginalis.
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
The mass is associated with the spermatic cord.
How does a direct inguinal hernia differ in its passage compared to an indirect hernia?
Not through the inguinal canal
It passes through a weakness in the abdominal wall.
Where is the mass located in a direct inguinal hernia?
Adjacent to the spermatic cord
It rarely enters the scrotum or labia.
How does the location of the mass in a direct inguinal hernia relate to the inferior epigastric artery?
Lateral to inferior epigastric artery
This is in contrast to indirect hernias, which are medial to the inferior epigastric artery.
Which gender is more commonly affected by inguinal hernias?
Males
Inguinal hernias are 20 times more common in males.
What is the peritoneum?
A serous membrane that forms the lining of the abdominal cavity
The peritoneum supports the abdominal organs and serves as a conduit for their blood vessels, lymphatics, and nerves.
What are the layers involved in an inguinal hernia?
• Peritoneum
• Transversalis fascia
• Transversus abdominis muscle
• Internal oblique muscle
• External oblique muscle
These layers are crucial for understanding the anatomy involved in hernia formation.
In an indirect inguinal hernia, where does the herniating bowel pass?
LATERAL to inferior epigastric vessels to enter deep inguinal ring
This is in contrast to direct inguinal hernias where the bowel passes MEDIAL to these vessels.
What structures are involved in a direct inguinal hernia?
Herniating bowel passes MEDIAL to inferior epigastric vessels
The bowel pushes through the peritoneum and transversalis fascia in the inguinal triangle.
List the types of hernias.
• Inguinal
• Femoral
• Umbilical or paraumbilical
• Incisional and recurrent
• Epigastric
Understanding the types of hernias is essential for diagnosis and treatment.
What is the inguinal falx?
Also known as the conjoint tendon
It is formed by the fusion of the internal oblique and transversus abdominis muscles.
What is the role of the spermatic cord in hernias?
It contains the hernial sac in indirect hernias
The hernial sac parallels the spermatic cord in males.
True or False: The deep inguinal ring is the entry point for direct inguinal hernias.
False
The deep inguinal ring is the entry point for indirect inguinal hernias.
Fill in the blank: Herniating bowel in a direct inguinal hernia passes ______ to inferior epigastric vessels.
MEDIAL
Fill in the blank: Herniating bowel in an indirect inguinal hernia passes ______ to inferior epigastric vessels.
LATERAL
What are the two types of inguinal hernias?
Indirect and direct
Indirect inguinal hernia passes via the deep inguinal ring, while direct inguinal hernia passes through the posterior wall of the canal.
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
This type of hernia goes through the inguinal tunnel.
What characterizes a direct inguinal hernia?
Rarely protrudes into the scrotum and bursts through the posterior wall
This type is associated with weakness in the abdominal wall, often due to aging.
At what age is a direct inguinal hernia most likely to occur?
Almost always in middle-aged or elderly individuals
Aging contributes to wall weakness leading to hernias.
What are the two types of hiatal hernia?
Sliding hiatus hernia and paraesophageal hiatus hernia
These types are classified based on their anatomical characteristics and involvement of the diaphragm.
What is a characteristic feature of a sliding hiatus hernia?
Weak diaphragm and oesophageal sphincter
This type of hernia allows the stomach to slide up into the chest through the diaphragm.
What symptoms are associated with hiatal hernia?
- Heartburn
- Sudden regurgitation
- Gastroesophageal reflux
- Pain on swallowing hot liquids
These symptoms can vary in severity and frequency among individuals.
What diagnostic methods are used for hiatal hernia?
- Barium meal x-rays
- Gastroscopy
These methods help visualize the hernia and assess its impact on surrounding structures.
True or False: The oesophageal sphincter is involved in both types of hiatal hernia.
True
The involvement of the oesophageal sphincter is a key factor in the development of sliding and paraesophageal hernias.
Fill in the blank: A hiatal hernia can occur due to a _______ diaphragm.
Weak
A weak diaphragm contributes to the displacement of the stomach into the thoracic cavity.
What is the role of the pyloric sphincter in the digestive system?
Regulates the passage of food from the stomach to the duodenum
This sphincter helps control gastric emptying and prevents backflow.
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
This anatomical relationship is crucial for understanding how hiatal hernias develop.
What is gastroesophageal reflux?
The backflow of stomach contents into the oesophagus
This condition is often associated with hiatal hernias and can lead to heartburn and discomfort.
What is a sliding hiatus hernia?
A condition where the stomach and part of the esophagus slide up into the chest through the hiatus.
More common than paraesophageal hernias.
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.
More cause for concern due to the risk of strangulation and loss of blood supply.
What are the main risk factors for a femoral hernia?
Rare incidence, usually occurs in females.
Femoral hernias are generally less common than inguinal hernias.
Where is a femoral hernia located?
Below and lateral to the pubic tubercle.
This location is important for diagnosis and surgical intervention.
What are the contents of a femoral hernia?
The femoral sheath, which includes:
* Lateral compartment: femoral artery
* Intermediate compartment: femoral vein
* Medial compartment: femoral canal
The femoral canal contains efferent lymphatic vessels and lymph nodes.
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.
This can lead to complications if not addressed.
True or False: A sliding hiatus hernia is more common than a paraesophageal hernia.
True
Sliding hiatus hernias occur more frequently in the general population.
Fill in the blank: A paraesophageal hernia is characterized by the stomach squeezing up through the hiatus _______ the esophagus.
next to
This positioning differentiates it from sliding hiatus hernias.
What is a risk associated with hernias?
Becoming irreducible and strangulated
Strangulation can lead to tissue necrosis and requires immediate medical intervention.
What are the three compartments of the femoral sheath?
Lateral compartment, intermediate compartment, medial compartment
Each compartment contains specific vessels: the lateral contains the femoral artery, the intermediate contains the femoral vein, and the medial contains the femoral canal.
What does the medial compartment of the femoral sheath contain?
Femoral canal
The femoral canal contains efferent lymphatic vessels and lymph nodes.
Fill in the blank: The lateral compartment of the femoral sheath contains the _______.
Femoral artery
Fill in the blank: The intermediate compartment of the femoral sheath contains the _______.
Femoral vein
What is the sac of a femoral hernia?
A protrusion in the femoral canal
Femoral hernias are more common in females due to pelvic anatomy.
What is an indirect inguinal hernia?
A hernia that occurs through the inguinal ring
It often occurs in males and can be congenital.
What percentage of hernias are umbilical hernias?
10-30%
Umbilical hernias are often noted after birth.
What causes umbilical hernias in babies?
Failure of abdominal muscle near navel to close completely after birth
What can cause umbilical hernias in adults?
Excessive pressure on abdomen
Factors contributing to this pressure include obesity and previous surgery.
What are the risk factors for developing an umbilical hernia?
Obesity, surgery, multiple pregnancies, & fluid build up
Other factors may include chronic cough, heavy lifting, and pregnancy.
What type of hernia is more common in adults?
Paraumbilical hernias
Paraumbilical hernias are more prevalent than umbilical hernias in adults.
Through what structure do paraumbilical hernias herniate?
Linea alba
They do not herniate directly through the umbilicus.
What percentage of abdominal surgeries result in incisional hernias?
2-10%
Incisional hernias occur after surgical procedures.
What is the recurrence rate of incisional hernias after surgical repair?
20-45%
This indicates a significant risk of hernia recurrence.
List some risk factors associated with hernias.
- Infection
- Bowel obstruction
- Obesity
These factors can lead to hernia development.
What results from muscles and aponeurotic layers of the abdomen not healing properly?
Hernias
Poor healing can create areas of weakness leading to hernias.
What does the site of incision create that contributes to hernias?
An area of weakness
This weakness allows for potential herniation.
What can protrude through a surgical incision in the case of a hernia?
Omentum or organ
This protrusion is a defining characteristic of hernias.
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
These complications can arise as a hernia grows.
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.
Does an obturator hernia appear as a bulge?
No, an obturator hernia will not appear as a bulge.
What symptoms can an obturator hernia cause?
An obturator hernia can act like a bowel obstruction, causing nausea and vomiting.
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.
How is an epigastric hernia characterized when first discovered?
An epigastric hernia is painless and irreducible when first discovered.
What is the location of an epigastric incision?
Upper abdomen at midline
Epigastric incisions are made in the upper part of the abdomen, typically for surgical access.
Where is an incisional hernia typically found?
At the site of previous surgical invasion
Incisional hernias occur at locations where previous surgeries have taken place.
What characterizes a direct inguinal hernia?
Near the opening of the inguinal canal
Direct inguinal hernias protrude through a weakness in the abdominal wall near the inguinal canal.
Define an indirect inguinal hernia.
At the opening of the inguinal canal
Indirect inguinal hernias occur at the inguinal canal and can follow the path of the spermatic cord.
What is the location of an umbilical hernia?
At the navel
Umbilical hernias occur around the area of the belly button.
Where do femoral hernias occur?
In the femoral canal
Femoral hernias protrude through the femoral canal, which is located below the inguinal ligament.
What is the best direction for an incision to minimize scarring?
In the direction of the cleavage
Incisions made along the lines of skin cleavage tend to heal better and result in less visible scarring.
What happens to muscle fibers when an incision is made along their line?
Fibers will fall back into position and function normally
Making incisions along muscle fiber lines helps maintain function post-surgery.
Why should main nerves be avoided during an incision?
Dividing a main nerve can result in paralysis of part of the anterior abdominal musculature
Protecting nerves is crucial to prevent loss of muscle function in the abdominal area.
What can weakness in the abdominal wall lead to?
Bulging forward of the abdominal wall and visceroptosis
Weakness in the abdominal wall can cause displacement or prolapse of abdominal organs below their natural position.
What is the location of a Vertical Midline incision?
Sternal notch to symphysis pubis
This incision allows primary exposure of any part of the abdominal cavity.
What is the primary indication for a McBurney incision?
Open appendectomy
The incision is located at the McBurney point and extends toward the right flank.
What is the location of an Inguinal incision?
Pubic tubercle to anterior iliac crest
This incision is above and parallel to the inguinal crease and may be extended for various procedures.
What are the indications for a Subcostal (Kocher) incision?
Open procedures of the gallbladder, biliary system, pancreas, and spleen
This incision extends laterally and obliquely downward to just below the costal margin.
What is the location of a Pfannenstiel incision?
Transverse, across the lower abdomen
This incision is typically used for gynecologic and obstetric procedures.
What is the indication for a Midabdominal incision?
Colectomy or colostomy
This incision extends laterally to the lumbar region at an angle between the ribs and iliac crest.
What is the location of a Thoracoabdominal incision?
Midpoint between the xiphoid and umbilicus extending posteriorly across the 7th or 8th interspace
This incision is used for surgery of the proximal stomach, distal esophagus, and anterior spine.
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
Other advantages include good access to inguinal canal and related structures, good cosmetic results, and minimal nerve damage.
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
This incision also interrupts lateral blood supply and innervation to the rectus muscle.
True or False: A Subcostal (Kocher) incision alters the blood supply to the abdominal wall.
False
It does not alter blood supply to the abdominal wall if the deep inferior epigastric artery is left intact.
Fill in the blank: The Pfannenstiel incision is typically used for _______.
[gynecologic and obstetric procedures]
What is a common issue associated with a Vertical Midline incision?
Postoperative hernias
This issue is particularly common above the umbilicus.
