Abdominal Hernia

Question 1

defects in the parietal abdominal wall fascia and muscle through which intra-abdominal or preperitoneal contents can protrude

Answer 1

ventral hernia

Question 2

may develop via slow architectural deterioration of the musculoaponeurotic tissues

Answer 2

acquired hernia

Question 3

may develop from failed healing of an anterior abdominal wall incision

Answer 3

incisional hernia

Question 4

a hernia that cannot be reduced

Answer 4

incarcerated hernia

incarceration of an intestinal segment may be accompanied by N/V and significant pain. true surgical emergency

Question 5

when blood supply to the incarcerated bowel is compromised

Answer 5

strangulated hernia

localized ischemia may lead to infarction and perforation

Question 6

epigastric hernias

Answer 6

located in the midline bet. the xiphoid process and the umbilicus,
generally small and may be multiple, and at elective repair, they are usually found to contain omentum or a portion of the falciform ligament.

Question 7

umbilical hernias

Answer 7

occur at the umbilical ring and may be present at birth or develop later

umbilical hernia repair should be deferred until after the ascites is controlled in patients with advanced liver disease, ascites and umbilical hernia

Question 8

spigelian hernias

Answer 8

anywhere along the length of the Spigelian line or zone – an aponeurotic band of variable width at the lateral border of the rectus abdominis.
most frequent location: is at or slightly above the level of the arcuate line.
mandatory repair due to high risk of incarceration at the time of diagnosis

Question 9

Infant patient presented with intestinal obstruction at surgery only the antimesenteric boarder of the small intestine is incarcerated in the deep inguinal ring, what is the diagnosis?

Answer 9

Richter hernia

common in premature infants
presents with intestinal obstruction
no hernia may be palpable or visible

Question 10

Richter hernia

Answer 10

common in premature infants
presents with intestinal obstruction
no hernia may be palpable or visible

Question 11

A post appendectomy patient is presented with intestinal obstruction the ileum is found incarcerated in the roux-en-y, what is the diagnosis?

Answer 11

Peterson Hernia

internal hernias which occur in the potential space posterior to a gastrojejunostomy,
caused by the herniation of intestinal loops through the defect between the small bowel limbs, the transverse mesocolon and the retroperitoneum, after any type of gastrojejunostomy.
Usually happens after a ROUX EN Y RECONSTRUCTION

Question 12

internal hernias which occur in the potential space posterior to a gastrojejunostomy,
caused by the herniation of intestinal loops through the defect between the small bowel limbs, the transverse mesocolon and the retroperitoneum, after any type of gastrojejunostomy.

Answer 12

Peterson Hernia

Question 13

Pain in the middle of the rib, knee and in the medial aspect of the thigh because of pressure in the obturator nerve via obturator hernia is?

Answer 13

Howship-Romberg’s sign

Obturator hernia

Question 14

presents with pain in the region of the hip, knee and inner thigh because of pressure in the obturator nerve.
Often with large or small bowel incarceration or strangulation. Repair by midline approach. 50% with howship romberg sign

Answer 14

Obturator hernia

Question 15

Five layer repair for mid-line Incisional Hernia

Answer 15

Cattel repair

Question 16

As a result of congenital weakness of the abdominal wall combined with intraabdominal pressure

Answer 16

Epigastric hernia

Question 17

a.k.a. inferior lumbar triangle hernia

Answer 17

Petit’s hernia

a lumbar hernia

Question 18

a.k.a. superior lumbar triangle hernia

Answer 18

Grynfelt’s hernia

a lumbar hernia

Question 19

most frequent location: is at or slightly above the level of the arcuate line.

Answer 19

Spigelian hernia

Usual location: just below semicircular line of Douglas; Defect in Transversus Abdominis

Question 20

In infants aponeurotic defect of 1.5 cm or less

would close spontaneously

Answer 20

umbilical hernia

Repair for children present by the age of 3 or 4, and
infants whose defect is 2 cm.

Question 21

Tx for Umbilical Hernia

Answer 21

Mayo Hernioplasty

Vest over pants imbrication of the superior & inferior aponeurotic fascia layer

Question 22

Wide gap between the medial borders of the rectus sheath
Diffuse bulge at upper midline of abdomen
Not a fascial defect, hence repaired for cosmetic purposes

Answer 22

Diastasis Recti

Question 23

Tx for Incisional Hernia

Answer 23

Cattell Repair

Question 24

Primary repair w/ non-absorbable monofilament

Answer 24

Mayo repair (fascial imbrication)
“Far and Near” suturing by Shukla
Internal retention suturing

Question 25

Ventral hernia occurring along the subumbilical portion of the Spieghel’s Semilunar line & through Spieghel’s Fascia.

Answer 25

Spigelian Hernia

Question 26

PETIT’S TRIANGLE is bounded by:

Answer 26

Medial= Latissimus dorsi muscle
Lateral= External oblique muscle
Inferior= Iliac crest
 Covered by superficial fascia

Question 27

GRYNFELT’S TRIANGLE is bounded by:

Answer 27

Superior= 12th rib
Lateral= Internal oblique abdominal muscle
Medial=Sacrospinalis muscle
 Covered by latissimus dorsi

Question 28

Occur spontaneously or after APR or pelvic exenteration

Answer 28

Perineal Hernia

Question 29

Internal hernia. iatrogenic (post-operative). defect in mesentery or omentum

Answer 29

Peterson Hernia

through Roux Limb

Question 30

Herniation of abdominal viscera WITHOUT a SAC, intact umbilical cord

Answer 30

Gastroschisis

Question 31

Herniation of abdominal viscera into the umbilical cord, hence lined by internally by peritoneal SAC and externally by amnion

Answer 31

Omphalocele

Question 32

Associated anomalies with omphalocele

Answer 32

Cloacal exstrophy

Chromosomal abnormality in 50%

Question 33

Associated anomalies with Gastroschisis

Answer 33

Intestinal Atresia 10%

Question 34

(a) Postero-lateral, most common at costal and spinal diaphragmatic attachment
(b) Associated with malrotation, pulmonary hypoplasia
(c) 4 x more common in the left side
(d) Only 10-20% have a sac; 80% mortality by the first year of life
(e) Better repaired after a few days to weeks when the child stabilizes; higher mortality if repaired at birth
(f) Repair: Transabdominal with the Ladd procedure for the malrotation

Answer 34

Bochdalek Hernia

Question 35

Repair for Bochdalek Hernia

Answer 35

Transabdominal with the Ladd procedure for the malrotation