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CP3 Medicine > Abdominal Wall > Flashcards

Abdominal Wall Flashcards

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1
Q

Def hernia

A

Protrusion of an organ through a defect in the wall of the cavity containing it, into an abnormal position

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2
Q

Reducible hernia

A

The contents of the hernia can be completely replaced into the cavity

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3
Q

Irreducible hernia

A

Contents of the hernia can’t be completely replaced into the cavity

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4
Q

Obstructed hernia

A

Bowel contents can’t pass through the hernaited bowel

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5
Q

Strangulated hernia

A

There is ischaemia of contents of hernia (b/c constructed vv return) - which unless relived –> gangrene + perforation

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6
Q

Incarcerated hernia

A

Contents of hernia sac = stuck inside by adhesions

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7
Q

Mx hernia if irreversible

A

Elective surgery - Lichenstein repair mesh technique being gold standard

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8
Q

Mx of hernia if strangulated/obstructed

A

Emergency Hartmanns procedure

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9
Q

Mx congenital inguinal hernia in infants

A

Herniotomy + ligation processus vaginalis at 1y

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10
Q

What is the inguinal canal formed from?

A

Relocation of testes during foetal development

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11
Q

what does the inguinal contain?

A

3aa
3nn
3 other

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12
Q

3aa contained in the inguinal canal

A

testicular/ovarian aa
aa to vas deferens
cremasteric aa

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13
Q

3 nn contained in the inguinal canal

A

genital branch genitofemoral
ilioinguinal
sympathetic nn

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14
Q

what are the 3 other structures contained in the inguinal canal

A

vas deferens/ round ligament uterus
pampiniform plexus
testicular lymphatics

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15
Q

what are the 3fascial coverings related to the mm layers of the abdomen

A

Internal spermatic fascia
Cremasteric fascia
External spermatic fascia

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16
Q

Where is the deep inguinal ring located

A

1cm superior to mid point of inguinal ligament

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17
Q

WHere is the midpoint of the inguinal ligament

A

Halfway between ASIS to PT

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18
Q

where is the mid inguinal point

A

Halfway between ASIS to PS

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19
Q

Where is the superficial inguinal ring located

A

1cm superior.+ lat to PT

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20
Q

what are the 4 boundaries of the inguinal ligament

A

Superior wall M
Anterior wall A
Inferior wall L
Posterior wall T

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21
Q

superior wall inguinal ligament (2Mms)

A

Int oblique

Transversus abdominalis

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22
Q

anterior wall inguinal ligament (2 aponeurosis)

A

Aponeurosis of: int oblique + ext oblique

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23
Q

Inferior wall inguinal ligament (2 ligaments)

A

lacunar ligament

inguinal ligament

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24
Q

posterior wall inguinal ligament (2 Ts)

A

Transversalis fascia

Conjoint tendon

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25
What % of inguinal hernias are indirect
66%
26
What is the hernia covered by in indirect inguinal hernia
processus vaginalis | all 3 fascia coverigns
27
Where does indirect inguinal hernia exit
exits superficial ring inside cord . can pass into scrotum
28
Why are indirect inguinal hernias more likely to strangulate
B/c superficial ring is not dilated
29
Direct inguinal hernia
Contents pass through weakness in anterior abdo wall in inguinal triangle
30
Cause direct inguinal hernia (4)
chronic cough straining at micturition/defacation heavy lifting smoking
31
coverings direct inguinal hernia
peritoneium + transveralis fascia
32
Exit direct inguinal hernia
Exits superficial ring lateral to the cord
33
Ix if you cannot feeel the inguinal hernia
USS
34
How is absolute differentiation between the 2 rtypes of inguinal hernia achieved
in theatre indirect passes lateral to inf epigastric aa direct passes medial to inf epigastric aa
35
Physical findings inguinal hernia
Ask pt to cough / Scrotal continuation Increased bowel sounds
36
features of incarcerated inguinal hernia (4)
Constipation Distention Vomiting Pain
37
Which sex is femoral hernia more common in
F
38
borders of the femoral triangle
SUP: inguinal ligament LAT: med border of sartorius MED: lat border of adductor longus
39
What does the femoral triangle contain
NAVY (lat to med) Femoral nn Femoral aa Femoral vv
40
What is the femoral sheath
inferior prolongation of transversalis/iliapsoas fascia that passes deep to inguinal ligament to allow passage of female aa/vv into triangle
41
Where is the femoral canal
At medial extremity of femoral sheath
42
where does bowel exit the abdominal cavity in a femoral hernia
femoral ring
43
Why is there a high risk of strangulation/obstruction in femoral hernia
Femoral canal is v small w/ strong borders
44
What is a Richter's hernia
Hernia involving only 1 sidewall of bowel + not bowel lumen
45
Where is a Richter's hernia particularly likely
Femoral sac
46
Sx femoral hernia
globular lump below + lat to PT
47
What % femoral hernia present as an emergency
50%
48
If a femoral hernia is hard and tender - what has likely happened
Strangulation.obstruction
49
DDx lump in groin (6)
``` Inguinal hernia Lipoma Femoral aa aneurysm Saphenous ovarix Psoas abscess LN ```
50
what are true umbilical hernias due to
incomplete closure of umbilical cicatrix
51
Which babies are more at risk of true umbilical hernias? (3)
Black Male Premature
52
Sx true umbilical hernia
Usually asymp
53
What % umbilical hernia retract by age 2
90%
54
what is a paraumbilical hernia
Acquired hernia that occurs just above/below umbilicus
55
Cause paraumbilical hernia
raised IAP
56
Who is paraambulical hernia more common in
Obese, middle aged, multiparous F
57
PS paraumbilical hernia
localised dragging pain Enlarged hernia over time Tender
58
Mx paraumbilical hernia
Early operative | Excision of sac + stitching of rectus sheath = Mayo's operation
59
What % of hernias are incisional
10%
60
Pre-op RF incisional hernias (7)
``` Old age Poor nutrition Sepsis Uraemia jaundice obesity steroids ```
61
Operative RF incisional hernia (3)
Veritcal incisions KNots that are too loose/tight Presence of drains
62
Postop RF incisional hernia (4)
Post op ileus Coughing Obesity Wound infections
63
Sx incisional hernia
Bulge in scar | Local discomfort
64
Which type of incision most commonly leads to incisional hernia
midline laparotomy scars
65
Def epigastric hernia
1 or > protrusions through linea alba above umbilicus usually containing only extraperitoneal fat
66
What % epigastric hernia are asymp
75%
67
When is pain of an epigastric hernia worst
On physical exertion | After meals
68
What is divarification of rectus mm
when the rectus mm do not meet at the midline of linea alba - hence split apart when pt flexes abdo mm
69
Who gets divarification of rectus mm
Obese men Parous F People w/ chronically raised IAP

CP3 Medicine (29 decks)

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