ana surge 1 Flashcards Preview

Patho flash cards > ana surge 1 > Flashcards

Flashcards in ana surge 1 Deck (264):
1

Lining of epidermis

Stratified squamous epithelium

2

Immune cells in the epidermis

Langerhan's cells

3

Nerve cells in dermis

Meissner's (light touch), Pacinian (pressure)

4

Major chemoattractant for fibroblasts during the proliferation phase of wound healing

PDGF

5

Threshold of pressure injury

At least 1 hour of 60mmHg pressure

6

Apocrine gland blockage, infection and abscess formation

Hidradenitis suppurativa

7

Present as nodules and spread to form draining tracts. (+) sulfur granules on histology

Actinomycosis - follows tooth extraction, osontogenic infection, facial trauma

8

Rapidly enlarging, necrotic ulcer with violet border and surrounding erythematous halo

Pyoderma gangrenosum - linked to ulcerative colitis, IBD

9

Immune mediated, separation of skin at dermo-epidermal junction and >30% TBSA involvement

Toxic Epidermal Necrolysis

10

Most common site of dermoid cyst

Eyebrow

11

Skin lesions that yellow, non-tender, pruritic with a velvety greasy texture. Found in chest, back and abdomen,

Seborrheic keratoses - unrelated to sun exposure

12

Sudden multiple eruptions of seborrheic keratoses associated with ovarian or gastric Ca

Lesser Trelat Sign

13

Tender, warty, brown or black lesions on sun exposed areas

Solar (actinic) keratoses - premalignant (SCC)

14

Treatment for congenital nevi

Excision, since it is premalignant

15

Most common benign head and neck tumor in adults

Hemangioma - initial rapid proliferation followed by slow involution

16

Consumptive coagulopathy due to a hemangioma

Kasabach Merritt Syndrome

17

Benign neoplasm usually affecting hands

Glomus tumor - blue, subungual discolortion associated with tenderness and cold sensitivity

18

Most common soft tissue tumor

Lipoma

19

Neural tumor that invades striated skeletal muscles

Granular Cell Tumor

20

Histology: Neurilemoma

Schwann cells packed in palisading rows

21

Most common type of skin cancer?

Basal Cell Carcinoma - waxy, cream colored with rolled, pearly borders surrounding a central ulcer

22

Histopath: Squamous cell carcinoma

Keratin pearls

23

SCC in situ

Bowen's Disease

24

SCC in penis

Erythroplasia of Queyrat

25

SCC arising from burn areas

Marjolin's Ulcer - has an earlier metastasis

26

Most common spread of malignant melanoma

Superficial spread (70%) - anywhere except hands and feet

27

Malignant melanoma with the best prognosis

Lentigo maligna - face, neck, hands of elderly

28

Least common malignant melanoma, most common on great toe or thumb

Acral lentiginous - (+) Hutchinson's sign or pigment in paronychial area

29

Provides structural support to the breast

Cooper's suspensory ligaments - anchors the dermis to the pectoralis fascia

30

Provides a route for Breast Ca metastases to bone

Batson's Vertebral Plexus

31

Measurement of gynecomastia

At least 2cm in diameter

32

Thrombophlebitis that involves the superficial veins of the anterior chest wall and breast

Mondor's Disease - acute pain on lateral side, tender and firm cord following vein distribution

33

Veins involved in Mondor's Disease

Lateral thoracic vein, thoracoepigastric vein, superficial epigastric vein

34

Epidemic puerperal mastitis is due to?

MRSA

35

Tx for non epidemic (sporadic) mastitis

Empty breast using suction pumps, I&D cannot be done

36

Mimics Breast Ca on PE, mammogram and gross pathologic examination

Radial Scars and Complex Sclerosing Lesions - need to do biopsy

37

Large, pale, vacuolated cells in the rete pegs of epithelium of the breast

Paget Cells - chronic eczematous eruption of the nipple

38

Differentiate Paget's Disease from Melanoma

(+) CEA - Paget's Disease, (+) S 100 - Melanoma

39

Most common invasive Breast Ca

Invasive ductal Ca - (+) axillary LN, central stellate configuration with chalky white or yellow streaks

40

Invasive Breast Ca associated with BRCA 1 cancers

Medullary Ca - soft, hemorrhagic and bulky

41

Invasive Breast Ca with the best prognosis

Tubular Ca

42

Histopathology: Indian file configuration of cells, Signet ring cell Ca

Invasive Lobular Carcinoma

43

Biopsy method for breast lesions

Core needle biopsy

44

Gold standard in Breast Ca management

MRM - removal of all breast tissue and pectoralis fascia, ALND (I and II)

45

Moveable, midline neck mass

Thyroglossal Duct Cyst - Tx is Sistrunk Operation

46

Most common Branchial Cleft Anomaly

2nd - lateral neck at SCM and tonsillar fossa openings

47

Mucous retention cyst involving the sublingual gland

Ranula - found in the floor of the mouth, treat with Marsupialization

48

Granulomatous lesion in the oral cavity that is an exaggerated inflammatory response

Epulis - Tx is excision if symptomatic, same appearance as a malignant lesion in the gingiva

49

Expansive endosteal lesion of the mandible, of bony origin

Central Giant Cell Reparative Granuloma - Tx is curettage

50

Rare benign tumor of tongue (mid 1/3), derived from Schwann cells

Granular Cell Myoblastoma or Abrikossof tumor - Tx is wedge excision to r/o SCC of tongue

51

Benign lesion but highly expansile and destructive fibrovascular neoplasms of the nose among adolescent males

Juvenile Nasopharyngeal Angiofibroma - massive epistaxis

52

Tx for Juvenile Nasopharyngeal Angiofibroma

Angioembolization or open surgery (Weber Ferguson approach)

53

Removes cervical LN I-V, spinal accessory nerve, IJV, SCM

Radical neck dissection: Crile Procedure

54

Removes cervical LN I-V

Modified RN/Functional Neck Dissection: Bocca Procedure

55

Selective neck dissection for oral malignancies

Supraomohyoid (I,II, III)

56

Selective neck dissection for laryngeal malignancies

Lateral (II, III, IV)

57

Selective neck dissection for thyroid malignancies

Posterolateral (II, III, IV and V)

58

Cervical LN with the highest yield for biopsy

Level IV

59

Majority of lip Ca occurs in the lower lip except?

BCC in the upper lip

60

Paresthesia in Ca of lip indicates?

Mental nerve involvement

61

Most common location of tongue Ca

Lateral and ventral surface

62

Blind biopsies in unknown primary head and neck Ca

Base of tongue, pyriform sinus, tonsillar fossa, nasopharynx

63

Tx for subglottic laryngeal Ca

Total laryngectomy with bilateral neck dissection (MRND)

64

True or false: the smaller the salivary gland, the higher the risk of malignancy

TRUE

65

Most common benign epithelial salivary gland tumor

Pleomorphic adenoma

66

Most important branch of the facial nerve to preserve

Temporal branch - closes the eyes

67

Young patients with long standing nodule and symptoms of hyperthyroidism

Toxic Adenoma (Plummer's Disease) - unilateral lobectomy + isthmusectomy

68

Given 7-10 days pre-op to decrease vascularity of the thyroid and lessen risk of thyroid storm

Lugol's iodine solution

69

Condition to suspect when a patient has recurrent Acute Suppurative Thyroiditis

Persistent pyriform sinus fistula - 3rd branchial cleft anomaly

70

Autoimmune disorder involving HLA-B8 and HLA-DR3

Grave's Disease

71

Autoimmune disorder involving CD 8 T-helper cells, HLA-B8 HLA-DR3 and HLA-DR 5

Chronic thyroiditis or Hashimoto's Lymphocytic Thyroiditis

72

Most common inflammatory disorder of the thyroid gland and leading cause of hypothyroidism

Hashimoto's Thyroiditis - diffuse infiltration by small lymphocytes and plasma cells

73

Presentation is a painless, hard anterior neck mass with compressive symptoms in weeks

Reidel's thyroiditis - invasive fibrous thrombosis, diagnose through open biopsy and treat with wedge excision

74

FNAB: orphan annie nuclei, psammoma bodies

Papillary Thyroid Ca

75

Most important prognostic factor in Papillary thyroid Ca

Age

76

Thyroid Ca that cannot be diagnosed by FNAB

Follicular and Hurthle Cell Ca

77

Thyroid Ca common in iodine deficient areas

Follicular Ca - minimum Tx is lobectomy+isthmusectomy

78

Dx of Follicular Ca and Hurthle Cell Ca

Capsular and vascular invasion

79

Tx for unresectable, locally invasive or recurrent disease and for bony metastases

External beam RT - involves carotids and prevertebral fascia

80

When are thyroglobulin levels measured post-op?

6 months initially then annually - increased levels is suggestive of metastatic or persistent normal thyroid tissue

81

Ca that arises from the parafollicular or C cells locate at the superolateral lobes of the thyroid gland

Medullary Thyroid Ca

82

Medullary Thyroid Ca premalignant lesion for familial cases

C Cell hyperplasia

83

Familial MTC is secondary to?

Germ line mutation at the ret proto oncogene

84

Earliest symptom of hypocalcemia

Perioral numbness

85

Blood supply of parathyroids

Inferior thyroid artery - from thyrocervical trunk

86

Most common location of ectopic parathyroids

Paraesophageal

87

Most common cause of primary hyperparathyroidism

Parathyroid adenoma - only 1 gland involved

88

Pentad of Primary Hyperparathyroidism

Kidney stones, painful bones, abdominal groans, psychic moans, and fatigue overtones

89

Preoperative localization test for primary hyperparathyroidism

Sestamibi scan

90

Mainstay Tx for hypercalcemic crisis

IV 0.9% saline hydration to dilute the calcium

91

Secondary hyperparathyroidism happens among?

Patients with chronic renal failure

92

Level of esophagus

From C6 to T1

93

Relation of Vagus nerve to the esophagus

Left vagus - anterior surface, Right vagus - posterior surface

94

Hernia of the abdominal part of the esophagus and part of stomach

Hiatal hernia

95

Hernia of the fundus or body of the stomach

Paraesophageal hernia

96

Histology of the esophagus

Stratified squamous non-keratinized epithelium

97

Definitive Tx for GERD

Nissen Fundoplication - 360 degree wrap

98

Esophageal lengthening procedure

Collis gastroplasty

99

Procedure that anchors the esophagus to its new position in the crura

Hill posterior gastropexy

100

Borchardt's Triad: indicative of incarcerated intra thoracic stomach

Chest pain, retching with inability to vomit, inability to pass NGT

101

Most common esophageal diverticula

Zenker's Diverticula - found in Killian's Triangle

102

Killian's Triangle

Area of potential weakness situated behind the esophagus at the level of the cricopharyngeus muscle

103

Most common esophageal motility disorder

Achalasia - due to neurogenic degradation

104

Triad of Achalasia

Hypertensive LES, aperistalsis of esophageal body, failure of LES to relax

105

Gold standard in diagnosing Achalasia

Manometry

106

Tx for Achalasia

Heller's Myotomy + Partial fundoplication

107

Esophogeal motility disorder with continuous high amplitude peristalsis

Nutcracker esophagus - increased mean duration of contraction

108

Spontaneous rupture of the esophagus into the left pleural cavity or just above the gastroesophageal junction

Boerhaave's syndrome

109

Diagnosis of esophageal rupture

Water soluble contrast esophagogram (Gastrografin) shows extravasation in the lateral decubitus position

110

Grading in caustic injuries with pseudomembrane formation

2nd degree

111

Most common type of esophageal Ca

Esophageal SCC - located in middle 3rd of the thoracic esophagus

112

Plummer Vinson Syndrome: predisposing condition to esophageal Ca

Triad - dysphagia, IDA, esophageal webs

113

Precursor lesion of Esophageal Adenocarcinoma

Barret's metaplasia - squamous mucosa of the esophagus turns to columnar

114

Surgical Tx for Esophageal Ca

Ivor Lewis Procedure: trans thoracic esophagectomy, trans hiatal esophagectomy

115

Thin submucosal ring in the lower esophagus

Schatzki's Ring

116

Longitudinal tears at the gastroesophageal junction

Mallory Weiss Tear

117

Remnant of umbilical vein

Ligamentum teres or round ligament - between L lobe and quadrate lobe

118

Remnant of ductus venosus

Ligamentum venosum - between L lobe and caudate lobe

119

Connects the liver to the anterior abdominal wall

Falciform ligament

120

Portal Triad

Portal vein, Hepatic Artery, Bile Duct

121

Porta Hepatis

CBD, Portal Vein, Hepatic Artery, Lymphatics

122

Blood supply of liver

Portal vein (superior mesenteric and splenic vein), Hepatic artery (celiac artery)

123

Where is biopsy of the liver done?

R 10th ICS, mid axillary line

124

Phagocytic cells of the liver

Kupffer Cells

125

Fat storing cells of the liver

Eto cells

126

Interlobar fissure that divides the liver into R and L lobes

Cantlie's Line

127

Liver venous drainage: segments 5-8

R hepatic vein

128

Liver venous drainage: segments 4, 5, 8

Middle hepatic vein

129

Liver venous drainage: segments 2, 3

Left hepatic vein

130

Liver venous drainage: caudate lobe

IVC - hardest to resect, not removed in a L hepatectomy

131

All clotting factors are synthesized in the liver except:

Factor 8

132

Removes phosphate from phosphoryl choline, maintains solubility of cholesterol in the bile

Alkaline phosphatase

133

Serum bilirubin levels in jaundice

>2.5 to 3mg/dL

134

Monomicrobial cause of spontaneous bacterial peritonitis

E. coli

135

Predicts the surgical risks of intra-abdominal operations performed on patients with cirrhosis

Child Turcotte Pugh Score - nutritional status, ascites, encephalopathy, serum bilirubin, serum albumin, prothrombin time

136

Criteria for Portal Hypertension

Direct portal venous pressure > 5mmHg of IVC pressure, Splenic pressure > 15mmHg

137

Most accurate method of determining portal HTN

Hepatic venography

138

Most significant manifestation of portal HTN

Esophageal varices - can do prophylactic Endoscopic Variceal Ligation

139

Preferred medical management for acute variceal bleeding

Octreotide

140

Non selective shunt for acute variceal bleeding

Totally diverts blood away from the liver to the systemic circulation. For Child's A. Decrease in portal pressure. Encephalopathy as possible complication

141

Congestive hepatopathy characterized by obstruction to hepatic venous outflow

Budd Chiari Syndrome - caused by polycythemia vera, pregnancy, OCP use

142

Tx of Budd Chiari Syndrome

Systemic anticoagulants - most patients are Child C

143

Most common cause is impaired biliary drainage. Organism most implicated is E coli

Pyogenic liver abscess - elevated WBC, ESR, alkaline phosphatase

144

Pyogenic liver abscess UTZ

Hypoechoic lesions with well defined borders and variable internal echoes

145

Pyogenic liver abscess CT:

Hypodense lesions with peripheral enhancement

146

Organism in amebic liver abscess

Entamoeba histolytica - located at superior anterior aspect of R lobe

147

Amebic liver abscess

Necrotic central portion containing reddish brown pus like material (anchovy paste)

148

Tx for Amebic liver abscess

Metronidazole 750mg TID for 7-10 days, aspiration for abscess >10cm

149

Liver disease caused by Echinococcus granulosus

Hydatid Disease - cyst in the anteroinferior or posteroinferior portions of the R lobe

150

Result of cyst rupture in Hydatid Disease

Allergic or anaphylactic reaction

151

Most common benign solid masses in the liver

Hemangioma - common among women, pain is the most common symptom and an indication for resection

152

Hemangioma MRI:

Hypointense on T1 and Hyperintense on T2

153

Clearest risk factor for hepatic adenoma

Use of OCP - Tx is resection since it may undergo malignant degeneration

154

Tx for Liver Focal Nodular Hyperplasia

Observe, resect if with abdominal pain - no malignant degeneration

155

Diagnosis of Hepatocellular Ca

AFP >500ng/dL

156

Proximal or hilar cholangiocarcinoma

Klatskin Tumor - Tx through resection

157

Gallbladder contracts to expel bile upon release of this hormone

Cholecystokinin

158

Infundibulum of the GB, junction between neck and cystic duct

Hartmann's Pouch

159

Triangle of Calot

Liver (superior), cystic duct (inferior) common hepatic duct (medial)

160

Blood supply of GB

Cystic artery from R hepatic artery (SMA)

161

Common site of an impacted gallstone

Hepatopancreatic ampulla

162

Referred pain in gallstones

Dull, aching, poorly localized pain over the T5 through L1 dermatomes

163

Form from the invagination of the epithelium through the fibromusculat layer in the GB

Rokitansky Aschoff Sinus - result of inflammation and an increase in intraluminal pressure

164

Whipple Procedure

Head of the pancreas, a portion of the bile duct, the gallbladder and the duodenum is removed

165

Normal GB wall thickness

<4mm

166

True or false: GB lacks muscularis mucosa and submucosa

TRUE

167

Location of Hepatic Artery

Anterior to the portal vein and medial to CBD

168

Common source of postcholecystectomy biliary leaks

Ducts of Luschka

169

Action of Cholecystokinin

GB contraction and sphincter of Oddi relaxation

170

Hormones that cause GB contraction

CCK and Vagus

171

Hormones that inhibit GB contraction

VIP, Somatostatin

172

Bile duct opens into this structure, 10cm distal to pylorus, that is surrounded by the sphincter of Oddi

Ampulla of Vater

173

Regulates the flow of bile and pancreatic juice into the duodenum

Sphincter of Oddi - prevents regurgitation of duodenal contents into the biliary tree

174

GB stones UTZ:

Acoustically dense, (+) posterior shadow, moves with changes in position

175

Acute Cholecystitis UTZ:

GB thickening, pericholecystic fluid, sonographic murphy sign

176

Multiple, multifaceted mulberry shaped stone

Mixed type (>70% cholesterol)

177

Soft and mushy pigment stones secondary to bacterial infection of bile stasis

Brown Pigment Stones

178

Small, brittle, spiculated stones due to hemolytic disorders and cirrhosis

Black Pigment Stones - precipitation of unconjugated bilirubin

179

Disease due to partial obstruction of the cystic duct

Chronic cholecystitis (Biliary Colic) - episodic, subsides spontaneously

180

Stone in CBD

Choledocholithiasis

181

Primary choledocholithiasis

Brown pigment stone formed in CBD - biliary stasis and infection

182

Secondary choledocholithiasis

Cholesterol stone formed in the GB and migrate to CBD

183

Gold standard test for Choledocholithiasis

ERCP - diagnostic and therapeutic

184

Ascending bacterial infection associated with partial or complete blockage of bile duct

Cholangitis - gallstones most common cause

185

Charcot's Triad

Cholangitis - fever, pain and jaundice

186

Reynold's Pentad

Cholangitis - Charcot's Triad plus septic shock and disorientation

187

Tx for Cholangitis with distal obstruction

ERCP or stent

188

Tx Cholangitis with proximal obstruction

Percutaneous transhepatic cholangiogram

189

Congenital cystic dilatations of the biliary tree

Choledochal cysts - pancreatic secretions refluxes into the bile duct. (Abdominal pain, jaundice, mass)

190

Most common type of choledochal cyst

Type 1 Fusiform - Tx with excision + roux en Y hepaticojejunostomy

191

Choledochal cyst: Choledochocoele

Type 3 - Tx sphincterotomy

192

Tx for Type 4 choledochal cyst

Segmental liver resection

193

Type 5 choledochal cyst: Caroli's Disease

Tx liver transplantation

194

Inflammatory strictures involving both extra and intrahepatic biliary tree

Sclerosing Cholangitis - may degenerate into cholangiocarcinoma

195

Dx and Tx for sclerosing cholangitis

Dx ERCP/PTC, Tx is liver transplantation

196

Most common Gallbladder carcinoma

Adenocarcinoma - gallstones most important risk factor

197

Gallbladder Ca limited to muscular layer

T1 - Tx cholecystectomy

198

Gallbladder Ca reaching perimuscular connective tissue

T2 - Tx extended cholecystectomy, liver segments IVB and V

199

Gallbladder Ca with spread to other organs

T3 or T4 - Tx extended R hepatectomy, liver segments IV to VIII

200

Tumor that most commonly involves the hepatic duct bifurcation

Bile Duct Carcinoma - adenocarcinoma, nodular type most common

201

Tumor markers for Bile Duct Ca

CA 125, CEA, CA 19-9

202

Dx method for Bile Duct Ca that can determine its resectability

Percutaneous Transhepatic Cholangiogram

203

Retroperitoneal exocrine and endocrine gland

Pancreas

204

Pancreas: embraced by the C shaped curve of the duodenum

Head - Ca obstructs the bile duct causing obstructive jaundice

205

Projection from the inferior part of the head

Uncinate process - Ca here compresses the SMA

206

Begins in the tail of the pancreas and runs through the parenchyma to the head where it merges with the bile duct and opens to the 2nd part of the duodenum

Main Pancreatic Duct of Wirsung

207

Blood supply of the pancreatic head and neck

Superior pancreaticoduodenal artery (gastroduodenal) and Inferior pancreaticoduodenal artery (SMA)

208

Blood supply of the body and tail of the pancreas

Pancreatic arteries (splenic)

209

Venous drainage of pancreas

Pancreatic veins, empty into splenic veins

210

Cancer of neck and body of the pancreas

Portal or IVC obstruction

211

Dorsal and ventral fusion of the pancreas

Annular pancreas - ring of pancreatic tissue around duodenum

212

X ray: duodenal obstruction

Double bubble sign - dilation of stomach and distal duodenum

213

Pancreatic duct that drains the upper half of the head and opens in the duodenum on the minor duodenal papilla

Accessory Duct of Santorini - often absent

214

Most common congenital anomaly of the pancreas

Pancreas divisum - risk factor for acute and chronic pancreatitis

215

Tx of Annular Pancreas

Bypass, duodeno-duodenostomy (connect D1 and D3)

216

Flank ecchymosis: acute pancreatitis

Grey Turner's Sign

217

Periumbilical ecchymosis: Acute Pancreatitis

Cullen's Sign - blood dissects up the falciform ligament

218

Ecchymosis in the inguinal area: Hemorrhagic Pancreatitis

Fox's Sign

219

Gold standard in Dx Pancreatitis: Abdominal CT Scan

Peripancreatic fat stranding, fluid collections, non enhancing pancreatic parenchyma with gas (necrosis)

220

Colonic spasm adjacent to an inflamed pancreas

Cut-Off sign

221

Focal duodenal and jejunal ileus in the area of the head of the pancreas

Reversed 3 or Inverted 3 Sign

222

DOC for severe pancreatitis

Imipinem

223

Primary pathologic process of Chronic Pancreatitis

Chronic alcoholic pancreatitis - DM and steatorrhea are common

224

Calcifications in the pancreas establishes the diagnosis of?

Chronic Pancreatitis

225

Tx for chronic pancreatitis with a normal duct

Whipple - pancreaticoduodenectomy

226

Tx for chronic pancreatitis with dilated duct

Puestow - longitudinal pancreaticojejunostomy

227

Umbilicus is normally at the level of?

L3

228

External oblique vs Internal oblique

EO - downward and medially, IO - upward and medially

229

Innermost, flat abdominal muscle

Transversus abdominis

230

What makes up the conjoint tendon?

Internal oblique + Transversus abdominis

231

Cremaster muscle is derived from what layer of the abdominal wall?

Internal oblique

232

Congenital type of hernia

Indirect

233

Acquired type of hernia

Direct

234

Neck of hernial sac is narrow, lateral to inferior epigastric vessels, enters the scrotum

Indirect

235

Neck of hernial sac is wide, medial to inferior epigastric vessels, never enters the scrotum

Direct

236

Hernia that protrudes through the anterior abdominal wall and covered by peritoneum and layers of spermatic cord

Indirect

237

Hernia that passes directly through Hesselbach's Triangle

Direct

238

Hesselbach's Triangle

Medial - rectus abdominis. Superior and Lateral - inferior epigastric artery. Inferior and lateral - Poupart's or inguinal ligament.

239

Scrotal derivative of abdominal superficial fascia

Dartos muscle - gives the wrinkled appearance of the scrotum

240

Sensory and motor fibers of cremasteric reflex

Sensory - ilioinguinal nerve. Motor - genital branch of genitofemoral nerve.

241

Peritoneum: sensitive to pressure, heat and cold. Pain is localized

Parietal peritoneum

242

Peritoneum: stimulated by stretching, poorly localized pain

Visceral peritoneum

243

Opening or connection between the lesser peritoneal sac and greater peritoneal sac

Epiploic Foramen of Winslow

244

Connects the stomach with other viscera

Omentum

245

Abdominal policeman. From the greater curvature of the stomach to transverse colon

Greater omentum

246

From the lesser curvature of the stomach and proximal duodenum to the liver

Lesser omentum

247

Hepatoduodenal ligament conducts the Portal Triad

Portal vein lying posterior, CBD anterior and to the R, Hepatic artery anterior and to the L

248

Medial, fan shaped part of inguinal ligament

Lacunar (Gimbernat's) Ligament

249

Preperitoneal space behind pubic symphysis. Site of laparoscopic hernia repairs

Space of Retzius

250

Arching fibers that press down during increase in intra-abdominal pressure

Shutter mechanism - prevents hernia even if there is a weak spot or patent procesus

251

Triangle of Doom contains:

Iliac artery, Iliac vein

252

Lower expanded part of procesus vaginalis that is normally closed off just before birth

Tunica vaginalis

253

Inguinal hernia relation to pubic tubercle

Neck is above and medial to the pubic tubercle

254

Femoral hernia relation to pubic tubercle

Neck below and lateral to pubic tubercle

255

Hernia that is more common among elderly females

Femoral hernia

256

Repair for femoral hernia

McVay Repair - repair attached to pectineal or Cooper's ligament

257

Tension less repair of ernia

Lichtenstein Hernioplasty

258

Laparoscopic repair for recurrent, bilateral and femoral hernias

Transabdominal preperitoneal

259

Lumbar Hernia

Grynfeltt's hernia - superior lumbar triangle. Petit's hernia - inferior lumbar triangle.

260

Hernia at the posterior diaphragm

Bochdaleck's hernia

261

Hernia lateral to the rectus muscle

Spigelian hernia

262

Hernia that contains a Meckel's diverticulum

Littre's Hernia

263

Hernia with 2 loops in the same ring (W shaped)

Maydl's hernia

264

Hernia in the anterior diaphragm

Morgagni's hernia