Chapter 38 - Hernias, Abdomen & Surgical Technology Flashcards Preview

Fiser Absite > Chapter 38 - Hernias, Abdomen & Surgical Technology > Flashcards

Flashcards in Chapter 38 - Hernias, Abdomen & Surgical Technology Deck (69):
1

What forms the shelving edge in inguinal hernias?

External abdominal oblique (and fascia)

2

What forms the cremasteric muscles?

Internal abdominal oblique

3

What forms the inguinal canal floor?

Transversalis muscle

4

Where does the inguinal ligament run? What is it made from?

From ASIS to pubis
From external abdominal oblique

5

What makes up the lacunar ligament?

Where the inguinal ligament splays out to insert in the pubis

6

Where does the ileopubic tract run? What makes it up?

Runs from ASIS to pubis below inguinal ligament
From transversalis

7

What is another name for Cooper's ligament?

Pectineal ligament

8

What makes up the conjoined tendon?

Aponeurosis of the internal abdominal oblique and transversus abdominis muscle

9

Where does the vas deferens run in relation to the cord structures?

Medial to cord structures

10

What are the borders of Hesselbach's triangle?

Rectus muscle, inferior inguinal ligament, inferior epigastrics

11

Where are direct hernias in relation to Hesselbach's triangle? Indirect hernias?

Direct: inferior, medial to epigastric vessels (in triangle)
Indirect: Superior/lateral to epigastric vessels

12

Risk factors for inguinal hernia in adults?

Age, obesity, heavy lifting, COPD, chronic constipation, straining, ascites, pregnancy, peritoneal dialysis

13

Which type of inguinal hernia is most common?

Indirect; from persistently patent processus vaginalis

14

Which inguinal hernia has lower risk of incarceration? Higher recurrence?

Direct

15

What is a pantaloon hernia?

Direct and indirect component

16

What is most commonly contained in sliding hernias in females? Males?

Females: ovaries or fallopian tubes
Males: cecum or sigmoid

17

What is the procedure for a female with ovary in canal?

Ligate round ligament, return ovary to peritoneum, perform biopsy if looks abnormal

18

What is the procedure for hernias in infants and children?

High ligation (almost always indirect), open sac prior to ligation

19

What is a Lichtenstein repair?

Mesh; decreased recurrence

20

What is Bassini repair?

Approximation of conjoined tendon and transversalis fascia (superior) to the free edge of the inguinal ligament (inferior)

21

What is McVay repair?

Approximation of the conjoined tendon and transversalis fascia (superior) to Cooper's ligament (inferior); needs relaxing incision in external abdominal oblique fascia

22

What are the indications for lap hernia repair?

Bilateral or recurrent inguinal hernia

23

What is the most common early complication following hernia repair?

Urinary retention

24

What is the % of wound infections with hernia repair?

2%

25

What is the recurrence rate after hernia repair?

2%

26

When does testicular atrophy occur?

Usually with indirect hernias; secondary to dissection of the distal component of the hernia sac causing vessel disruption and thrombosis of spermatic cord veins

27

What is the most common cause of pain after hernia? Treatment?

Compression of ilioinguinal nerve
Local infiltration can be diagnostic and therapeutic

28

What is the result of ilioinguinal nerve injury?

Loss of cremasteric reflex; numbness on ipsilateral penis, scrotum and thigh

29

What is the result of genitofemoral nerve injury?

Usually injured with lap repair
Genital branch: cremaster (motor), and sensory to scrotum
Femoral branch: sensory to upper lateral thigh

30

What should be done with cord lipomas?

Removal

31

What is the trapezoid of doom?

In lap hernia repairs
Femoral branch of genitofemoral nerve, lateral cutaneous nerve, femoral artery
Need to dissect lateral to vessels, stay along inguinal ligament

32

What are femoral canal boundaries?

Cooper's ligament, inguinal ligament, femoral vein

33

What may need to be done to reduce bowel in femoral hernia?

Divide the inguinal ligament

34

How is a femoral hernia usually repaired?

Through an inguinal approach with McVay or Bassini repair

35

How long do you delay repair of umbilical hernia in children?

Until after 5 years

36

Where are Spigelian hernias?

Lateral border of the rectus muscle, through linea semilunaris
Almost always inferior to the semicircularis
Occurs between internal abdominal oblique muscle and line of insertion of the external abdominal oblique aponeurosis into rectus sheath

37

What is Richter's hernia?

Noncircumferential incarceration of the nonmesenteric bowel wall

38

What is Littre's hernia?

Incarcerated Meckel's

39

What is Petit's hernia?

Inferior lumbar hernia
External abdominal oblique, lat dorsi, iliac crest

40

What is Grynfeltt's hernia?

Superior lumbar hernia
Internal abdominal oblique, lumbodoral aponeurosis, 12th rib

41

What is Sciatic hernia?

Herniation through greater sciatic foramen; high rate of strangulation

42

What is Howship-Romberg sign?

Inner thigh pain with internal rotation; characteristic of obturator hernia

43

Who gets obturator hernias?

Elderly women, previous pregnancy, bowel gas below superior pubic ramus

44

Treatment for obturator hernia?

Operative reduction, may need mesh; check other side for similar defect

45

What type of hernia is most likely to recur?

Incisional hernia

46

What causes rectus sheath hematomas? Treatment?

Most common after trauma, due to epigastric vessel injury
Nonoperative, surgery if expanding

47

What is Fothergill's sign?

Rectus sheath hematoma: mass more prominent and painful with flexion of the rectus muscle

48

Characteristics of desmoid tumors?

Women, benign but locally invasive, high rate of recurrence

49

What syndrome is associated with desmoid tumors?

Gardner's

50

Treatment for desmoid tumor?

WLE; if involving small bowel may need excision
Often not completely resectable and can cause worsening fibrosis
NSAIDs, antiestrogens

51

What is a possible cause of retroperitoneal fibrosis?

Hypersensitivity to methysergide

52

What is the most sensitive test for retroperitoneal fibrosis?

IVP

53

Symptoms of retroperitoneal fibrosis? Treatment?

Symptoms related to trapped ureters and lymphatic obstruction
Steroids, nephrostomy and surgery if renal fxn becomes compromised

54

Where are malignant mesenteric tumors? Benign?

Malignant: closer to root of mesentery
Benign: more peripheral

55

What are malignant mesenteric tumor types?

Liposarcoma, leiomyosarcoma

56

What age group at risk for retroperitoneal tumors?

15% in children
5th-6th decade

57

What is the most common malignant retroperitoneal tumor?

#1 lymphoma, #2 liposarcoma

58

What is the 5 yr survival rate for retroperitoneal sarcomas? % resectable?

10% 5yr survival
<25% resectable

59

Where do mets from retroperitoneal sarcomas go?

Lung

60

What is the most common omental solid tumor?

Metastatic disease

61

Treatment of omental tumors?

Resection, do not biopsy due to risk of bleed

62

At what rate is saline absorbed from peritoneal membrane?

35cc/hr

63

What is removed with peritoneal dialysis?

NH3, Ca, Fe, lead; most drugs not removed

64

At what intraabdominal pressure can cardiopulmonary dysfunction occur?

>20mmHg

65

Treatment for CO2 embolus?

Head down, turn pt to the left
(Sudden risk in ETCO2 hypotension)

66

How does the harmonic scalpel work?

Disrupts protein H-bonds, causes coagulation

67

How does Argon beam work? What is it's depth of penetration?

Energy transferred across argon gas
Depth of necrosis related to power setting (2mm)

68

What type of graft (Gore-Tex/PTFE vs Dacron/polypropylene) allows fibroblast ingrowth?

Dacron

69

What is the incidence of vascular or bowel injury with Veress needle?

0.1%