EXAM #3: HERNIAS Flashcards Preview

Gastrointestinal System > EXAM #3: HERNIAS > Flashcards

Flashcards in EXAM #3: HERNIAS Deck (39):
1

What is the general school of thought for the surgical management of hernias?

Repair before they cause problems

2

What is the most common type of all hernias?

Inguinal

*Far more common in men*

3

Review the abdominal wall layers.

1) Skin
2) Subcutaneous tissue
- Camper's Fascia (fatty)
- Scarpa's Fascia (fibrous)
3) External Oblique
4) Internal Oblique
5) Transversus Abdominis m.
6) Transversalis fascia
7) Peritoneum

4

Review the anatomy of the inguinal canal.

N/A

5

What is an indirect inguinal hernia?

- Hernia through the internal inguinal ring
- Lateral to the inferior epigastric vessels
- Within the spermatic cord

MD's Don't Lie

6

Where does a direct inguinal hernia pass through?

Hasselbach's Triangle

7

What is a direct inguinal hernia?

Hernia that occurs
- Adjacent to rectus abdominus
- Medial to inferior epigastirc vessels
- Superior to inguinal ligament

8

What patient's more commonly have femoral hernias?

Female

9

What is a femoral hernia?

Hernia that passes into the femoral canal, below the inguinal ligament

10

How can an inguinal hernia be repaired with a "tissue repair?"

1) Bassini repair= single layer reconstruction of inguinal floor
2) Shouldice repair= four layer reconstruction of inginal floor
3) McVay repair= inguinal floor brought to Cooper's Ligament--closes the femoral space

11

What is the best tissue repair for an incarcerated femoral hernia?

McVay b.c is closes the femoral repair

12

Why perform a tissue repair?

1) No mesh available
2) INFECTION

13

What is the current standard hernia repair?

Lichtenstein Mesh Repair

14

What are the key characteristics of a Lichtenstein Mesh Repair?

1) Mesh reconstruction of inguinal floor
2) Tension-free

*Lowest risk of recurrence

15

What is the risk of a Lichtenstein Mesh Repair?

Prosthetic mesh infection

16

What is a Pre-Peritoneal Mesh Repair?

Mesh is placed INSIDE of fascia (vs. outside)

*Mesh is between peritoneum and transversus abdominus*

17

How do you place pre-peritoneal mesh?

Open or Laparoscopic

18

What are the benefits of Laparoscopic repair for pre-peritoneal mesh repair?

1) Less post-op pain
2) Less infection and hematoma
3) Quicker recovery with fewer work restrictions

19

What are the two approaches to the pre-peritoneal repair?

TAP and TEP

20

What is the TAP approach?

TransAbdominal Preperitoneal Laparoscopic Hernia Repair

21

What is the TEP approach?

Total Extraperitoneal Preperitoneal

22

How does the TEP differ from the TAP?

TAP= standard laprascopic approach

TEP= entry in RECTUS SHEATH

23

What are the evidence-based indications for laprascopic hernia repair?

1) Bilateral inguinal hernias
2) Comorbid umbilical
3) Young healthy individual that wants to return to work earlier

24

What is a Spigelian hernia?

Hernia along the semilunar line

25

What is the difference between an umbilical hernia in a kid and adult?

Kid= frequently regress (congenital)

Adult= acquired and progress/enlarge

26

How are umbilical hernias repaired?

1) Primary if 1-2cm
2) Mesh reinforcement for 2cm+ defects

27

What is an incisional hernia?

Failure of fascia healing

28

What are the risk factors for incisional hernias?

Infection
Early return to work
Obesity
Old-age
Male
Sleep apnea*
Emphysema*

*Chronic hypoxia states

29

How long should people be lifting restricted to prevent an incisional hernia?

6 weeks

30

What is a unique feature of epigastric hernias?

Small defect above the umbilicus that is PAINFUL

*Repaired to alleviate pain

31

What is the proposed etiology of Spigelian Hernias?

Vascular defects of the semilunar lines

32

What is a primary repair for an abdominal wall hernia?

Cut down a simply suture the defect

*Note that these are associated with a high recurrence rate

33

When is a primary repair done for a hernia?

1) Strangulation
2) Skin breakdown
3) Bowel resection

34

What is a mesh reinforeced repair for an abdominal wall hernia?

Mesh is placed to help reinforce the defect

35

When is a mesh reinforced repair CONTRAindicated?

Contaminated field/ infection

36

Where is abdominal wall mesh placed most commonly?

"Underlay" i.e. intraperitoneal

37

What is the gold standard for abdominal wall mesh placement?

"Retrorectus" i.e posterior to the rectus sheath

38

Is an incarcerated hernia a surgical emergency?

NO--an incarcerated hernia is one that cannot be reduced

*****A STRANGULATED hernia is an incarcerated hernia with compromised blood flow/ infection; this is a surgical emergency*****

39

What are the clinical features of a strangulated hernia?

1) Erythema of the overlying skin
2) Fever
3) Tachycardia
4) Elevated WBC count