EXAM #3: HERNIAS Flashcards Preview

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Flashcards in EXAM #3: HERNIAS Deck (39)
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1
Q
What is the general school of thought for the surgical management of hernias?
A
Repair before they cause problems
2
Q
What is the most common type of all hernias?
A
Inguinal

*Far more common in men*
3
Q
Review the abdominal wall layers.
A
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
Q
Review the anatomy of the inguinal canal.
A
N/A
5
Q
What is an indirect inguinal hernia?
A
- Hernia through the internal inguinal ring
- Lateral to the inferior epigastric vessels
- Within the spermatic cord

MD's Don't Lie
6
Q
Where does a direct inguinal hernia pass through?
A
Hasselbach's Triangle
7
Q
What is a direct inguinal hernia?
A
Hernia that occurs
- Adjacent to rectus abdominus
- Medial to inferior epigastirc vessels
- Superior to inguinal ligament
8
Q
What patient's more commonly have femoral hernias?
A
Female
9
Q
What is a femoral hernia?
A
Hernia that passes into the femoral canal, below the inguinal ligament
10
Q
How can an inguinal hernia be repaired with a "tissue repair?"
A
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
Q
What is the best tissue repair for an incarcerated femoral hernia?
A
McVay b.c is closes the femoral repair
12
Q
Why perform a tissue repair?
A
1) No mesh available
2) INFECTION
13
Q
What is the current standard hernia repair?
A
Lichtenstein Mesh Repair
14
Q
What are the key characteristics of a Lichtenstein Mesh Repair?
A
1) Mesh reconstruction of inguinal floor
2) Tension-free

*Lowest risk of recurrence
15
Q
What is the risk of a Lichtenstein Mesh Repair?
A
Prosthetic mesh infection
16
Q
What is a Pre-Peritoneal Mesh Repair?
A
Mesh is placed INSIDE of fascia (vs. outside)

*Mesh is between peritoneum and transversus abdominus*
17
Q
How do you place pre-peritoneal mesh?
A
Open or Laparoscopic
18
Q
What are the benefits of Laparoscopic repair for pre-peritoneal mesh repair?
A
1) Less post-op pain
2) Less infection and hematoma
3) Quicker recovery with fewer work restrictions
19
Q
What are the two approaches to the pre-peritoneal repair?
A
TAP and TEP
20
Q
What is the TAP approach?
A
TransAbdominal Preperitoneal Laparoscopic Hernia Repair
21
Q
What is the TEP approach?
A
Total Extraperitoneal Preperitoneal
22
Q
How does the TEP differ from the TAP?
A
TAP= standard laprascopic approach

TEP= entry in RECTUS SHEATH
23
Q
What are the evidence-based indications for laprascopic hernia repair?
A
1) Bilateral inguinal hernias
2) Comorbid umbilical
3) Young healthy individual that wants to return to work earlier
24
Q
What is a Spigelian hernia?
A
Hernia along the semilunar line
25
Q
What is the difference between an umbilical hernia in a kid and adult?
A
Kid= frequently regress (congenital)

Adult= acquired and progress/enlarge
26
Q
How are umbilical hernias repaired?
A
1) Primary if 1-2cm
2) Mesh reinforcement for 2cm+ defects
27
Q
What is an incisional hernia?
A
Failure of fascia healing
28
Q
What are the risk factors for incisional hernias?
A
Infection
Early return to work
Obesity
Old-age
Male
Sleep apnea*
Emphysema*

*Chronic hypoxia states
29
Q
How long should people be lifting restricted to prevent an incisional hernia?
A
6 weeks
30
Q
What is a unique feature of epigastric hernias?
A
Small defect above the umbilicus that is PAINFUL

*Repaired to alleviate pain
31
Q
What is the proposed etiology of Spigelian Hernias?
A
Vascular defects of the semilunar lines
32
Q
What is a primary repair for an abdominal wall hernia?
A
Cut down a simply suture the defect

*Note that these are associated with a high recurrence rate
33
Q
When is a primary repair done for a hernia?
A
1) Strangulation
2) Skin breakdown
3) Bowel resection
34
Q
What is a mesh reinforeced repair for an abdominal wall hernia?
A
Mesh is placed to help reinforce the defect
35
Q
When is a mesh reinforced repair CONTRAindicated?
A
Contaminated field/ infection
36
Q
Where is abdominal wall mesh placed most commonly?
A
"Underlay" i.e. intraperitoneal
37
Q
What is the gold standard for abdominal wall mesh placement?
A
"Retrorectus" i.e posterior to the rectus sheath
38
Q
Is an incarcerated hernia a surgical emergency?
A
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
Q
What are the clinical features of a strangulated hernia?
A
1) Erythema of the overlying skin
2) Fever
3) Tachycardia
4) Elevated WBC count