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Hernias Flashcards

1
Q

Where is a femoral hernia

A

Medial to femoral vessels, under the inguinal ligament

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2
Q

What does TEPA procedure stand for

A

Totally ExtraPeritoneal Approach

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3
Q

To what does the inguinal ligament attach?

A

ASIS to the pubic tubercle

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4
Q

What are the borders of hesselbach’s triangle

A

Epigastric vessels

Inguinal ligament

Lateral border of the rectus

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5
Q

What is the most common organ in an inguinal hernia sac in women

A

Ovary/fallopian tube

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6
Q

Risk of strangulation in groin hernias from most likely to least

A

Femoral

Indirect

Direct

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7
Q

Medial border of femoral canal

A

Lacunar ligament

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8
Q

What lies in the inguinal canal in females instead of the VAS?

A

Round ligament

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9
Q

What does TAPP procedure stand for

A

TransAbdominal PrePeritoneal inguinal hernia repair

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10
Q

What is the difference between complete and incomplete hernia

A

Incompete = defect present without sac or contents protruding completely through it

Complete = hernia sac and its contents protrude all the way through the defect

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11
Q

A hernia is a protrusion of a _______ through a ______

A

Peritoneal sac

Musculoaponuerotic barrier

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12
Q

What is an umbilical hernia

A

Hernia through the umbilical RING

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13
Q

What is an umbilical hernia associated with in adults

A

Ascites, pregnancy, and obesity

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14
Q

Which is more dangerous: a small or large hernia defect

A

Small

Tight defect = more likely to strangulate if incarcerated

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15
Q

Most common hernia in women

A

Indirect

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16
Q

What is the repair of a femoral hernia?

A

McVay, mesh plug repair

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17
Q

Risk factors associated with femoral hernia

A

Women

Preggos

Exertion

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18
Q

Where is a hiatal hernia

A

Hernia through esophageal hiatus

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19
Q

What is in the spermatic cord

A
  1. Cremasteric muscle fibers
  2. Vas deferens
  3. Testicular artery
  4. Testicular pampiniform venous plexus
  5. +/- hernia sac
  6. Genital branch of the genitofemoral nerve
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20
Q

Name the layers of the abdominal wall from superficial to deep

A

Skin ➡️ subcuntaneous fat ➡️ Scarpa’s fascia ➡️ External oblique ➡️ Internal oblique ➡️ Transversus abdominus ➡️ Transversalis fascia ➡️ Preperitoneal fat ➡️ Peritoneum

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21
Q

What is a ventral hernia

A

Primary hernias with no associated prior incision and are located anywhere along the midline above or below the umbilicus

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22
Q

What is a Richter’s hernia?

A

Incarcerated or strangulated hernia involving only one sidewall of the bowel, which can spontaneously reduce, resulting in gangrenous bowel and perforation within the abdomen without signs of obstruction

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23
Q

What is the most common cause of incisional hernia

A

Wound infection

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24
Q

What is Peterson’s hernia

A

Seen after bariatric gastric bypass-internal herniation of small bowel through the mesenteric defect from the Roux limb

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25
What is a “cord lipoma”
Preperitoneal fat on the cord structures (pushed in by the hernia sac); not a real lipoma
26
What is an obturator hernia
Hernia through obturator canal
27
Where in the inguinal canal does the hernia sac lie in relation to the other structures?
Anteromedially
28
What nerve runs with the spermatic cord in the inguinal canal?
Ilioinguinal nerve
29
What is a conjoint tendon?
Aponeurotic attachments of the “conjoining” of the internal oblique and transversus abdominis to the pubic tubercle
30
What is a pantaloon hernia
Hernia sac exists as both a direct and indirect hernia straddling the inferior epigastric vessels and prodtruding through the floor of the canal as well as the internal ring (Two sacs separated by the inferior epigastric artery)
31
What is the first identifiable subcutaneous named layer?
Scarpa’s fascia
32
Describe McVay procedure
Cooper’s ligament sutured to transversus abdominis aponeurosis
33
Posterior border of femoral canal
Cooper’s ligament
34
What is a small outpouching of testicular tissue off the testicle?
Testicular appendage
35
How tight should the nre internal inguinal ring be?
Should allow entrance of the tip of a kelly clamp but not a finger
36
What are the indications for laparoscopic inguinal hernia repair
1. Bilateral inguinal hernias 2. Recurring hernia 3. Need to resume full activity as soon as possible
37
Why do we repair hernias
To avoid complications of incarceration/strangulation, bowel necrosis, SBO, pain
38
What is an internal hernia
Hernia in or involving intra-abdominal structure
39
From what abdominal muscle layer is the inguinal ligament derived?
External oblique muscle aponeurosis
40
What is a “relaxing incision”
Incisions in the rectus sheath to relax the conjoint tendon so that it can be approximated to the reflection of the inguinal liagment without tension
41
Symptoms that the hernia is strangulated
``` Intractable nausea/vomiting Severe pain Tachycardia Fever Focal peritonitis Leukocytosis Acidosis Obstruction on imaging ```
42
What nerve travels within the spermatic cord
Genital branch of the genitofemoral nerve
43
What is the differential diagnosis of an inguinal hernia?
Lymphadenopathy Psoas abscess Ectopic testis Hydrocele of the cord Saphenous varix Lipoma Baricocele Testicular torsion Femoral artery aneurysm Abscess
44
How often do femoral hernias incarcerate?
1/3
45
What is Littre’s hernia
Hernia involving a Meckel’s diverticulum
46
What is a sliding hernia
Hernia sac partially formed by the wall of a viscus (bladder, cecum)
47
Describe the Lichtenstein procedure
“Tension-free repair” using mesh
48
Lateral border of femoral canal
Femoral vein
49
Most common hernia in men
Indirect inguinal
50
What is an epigastric hernia (location specifically)
Hernia through the linea alba above the umbilicus
51
Why do some surgeons deliverately cut the ilioinguinal nerve?
To remove the risk of entrapment and postoperative pain
52
What are the boundaries of Hasselbach’s triangle
Inferior epigastric vessels Inguinal ligament (Poupart’s) Lateral border of the rectus sheath Floor consists of internal oblique and the transversus abdominis muscle
53
What attaches the testicle to the scrotum
Gubernaculum
54
What happens if you cut the ilioinguinal nerve
Numbness of inner thigh or lateral scrotum, usually goes away in 6 months
55
What percentage of patients with a femoral hernia are female?
85%
56
Which nerve travels on the spermatic cord
Ilioinguinal nerve
57
Non-reducible hernia =
Incarcerated
58
What action should be taken if a suture is placed through the femoral artery or vein during an inguinal herniorrhaphy?
Remove the suture ASAP and apply pressure
59
What is a femoral hernia
Hernia traveling beneath the inguinal ligament down the femoral canal medial to the femoral vessels
60
What is the name of the surgery for hernia repair
Herniorrhaphy
61
Incarcerated hernia with resulting ischemia =
Strangulated
62
Describe High ligation
Ligation and transection of indirect hernia sacwithout repair of inguinal floor (used only in children)
63
Describe the Bassini procedure
Sutures approximate reflection of inguinal ligament to the transversus abdominis aponeurosis
64
Where is a direct hernia
Inguinal hernia within Hasselbach’s triangle
65
What is the hernia sac made of
Peritoneum (direct) Patent processus vaginalis (indirect)
66
What is the name of the subcutaneous vein that is ligated?
Superficial epigastric vein
67
What is a spigelian hernia
Hernia through the linea semilunaris Also known as spontaneous lateral ventral hernia
68
Describe “plug and patch” procedure
Placing a plug of mesh in hernia defect and then overlaying a patch of mesh over inguinal floor
69
Anterior border of femoral canal
Inguinal liagment
70
What is the nerve found on top of the spermatic cord
Ilioinguinal nerve
71
What is a hernia adjacent to an -ostomy called?
Parastromal hernia
72
What are the boundaries of the femoral canal?
1. Cooper’s ligament - posterior 2. Inguinal ligament - anterior 3. Femoral vein - lateral 4. Lacunar ligament - medial
73
What is a ventral hernia
Incisional hernia in the ventral abdominal wall
74
Where is an indirect hernia
Inguinal hernia lateral to hasselbach’s triangle
75
From what abdominal muscle layer is the cremaster muscle derived?
Internal oblique muscle
76
Precipitating factors for hernia
Increased intra-abdominal pressure: Straining at defecation/urination, obesity, pregnancy, ascites, valsavagenic COPD, abnormal congenital anatomic route
77
What is reducing a hernia “en masse”
Reducing the hernia contents and hernia sac
78
What is the most common organ in an inguinal hernia sac in men
Small intenstin

Surgery (5 decks)

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