Hernias,Abdomen, Surgical technology

Question 1

indirect hernia

Answer 1

patent processus vaginalis
most common
superior and lateral to epigastric muscles

Question 2

runs medial to cord structures

Answer 2

vas deferens

Question 3

forms external abdominal oblique fascia and shelving edge

Answer 3

external abdominal oblique

Question 4

forms cremasteric muscles

Answer 4

internal abdominal oblique

Question 5

forms inguinal canal floor

Answer 5

transversalis muscle

Question 6

lacunar ligamnet

Answer 6

where inguinal ligament splays out to insert in the pubis

Question 7

below inguinal ligament , from transversalis

Answer 7

ileopubic tract

Question 8

composed of aponeurosis of the internal abdominal oblique and transversus abdomins muscles

Answer 8

conjoined tendon

Question 9

hasselbachs traiangle

Answer 9

medial - rectus muscle
inferior - inguinal ligament
superior - inferior epigastric

Question 10

direct hernias

Answer 10

lower risk of incarceration
rare in females
inferior/medial to epigastric vessels

Question 11

lichtenstein repair

Answer 11

decreases reccurence of hernia by using mesh

decreases tension

Question 12

bassini repair

Answer 12

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

Question 13

Mcvay repair

Answer 13

approximation of the conjoined tendon and transversalis fascia to coopers ligament
needs a relaxing incsions in the external abdominal oblique fascia

Question 14

most common early complication following hernia repair

Answer 14

urinary retention

Question 15

testicular atrophy after hernia repair

Answer 15

secondary to dissection of the distal component of the hernia sac causing vessel disruption
thrombosis of spermatic cord veins
usually with indirect hernia repair

Question 16

pain after hernia repair

Answer 16

ilioinuinal nerve compression

TX: local infiltration can be diagnostic and therapeutic

Question 17

ilioinguinal nerve injury

Answer 17

loss of cremasteric reflex, numbness on ipsilateral penis,scrotum, thigh
usually injured at external ring, nerve runs on top of cord

Question 18

genitofemoral nerve injury

Answer 18

genital branch -
motor cremaster/ scrotum sensory
femoral - sensory upper lateral thigh

Question 19

cord lipomas

Answer 19

remove

Question 20

trapezoid of doom

Answer 20

laparoscopic hernia repair- femoral branch of genitfemoral nerve, lateral cutaneous nerve, femoral artery
dissect lateral to vessels stay along inguinal ligament

Question 21

femoral hernia

Answer 21

medial to femoral vein and lateral to the lymphatics
boundaries:
coopers ligament, inguinal ligament, femoral vein
TX use a Mcvay or bassni repair

Question 22

spigelian hernia

Answer 22

lateral border of rectus muscle throug linea semilunaris and usually inferior to semicicrularis

Question 23

richters hernia

Answer 23

noncircumfrential incarceration of thre nonmesenteric bowel wall

Question 24

littres hernia

Answer 24

incarcerated meckels

Question 25

Petis hernia

Answer 25

inferior lumbar hernia boarders: external abdominal oblique latissimus dorsi ilia crest

Question 26

grynfelts hernia

Answer 26

superior lumbar hernia | boarders: internal abdominal oblique, lumbrodorsal aponeurosis, 12 th rib

Question 27

sciatic hernia

Answer 27

herniation through the greater sciatic foramen, high rate of strangulation

Question 28

obturator hernia

Answer 28

howship romberg sign - inner thigh pain with internal rotation elderly women, previous pregnancy, bowel gas below superior pubic ramus TX: operative reduction

Question 29

CO2 pneumoperitoneum

Answer 29

increased pulmonary artery pressure, HR, systemic vascular resistance, CVP, mean airway pressure, peak inspiratory pressure, and CO2 decreased venous return (IVC compression), pH, renal flow , CO PEEP has additive effect--> increased P --> decreased renal blood flow and increases renin production

Question 30

Co2 embolus

Answer 30

head down, turn patient to left

Question 31

sudden rise in ETCO and hypotension during laprascopy

Answer 31

CO2 embolus

Question 32

harmonic scalpel

Answer 32

disrupts H bonds, causes coagulation