Fiser Chapter 38 HERNIAS, ABDOMEN, AND SURGICAL TECHNOLOGY Flashcards Preview

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Flashcards in Fiser Chapter 38 HERNIAS, ABDOMEN, AND SURGICAL TECHNOLOGY Deck (50)
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1

What does the external oblique fascia form in inguinal canal?

Inguinal ligament (shelving edge) at inferior portion of inguinal canal

2

What does the internal oblique form in the inguinal canal?

Cremasteric muscles

3

What does the transversalis muscle and fascia form in the inguinal canal?

Conjoined tendon and inguinal floor (respectively)

4

Lacunar ligament

Where the inguinal ligament splays out to insert in the pubis

5

Cooper's ligament (pectineal ligament)

Posterior to femoral vessels, lies against bone

6

What is the vas deferens in inguinal canal?

Runs medial to cord structures

7

Hesselbach's triangle

Recus muscle lateral border, inguinal ligament, inferior epigastrics

Direct hernias are in the triangle, indirect hernias are lateral to epigastric vessels

8

Etiology of indirect hernia

Persistent patent processor vaginalis; most common

9

Direct hernias

Lower risk of incarceration, rare in females, higher recurrence than indirect

10

Pantaloon hernia

Both direct and indirect components

11

Risk factors for inguinal hernia in adults

Age

Obesity

Heavy lifting

COPD (coughing)

Chronic constipation

Straining (BPH)

Ascites

Pregnancy

Peritoneal dialysis

12

Incarcerated hernia

Can lead to bowel strangulation and should be repaired emergently

13

Sliding hernias

Retroperitoneal organ in hernia sac (ovaries, fallopian tubes, cecum, sigmoid bladder)

14

Tx of female with ovary in inguinal canal

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

15

Infants and children with inguinal hernia

Open sac and then perform high ligation (almost always indirect)

16

Lichtenstein inguinal hernia repair

Mesh (less tension, decreases recurrence)

17

Bassini inguinal hernia repair

Approximate conjoined tendon and transversalis fascia to the free shelving edge of the inguinal ligament

18

Cooper's (pectineal) ligament inguinal hernia repair

Approximate conjoined tendon and transversalis fascia to Cooper's ligament

-Needs relaxing incision in external oblique fascia
-Can use for femoral hernia repair

19

Indication for laparoscopic inguinal hernia repair

Bilateral or recurrence

20

Most common early complication following inguinal hernia repair

-Urinary retention

-Recurrent 2%
-Wound infection 1%
-Testicular atrophy (d/t dissection of distal component of sac causing vessel disruption, spermatic cord vein thrombosis, usually with indirect hernias)
-Pain (ilioinguinal nerve compression, tx is local infiltration)
-Nerve injury to ilioinguinal or genitofemoral

21

Postop inguinal hernia repair, patient has loss of cremasteric reflex, numbness on ipsilateral penis, scrotum, and thigh

Ilioinguinal nerve injury, usual at external ring, runs on top of cord

22

Postop laparoscopic inguinal hernia repair, patient has loss of cremastric reflex, scrotum numbness, and upper lateral thigh numbness

-Genitofemoral nerve injury

23

Femoral hernia characteristics

Bulge on anterior-medial thigh, below inguinal ligament; usually repair through inguinal approach with Cooper's ligament repair

Most common in females over males (but indirect inguinal hernia still most common in females)

Hernia passes under inguinal ligament, medial to femoral vein, lateral to lymphatics (in empty space)

High risk of incarceration -> may need to divide inguinal ligament to reduce bowel

24

Femoral canal boundaries

Cooper's (pectineal) ligament posteriorly

Inguinal ligament anteriosuperiorly

Femoral vein laterally

Lacunar ligament medially

Contains lymph node of Cloquet

25

Umbilical hernia characteristics

Increased in African Americans

Delay repair until 5yo, often close on own

Risk of incarceration in adults, not kids

26

Spigelian hernia characteristics

Lateral border of rectus muscle, adjacent to linea semilunaris; almost always inferior to semicircularis

Occurs between muscle fibers of internal oblique muscle and insertion of external oblique aponeurosis into rectus sheath

27

Old woman with previous pregnancies, presents with tender medial thigh mass and SBO, has inner thigh pain with internal rotation (Hoship-Romberg sign)

Obturator hernia (anterior pelvis)

Tx: operative reduction, may need mesh; check other side for similar defect

28

Sciatic thigh hernia characteristics

Posterior pelvis (versus obturator hernia)

Herniation through greater sciatic foramen

High rate of strangulation

29

Incisional hernia characteristics

Most likely to recur

Inadequate closure most common cause

30

Rectus sheath above and below arcuate line

Anterior present all the way down

Posterior is present until arcuate line: is made of posterior aponeurosis of internal oblique and transversalis aponeurosis