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67 Cards in this Set
- Front
- Back
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What forms the cremasteric muscles? |
internal oblique
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What forms the inguinal canal floor?
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transversalis muscle
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Where does the inguinal ligament come from?
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external oblique
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What forms where the inguinal ligament splays out to insert in the pubis?
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Lacunar ligament
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What comes from the transversalis, runs from asis to the pubis and is below the inguinal ligament?
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ileopubic tract
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Cooper's ligament aka?
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pectineal ligament
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What runs medial to the cord structures?
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vas deferens
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What forms Hesselbach's triangle?
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rectus muscle, inferior inguinal ligament, and inferior epigastrics
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What type of inguinal hernia is most common and comes from a patent processus vaginalis?
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indirect hernia
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What type of inguinal hernia has a lower risk of incarceration, rare in females, and has a higher recurrence than indirect?
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direct hernia
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What type of hernia has direct and indirect components?
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Pantaloon hernia
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What type of hernia occurs when the wall of the hernia sac is an organ?
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sliding hernia
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What are the 2 most common organs involved in a sliding inguinal hernia in women? and men?
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ovaries or fallopian tubes
cecum or sigmoid |
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3 steps in repair of female with ovary in inguinal canal?
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ligate the round ligament, return ovary to peritoneum, perform biopsy if looks abnormal
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Inguinal hernia in children is almost always what type? and what is the treatment?
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nearly always indirect, just perform high ligation (open sac prior to ligation)
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Describe the Bassini repair
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approximation of the conjoined tendon and transversalis fascia (superior) to the free edge of the inguinal ligament (inferior)
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Describe the McVay repair
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approximation of the conjoined tendon and transversalis fascia (superior) to Cooper's ligament (pectineal ligament, inferior)
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The McVay repair needs a relaxing incision where?
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external abdominal oblique fascia
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When is laparoscopic inguinal hernia repair indicated?
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bilateral or recurrent
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What is the advantage of the Lichtenstein mesh repair?
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decreased recurrence due to decreased tension
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What is the most common early complication following hernia repair?
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urinary retention
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What is the infection rate for inguinal hernia repair? and recurrence rate?
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2%, 2%
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What can occur secondary to dissection of the distal components of the hernia sac causing vessel disruption and thrombosis of spermatic cord veins?
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testicular atrophy
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Pain after hernia is usually caused by what? What is the tx?
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compression of ilioinguinal nerve, local infiltration (diagnostic and therapueutic)
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Loss of cremasteric reflex; numbness on ipsilateral penis, scrotum and thigh are sx of what?
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ilioinguinal nerve injury
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Where is the ilioinguinal nerve injury usually occur?
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at the external ring; nerve runs on top of cord
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What nerve is usually injured with laparscopic hernia repair?
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genitofemoral
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What are the two branches of the genitofemoral nerve and what do they do?
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genital branch - cremasteric (motor) and scotum (sensory)
femoral branch - uppler lateral thigh (sensory) |
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What is the tx for cord lipomas?
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should be removed
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What is in the trapezoid of doom in laparoscopic hernia repairs?
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femoral branch of genitofemoral nerve, lateral cutaneous nerve and femoral artery
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What are the boundaries of the femoral canal?
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Cooper's ligament, inguinal ligament and femoral vein
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Where in NAVEL dose femoral hernias occur?
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Empty space
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Fermoral hernias carry a high risk of incarceration. What may be necessary to divide to reduce bowel?
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inguinal ligament
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Femoral hernias are usually repaired through what approach? and what two possible tissue repairs?
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inguinal approach, McVay or Bassini
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What patient population has an increased risk of umbilical hernias?
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african americans
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Until what age should umbilical hernia repair be delayed?
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5 years
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Is the risk of incarceration of umbilical hernia in children or adults?
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Adults
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Where does a Spigelian hernia occur?
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lateral border of the rectus muscle through linea semilunaris, almost always inferior to the semicircularis
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What is as noncircumferencial incarceration of the nonmesenteric bowel wall?
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Richter's hernia
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What is an incarcerated Meckel's called?
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Littre's
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What is an inferior lumbar hernia called? and superior lumbar hernia?
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Petit's hernia is inferior lumbar. Grynfeltt's is a superior lumbar hernia
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What type of hernia goes through the greater sciatic foramen and has a high rate of strangulation?
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Sciatic hernia
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What is the tx for obturator hernia?
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operative reduction, may need mesh, check other side for similar defect. diagnosis usually made at the time of surgery for small bowel obstruction
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What type of hernia is the most likely to recur? what is the most common cause of this hernia?
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incisional, inadequate closure
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Peristomal hernias can be true of pseudo what is the cause and tx for both?
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missed the rectus, need to move and place in rectus muscle
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What is the tx for peristomal hernia - prolapse?
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keep stoma at the same site, fix mesentery (is in rectus but prolapsing through)
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What Fothergill's sign and what can it indicate?
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abdominal wall mass more prominent and painful with flexion of the rectus muscle
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Tx for rectus sheath hematoma is usually nonoperative. When do you operate?
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if expanding
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desmoid tumors occur more often in women, are benign but locally invasive and recurr. What syndrome are they associated with?
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Gardner's
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What is the tx for desmoid tumor?
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Wide local incision, if involving small bowel, excision may not be indicated -> often not completely resectable and can cause worsening fibrosis
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What are 2 possible medical treatments for desmoid tumors?
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NSAIDs and antiestrogens
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Retroperitoneal fibrosis can occur with hypersensitivity to what?
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methysergide (former migraine/cluster headache tx)
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What are the sx of retroperitoneal fibrosis and what is the most sensitive text?
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trapped ureters and lymphatic obstruction, IVP is most sensitive
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Tx for retroperitoneal fibrosis includes what medical tx? or what procedure if infection is present?
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steroids, nephrostomy if infection is present
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What is the indication for surgery in retroperitoneal fibriosis? and what is done in the surgery?
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surgery if renal function becomes compromised, free up ureters and wrap in omentum
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Of the primary mesenteric tumors, most are cystic. Where are malignant tumors located? and benign?
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malignant closer to the root of the mesentery, benign more peripheral
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Most solid tumors of the mesentery are benign. What two malignant types?
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liposcarcoma, leiomyosarcoma
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Retroperitoneal tumors, 15% in children, others in 5th-6th decade. Malignant > benign. What are the #1 and #2 malignant retroperitoneal tumors?
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#1 lymphoma, #2 liposarcoma
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Retropertoneal sarcomas what % are resectable? what is the 5 year survival rate?
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<25%, 10%
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Retroperitoneal sarcomas have a pseudocapsule but cannot shell out -> leave residual tumor. Where do the mets go?
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to the lung
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What is the most common omental solid tumor?
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metastatic disease
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Omentectomy for metastatic cancer has a role for some cancers such as ovarian CA. Omental cysts are usually asymptomatic, can ungergo torsion. Primary solid omental tumors are rate 1/3 maligant. What is the dx and tx?
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No biopsy -> can bleed. Tx: resection
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Most drugs are not removed with peritoneal dialysis: NH3, Ca, Fe and lead are removed. What is the rate saline is absorbed through the peritoneal membrane?
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35 cc/hr
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CO2 pneumoperitoneum, cardiopulmonary dysfunction can occur with intra-abdominal pressure > ?
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20
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What are the sx of CO2 embolus? the tx?
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sudden rise in ETCO2, hypotension; head down, turn patient to the left
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What is the difference in fibroblast ingrowth with Gore-Tex (PTFE) and Dacron (polypropylene)?
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Gore-Tex (PTFE) – cannot get fibroblast ingrowth
Dacron (polypropylene) – allows fibroblast ingrowth |
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What is the incidence of vascular or bowel injury with Veress needle or trocar?
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0.1%
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