Hernia Absite Flashcards

Front 1

Traumatic rupture of the diaphragm is most common @ which location?

Back 1

Traumatic rupture of the diaphragm: ~1% of thoracic trauma, up to 8% of those requiring laparotomy.
-high energy injuries, usually MVCs.
LEFT 2x more common than R. Usually tears in a radial orientation along the weak posterolateral aspect of L hemidiaphragm
-Sx: epigastric and abdominal pain, referred shoulder pain, SOB, vomiting, dysphagia, or shock.
-Initial CXR is nondiagnostic in up to 50 %.
-Collar sign = focal constriction of herniated viscera at the site of the tear, producing circumferential compression.
-Acute diaphragmatic injuries are best managed through an abdominal approach

Front 2

what are the borders of the femoral canal?

Back 2

Femoral canal:
Superior: inguinal ligament
Medial: lacunar ligament (from inguinal ligament to the pectineal ligament; part of ext oblique aponeurosis)
Lateral: femoral vein
-Posterior (floor): iliacus + psoas tendons, pectineal AKA Coopers ligament (extension of the lacunar ligament that runs on the pectineal line of the pubic bone)

Front 3

65M presents c/ tender mass below the inguinal ligament
-Suspect _
-Tx is _

Back 3

Femoral hernia:
-M>F
-Bulge on the anterior-medial thigh below the inguinal ligament, medial to femoral vein, lateral to lymphatics (in empty space)
-Femoral canal bounderies: Cooper's ligament, inguinal ligament, femoral vein (Poupart's ligament is medial)
-High risk of incarceration => may need to divide inguinal ligament to reduce the bowel, then repair the ligament
-Hernia usually repaired through an inguinal approach c/ McVay or Bassini repair (suprainguinal groin incision)

Front 4

The lateral boundary of a femoral hernia sac is formed by _

Back 4

Femoral hernias develop in an empty space at the medial aspect of the femoral canal after passing through the femoral ring (navEl). The boundaries of the sac include: medial - lacunar ligament, lateral - fascia on the femoral vein, anterior - inguinal ligament, and posterior - fascia on the pectineus muscle.

Front 5

The nerve injury associated with laparoscopic preperitoneal inguinal hernia repair is _

Back 5

Genitofemoral nerve.
-Genital branch runs on spermatic cord to cremaster (motor) and scrotum (sensory )
-Femoral branch: sensory to upper lateral thigh

Front 6

What is the most likely etiology of small bowel obstruction in a 50 year old obese female with no previous abdominal surgery?

Back 6

Incarcerated groin hernia

Front 7

Congenital condition _ results from ischemia of the right omphalomesenteric artery

Back 7

Gastroschisis:
Intrauterine rupture of umbilical vein before collateral circulation is established, and ischemia of the R omphalomesenteric artery (OMA) -> mesodermal and ectodermal defects.
-Disruption of the distal segment of the right OMA -> R paraumbilical ischemia -> paramedian defect.
-After infarction, the bowel herniates through the necrotic abdominal wall and enters the amniotic cavity.
-Further SMA ischemia => high incidence of concomitant JEJUNAL ATRESIA
-10% rate of congenital anomalies, esp. malrotation (vs. 50% c/ omphalocele)

Front 8

what hernia goes through defect made by 12h rib, internal oblique, and lumbosacral aponeurosis

Back 8

Grynfelt's hernia = superior lumbar hernia
-Internal ab oblique, lumbodorsal aponeurosis, and 23th rib (or posterior lumbocostal ligament)

Front 9

what are the borders of hesselbach's triangle?

Back 9

Rectus abdominis muscle (medially)
Inferior epigastric vessels (superior and laterally).
Inguinal ligament AKA Poupart's ligament (inferiorly)

Front 10

old lady presents c/ inner thigh pain c/ internal rotation. this is _

Back 10

Obturator hernia:
-Howship-Romberg sign = inner thigh pain c/ internal rotation
-X-ray: bowel gas below superior pelvic ramus
-5:1 women: men
-Tx: operative reduction +/- mesh. check other side for similar defect. may find bowel obstruction in OR.

Front 11

Patient presents after inguinal hernia repair c/ numbness on ipsilateral penis, scrotum, and thigh. Loss of cremasteric reflex.
-The _ nerve was injured, most likely @ landmark _

Back 11

Ilioinguinal nerve:
-traverses inguinal canal. runs on top of cord.
-Sensation to supero-medial thigh and scrotum
-Injury (usually @ external ring) -> loss of cremasteric reflex. numbness on ipsilateral penis, scrotum, thigh

Front 12

pt c/o pain following inguinal hernia repair.
-Suspect _
-_ can be diagnostic and therapeutic

Back 12

Inguinal hernia repair ->
compression of ilioinguinal nerve (branch of L1) ->
PAIN
-Local infiltration can be diagnostic, therapeutic

Front 13

#! Complication following inguinal hernia repair = _

Back 13

Inguinal hernia repair:
-Urinary retention = #1 early post-op complication (RFs: old, male, narcotics)
-2% wound infection, 2% recurrence
-Spematic cord venous thrombosis in indirect hernia repair -> Testicular atrophy
-Pain 2/2 compression of ilioinguinal nerve (runs on top of cord, usually injured @ external ring) -> loss of cremasteric reflex, thigh/scrotum numbness
-Genitofemoral nerve injury: usually c/ laparoscopic hernia repair

Front 14

Testicular atrophy following inguinal hernioplasty is usually due to _

Back 14

Testicular atrophy following inguinal hernioplasty is usually due to thrombosis of the veins in the spermatic cord

Front 15

What is the rate of recurrence with Lichtenstein repair of inguinal hernia?

Back 15

recurrence <1% for Lichtenstein repair. Some investigators, however, have reported 0.2% recurrence rate with mesh plug repair.
-Tension free synthetic mesh repair also has a reported recurrence rate of less than 1%. The recurrence rate for laparoscopic repair performed by experienced surgeons is reported to be around 1%. Lichtenstein: Mesh is sutured from the transversus arch to the shelving edge of the inguinal ligament creating a "tension-free" repair.

Front 16

what is the #1 abdominal hernia?

Back 16

Abdominal hernias develop in nearly 5% of the world population over a lifetime. Inguinal hernias are the most common abdominal wall hernias and constitute about 80% of the total cases. Femoral hernias are found in approximately 5%, while incisional, umbilical, epigastric, and other miscellaneous hernias make up the other 15%. Most inguinal hernias are found with a male to female ratio of 7:1. Femoral hernias have a female dominance of approximately 1.8:1.

Front 17

At reoperation for inguinal hernia recurrence following laparoscopic repair, #1 location for recurrence = _

Back 17

Inguinal hernia recurrence s/p laparoscopic repair:
-Most commonly @ medial portion of mesh, usually b/c mesh is too small > failure to attach mesh appropriately on medial aspect

Front 18

What is the most commonly injured nerve in inguinal hernia repair:

Back 18

Inguinal hernia repair:
-Ilioinguinal = most common nerve injury (runs on top of cord, usually injured @ external ring) -> loss of cremasteric reflex, thigh/scrotum numbness
-Genitofemoral nerve injury: usually c/ laparoscopic hernia repair -> genital branch => cremaster (motor), scroum (sensory); Femoral branch => upper lateral thigh (sensory)

Front 19

complication of laparoscopic indirect inguinal hernia repair that is most frequently ass'd c/ signficant post-op pain

Back 19

entrapment of the lateral femoral cutaneous nerve = complication of laparoscopic indirect inguinal hernia repair that is most frequently ass'd c/ signficant post-op pain
-Pain in lateral thigh
-arises from the dorsal divisions of the second and third lumbar nerves (genitofemoral also arises from these)

Front 20

60M presents with pain in his long standing inguinal hernia. The ER resident reduces the hernia with difficulty and sends the patient home. The patient presents again a few hours later with hypotension, tachycardia and localized tenderness in the lower quadrant, but without hernia. What is the likely diagnosis?

Back 20

Maydl's hernia = strangulated bowel within the abdominal cavity, with the loops of the intestines forming a W

2 adjacent loops of small intestine are within a hernial sac with a tight neck. The intervening portion of bowel within the abdomen is deprived of its blood supply and eventually becomes necrotic.

Front 21

Pt presents c/ tender medial thigh mass
-Pain increases c/ medial thigh rotation
-Suspect _
-Tx is _

Back 21

Obturator hernia: anterior pelvis
-Xray: bowel gas below inferior pubic ramus
-Howship-Romberg sign = pain c/ internal thigh rotation
-RFs: elderly women, previous pregnancy
-Bowel gas below superior pubic ramus
-Tx: operative reduction (inguinal approach requires incision in the inguinal floor = transverse fascia), may need mesh; check other side for similar defect
-Diagnosis usually made @ time of surgery for SBO

Front 22

How does an obturator hernia commonly present?

Back 22

Obturator hernias:
- Age 60+. 9x more common in females (large, wide pelvic bones and more horizontally oriented obturator canals).
-RFs: thin, prior pregnancy, chronic illness, malnutrition,
-Protrude through the obturator foramina: anterolateral pelvic wall immediately inferior to the acetabula.
-SBO = #1 symptom. May be mild + intermittent.
-Related physical findings are rare since the incarcerated hernia is located posterior to the pectineus and adductor longus muscles.
-Howship-Romberg sign in 50%= pain along the medial aspect of the thigh, extending to the knee, 2/2 irritation of the obturator nerve.
-CT plays an important role in the diagnosis of obturator hernia by demonstrating incarcerated small bowel posterior to the pectineus muscle.
-Tx: laparotomy and repair of the hernia defect.

Front 23

Petit's hernia (inferior lumbar hernia) goes through triangle made by what 3 anatomic strucures?

Back 23

Petit's hernia:
-inferior lumbar triangle (ilaic crest, ext oblique, lat dorsi)
-lmakes a preety large defect, so lower risk of strangulation

Front 24

What is the most common organ involved in sliding hernia in men?

Back 24

Sliding hernia: A VISCERAL WALL MAKES UP PART OF THE SAC
-occurs when an organ drags along part of the peritoneum, i.e. the organ is part of the hernia sac.
-Women, OVARY (or fallopian) tubes = most common (=> ligate the round ligament, return ovary to peritoneum, bx if it looks abnormal)
-Men: CECUM OR SIGMOID = most common
-Bladder also commonly involved

Front 25

What is the most common organ involved in sliding hernia in women?

Back 25

Sliding hernia: A VISCERAL WALL MAKES UP PART OF THE SAC
-occurs when an organ drags along part of the peritoneum, i.e. the organ is part of the hernia sac.
-Women, OVARY (or fallopian) tubes = most common (=> ligate the round ligament, return ovary to peritoneum, bx if it looks abnormal)
-Men: CECUM OR SIGMOID = most common
-Bladder also commonly involved

Front 26

_ hernias almost always develop at or below the arcuate line = linea semicurcularis

Back 26

Spigelian hernia or lateral ventral hernia arise through the spigelian fascia, = aponeurotic layer between the rectus abdominis muscle medially, and the semilunar line laterally.
-Develop at or below the arcuate line (linear semicircularis) 2/2 lack of posterior rectus sheath.
- interparietal = do not lie below the subcutaneous fat but penetrate between the muscles of the abdominal wall; therefore, there is often no notable swelling.
Sx: intermittent mass, localized pain, or signs of bowel obstruction.
-Dx: US, CT (more sensitive and specific)
-Tx: surgery b/c high risk of strangulation.