(Iii-Surgery) Hernias

Front 1

Most superficial fascia layer on the abdomen:

Back 1

Campers

Front 2

What is the linea alba?

Back 2

The midline decussation of the three aponeruosis of the abdominal wall.

Front 3

Fibers from this muscle forms the superifical inguinal ring?:

Back 3

External oblique muscle

Front 4

Fibers from the aponeurosis of this muscle splits to envelope the rectus abdominus superior to the umbilicus anteriorly, and is anterior to the rectus inferior to the umbilicus:

Back 4

Internal oblique muscle

Front 5

Does the aponeurosis of the transversus abdominis muscle split superior and inferior to the umbilicus?

Back 5

Yes.

Front 6

What is the aponeurotic arch? What is the clinical significance?

Back 6

The termination of the aponeurosis of the transversus abdominis.

If the arch is large, it can predispose a person to a direct inguinal hernia.

Front 7

Principle blood supply of the rectus abdominis muscles:

Back 7

Superior and inferior epigastric arteries.

Front 8

What is the semilunar line?

Back 8

A slight depression in aponeurosis at the lateral edge of the rectus abdominis muscle. Insertion of the aponeurotic tendons of the lateral abdominal muscles.

Front 9

What are the components of the anterior rectus sheath superior to the umbiliculs?

Back 9

EAO aponeurois, anterior lamina of IAO, NO transversus aponeurosis.

Front 10

What is the petit triangle?

Back 10

Space formed between the EAO, lats, and iliac crest.

Front 11

Male to female ratio of inguinal hernias?

Back 11

7:1

Front 12

Male to female ratio of femoral hernia:

Back 12

1:1.8

Front 13

Two clinical ways to tell the difference between a hydrocele and a hernia:

Back 13

You can get examining fingers above a hydrocele, but not a hernia

Also hydroceles transiluminate, while hernias don't

Front 14

Incidence of hernias in premature infants:

Back 14

10%

Front 15

Signs of a strangulated hernia:

Back 15

Tender irreducible mass, toxicity, dehydration, fever.

Very tender to touch

Skin changes

Bowel sounds absent

Metabolic acidosis

Front 16

Treatment for a strangulated hernia:

Back 16

NG suction, fluids, and electrolytes until you can get the patient to surgery.

Front 17

X-Ray of a strangulated hernia:

Back 17

Dilated loops of bowl with air-flud levels. Bowel shadows may indicate site of herniation

Front 18

What is a periumbilical hernia? What age do they typically present?

Back 18

Occurs in infants, due to improper healing of umbilical scar, leaving a fascial defect covered by skin.

Typically 1-2 cm in infants.

Front 19

Cause of periumbilical hernia in older adults:

Back 19

Increased intra-abdominal pressure.

Note that it is important to look for a cause of the increased pressure.

Front 20

This type of hernia is often described as a painful nodule in the upper midline.

Back 20

Epigastric hernia

Front 21

What is the defect that typically leads to epigastric hernias?

Back 21

Lacking the normal tripledecussation in the upper midline.

Front 22

What type of surgeries typically lead to incisional hernias?

Back 22

Trick question! Any type of surgery can lead to incisional hernias.

However midline and transverse incisions have the highest incidece.

Front 23

Risk factors for incisional hernias:

Back 23

Obesity
Smoking
Pulmonary disease
Hypoalbuminemia

Front 24

Which is a more common site for parastomal hernias: Small bowel or colon?

Back 24

Colon

Front 25

Etiology of parastomal hernias

Back 25

Poor site selection

Front 26

How common are parastomal hernias?

Back 26

Very common. 50% of pts with stomas will have a stoma hernia after 5 years.

However, most don't require treatment.

Front 27

This type of hernia is a protrusion of the hernia contents through the semilunar line.

Back 27

Spigelian hernia.

Note that you won't feel a hernia on physical exam since they don't penetrate the external oblique fascia.

Front 28

Describe the location of the superior lumbar hernia of Grynfelt:

Back 28

Through the space between the latissimus dorsi, serratus posterior inferior, and internal oblique posterior posterior border

Front 29

This type of hernia is often found in women and associated with laxity of pelvic floor.

Back 29

Obterator hernia.
Herniation through obturator canal with obturator vessels and nerves.

Front 30

This type of hernia is very rare. It presents as a swelling on the buttocks with possible ureter obstruction

Back 30

Sciatic hernia

Front 31

This type of hernia is associated with meckel diverticulum

Back 31

Littre hernia.

Note that it may also contain the appendix

Front 32

This type of hernia can occur at any location, and happens when only part of the bowel wall is partially incarcerated:

Back 32

Richter hernia

Front 33

This type of hernia is when the hernia sac is made up of an intra-abdominal organ

Back 33

Sliding hernia

Front 34

Contents of the spermatic cord:

Back 34

Testicular and cremasteri arteries, pampiniform venous plexus, vas deference, and processus vaginalis

Front 35

Borders of Hasselbach's triangle.

This is a k-n-o-w

Back 35

Inferior epigastric vessels (laterally), inguinal ligament, lateral border of the rectus sheath.

Front 36

What does NAVEL refer to?

Back 36

The contents of the femoral canal from lateral to medial:

Femoral nerve, femoral artery, femoral vein, empty space, lymphatics

Front 37

Which type of inguinal hernia?

Lateral to hasselback triangle

Back 37

Indirect

Front 38

This type of hernia is the presence of both direct and indirect inguinal hernias:

Back 38

Pantaloon hernia

Front 39

This type of hernia is one that's through the femoral canal that tracks into the scrotum or labia majus

Back 39

Cooper hernia

Front 40

Which type of hernia can be controlled by applying pressure over the midinguinal point?

Back 40

Indirect inguinal hernia

Front 41

DDx of inguinal hernias:

Back 41

Hydrocele, varicocele, testicular torsion, undescended or ectopic testis, lipoma, inguinal lymphaadenopathy

Front 42

This "non-surgical" repair of hernias is an acceptible choice for patients who cannot tolerate surgery.

Back 42

Truss.

External device that applies pressure over the hernia.

This is not routinely recommended.