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97 Cards in this Set

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A device used to hold a reducible hernia in place
Truss
Protrusion of the stomach upward around the stomach
Hiatal Hernia
Incisional hernia is one type...
Ventral hernia
Congenital (born with) defect in children characterized by protrusion of the peritoneum through the umbilical ring...
Unbilical hernia
Congenital hernia protruding through the internal ring...
Indirect inguinal
Hernia more commonly found in women
Femoral hernia
A part (knuckle) of bowel is strangulated
Richter's hernia
Hernia originating from within Hesselbach's Triangle
Direct Inguinal
Contents of the hernia are irreducible or 'trapped.'
Incarcerated hernia
An incarcerated hernia may become trapped and strangulated, then die, which was why I was worrid when abe had a hernia and he wouldn't relax enough to let me push it back through (reduce) the inguinal ring and had to be taken to the ER for morphine so he would relax and it wouln't become strangulated, which is rare.
An irreducible hernia that lacks blood supply leading to necrosis...
Strangulated hernia
Think, it's being stangled,therefore losing blood supply
Hernia contents can be returned to the normal cavity by external manipulation (pushing it back in).
Reducible hernia
Also called an intramuscular hernia. is uncommon and difficult to diagnose...
Spigelian Hernia
Think spy... hidden ...in the muscle.
What is the difference between a direct and indirect hernia??
Direct hernis occur through a weak spot in the abdominal wall and indirect hernias occur when there is a protrusion through the deep inguinal ring from failure of embryonic closure of the processus vaginalis.
Abe's was indirect.
An abnormal protrusion of the peritoneal lined sac through the musculoaponeuronic covering of the abdomen (rupture portion of a structure)
Hernia
List common weak places in the abdominal inguinal wall...
Spermatic cord in men
Round ligament in women
List any weak places in the femoral wall...
below the pelvis where arteries go into the legs, mostly occurs in women (femoral ring).
List weak places of the umbilical wall...
congenital (born with) or accrued (acquired) by lifting or chronic cough.
Hernia caused by failure of an incision to heal properly
Incisional hernia
Epigastric =
Above the stomach
Umbilical hernia
Occurs through a congenital defect in the stomach
Femoral hernia occurs through the...
femoral ring
Indirect Inguinal Hernia occurs through...
The inguinal ring
Direct Inguinal ring occurs through...
Areas of weakness
Most common hernia
Indirect Hernia
Most common spt for a hernia
Right side
Term commonly used by patients for hernia
Rupture
What is the mass of the herna composed of?
Usually a portion of intestine or some other viscerathat pushes through a deft in the abdominal wall. As it pushes through it moves with a portion of the parietal perineum. Therefore the hernia 'sac' is just a piece of stretch perineum.
Contents of the hernia sac can be eturned to the normal intraabdominal position by manipulation (putting back in place with your hand)...
Reducible
Sometimes wrn to put pressure on the area to keep the area reduced....works like a girdle...
Truss
Content cannot be put back into the normal position, same as incarcerated...
Irreducible hernia
An incarcerated hernia which the blood supply has been cut off. The content becomes ischemic (dead or lacks blood supply to) and eventually become necrotic (die).
Strangulate Hernia
Protrudes into the inguinal canal through the internal ring
Indirect hernia
Presents laterally to the deep epigastric (above the stomach) vessels.
Indirect
Usually results from heavy lifting or other strenuous activity
Direct hernia
represents a weakness or tear in the transversalis fascia....
Indirect
More frequently found in men than women
Indirect
hernia sac found in the scrotum
Indirect
Repair necessary for pantaloon hernia
Indirect
A defect in the transversalis fascia
Direct
Most common type of hernia in men due to the tract of the decent of the testes...
Indirect
Difference between direct and indirect inguinal hernia is.....
Direct inguinal hernia occurs through an area of muscle weakness and indirect inguinal hernia occurs through the inguinal ring.
When both direct and indirect hernias occur the defect is called aa _____ hernia
Pantaloon hernia
Because the double hernia looks like pants
Occurs laterally to the deep epigastric vessels
internal ring weakness (indirect)
Are congenital or acquired weaknesses in the transversalis fascia
Indirect Inguinal Herrnias
Protrudes through the internal ring and pass down the inguinal canal, possibly even the scrotum.
Indirect inguinal hernia
Appears more frequently in men
Indirect inguinal hernia
Ar caused by a weakness in the floor (transversalis Fasica)of the inguinal canal causing a bulge 'directly' forward
Direct hernia
Caused by a weakness in the internal ring (also transversalis fascia) causing a loop of the intestine covered by peritoneum (hernia sac) to enter the inguinal canal and follow the path of the spermatic cord, may follow all the way to the spermatic cord.
Indirect hernia
The defect for both direct and indirect inguinal hernia is...
Transversalis fascia
What percentage of all hernas occur in the groin area?
75%
The inguinal canal is about ___ cm long and lies obliquely parallel to the groin crease.
4
What is contained in the inguinal canal in men?
Spermatic cord, Vas Deferens, nerve, artery and vein and premaster mas.
The inguinal canal in women contains....
The round ligament
The major supporting structure of the posterior inguinal "floor" is the
Transversalis fascia
The 'roof' of the inguinal canal is formed by the aponeuarosis of which muscle?
external oblique
What is the answer or culprit to most hernia problems?
Transversalis Fascia
A broad fascia that covers a large area. It has a natural area opening in it, the internal ring. Through the internal ring passes the testes of baby boys. The testes are formed in the abdominal cavity and pass through the inguinal canal to the scrotum before birth.
Transversalis fascia
The floor of the inguinal canal is the
Transversalis fascia
The roof of the inguinal canal is the
External oblique
The entrance to the inguinal canal (from the abdomen) is the
Internal ring and the exit is the external ring
The external oblique aponeurosis thickens forming the inguinal ligament also known as the _____ ligament.
Poupart Ligament
Another ligament, the ____ ligament anchors the transversalis fascia to teh symphasis pubis.
Cooper Ligament or
pectinal Ligament
A subcutaneous fascia in the inguinal area found directly under the skin...
Scarpa's Fascia
The internal oblique forms a sidewall of the inguinal canal then it encircles the spermatic cord near the external ring forming the ____ muscle. This muscle extends with the spermatic cord to the testes and supports the testes...
Cremaster muscle
The area medial to the inguinal canal is called the _____.
Hesselbach's Triangle
On the right and left side
What is the answer or culprit to most hernia problems?
Transversalis Fascia
A broad fascia that covers a large area. It has a natural area opening in it, the internal ring. Through the internal ring passes the testes of baby boys. The testes are formed in the abdominal cavity and pass through the inguinal canal to the scrotum before birth.
Transversalis fascia
The floor of the inguinal canal is the
Transversalis fascia
The roof of the inguinal canal is the
External oblique
The entrance to the inguinal canal (from the abdomen) is the
Internal ring and the exit is the external ring
The external oblique aponeurosis thickens forming the inguinal ligament also known as the _____ ligament.
Poupart Ligament
Another ligament, the ____ ligament anchors the transversalis fascia to teh symphasis pubis.
Cooper Ligament or
pectinal Ligament
A subcutaneous fascia in the inguinal area found directly under the skin...
Scarpa's Fascia
The internal oblique forms a sidewall of the inguinal canal then it encircles the spermatic cord near the external ring forming the ____ muscle. This muscle extends with the spermatic cord to the testes and supports the testes...
Cremaster muscle
The area medial to teh inguinal canal is called the _____.
Hesselbach's Triangle
On the right and left side
What is the answer or culprit to most hernia problems?
Transversalis Fascia
A broad fascia that covers a large area. It has a natural area opening in it, the internal ring. Through the internal ring passes the testes of baby boys. The testes are formed in the abdominal cavity and pass through the inguinal canal to the scrotum before birth.
Transversalis fascia
The floor of the inguinal canal is the
Transversalis fascia
The roof of the inguinal canal is the
External oblique
The entrance to the inguinal canal (from the abdomen) is the
Internal ring and the exit is the external ring
The external oblique aponeurosis thickens forming the inguinal ligament also known as the _____ ligament.
Poupart Ligament
Another ligament, the ____ ligament anchors the transversalis fascia to teh symphasis pubis.
Cooper Ligament or
pectinal Ligament
A subcutaneous fascia in the inguinal area found directly under the skin...
Scarpa's Fascia
The internal oblique forms a sidewall of the inguinal canal then it encircles the spermatic cord near the external ring forming the ____ muscle. This muscle extends with the spermatic cord to the testes and supports the testes...
Cremaster muscle
The area medial to teh inguinal canal is called the _____.
Hesselbach's Triangle
On the right and left side
The boundaries of Hesselbachs triangle are.....
-Laterally deep epigastric arteries and veins.
- inferiorally- inguinal ligament
- medially-
Doesn't include the internal ring
They are acquired weaknesses in the transversalis fascia usually from heavy lifting, coughing or straining. Occurs within Hesselbach's Triangle.
Direct Hernia
An Indirect hernia would escape through the triangle.
A self-retaining retractor such as ______ could facilitate exposure.
Weithlander Adson Celebrum
Kittners are used for
Blunt dissection or 4x4 sponge
A penrose drain is used for what purpose??
Retract vessels in the spermatic cord, dip in saline
What position is the client placed in for a herniorrapy?
Supine
What area should be prepped?
Belly button to mid thigh and genital region. The drape is the same for laparotomy
What type of technique should be used for hernia repair?
Clean, unless have to do a bowel resection, and then it would be classified as clean contaminated.
What are the highlights of inguinal hernia procedure??
! Layers of abdominal wall are incised.
2. The spermatic cord is identified and dissected free.
3. The hernia sac is identified
4. The sac is ligated and removed
5. Layers of the wound are closed individually.
How long is the incision usually?
6 cm and is oblique
What areas must be entered before getting to the spermatic cord??
The Scarpus fascia
External Oblique Aponeurosis
Cremaster Muscle
If an indirect hernia, the hernia sac may be adherant to the cord. it is carefully dissected free, before the cord is retracted with the ____.
Pen Rose Drain
(go to hint)
The saac is then opened and abdominal contents are pushed back. A purse string suture of absorbable is placed high in the sac and the excess is removed and sent to pathology. Note picture on pg 396 Then, any defect in the transversalis fascia is repaired (taper, non-absorbable porlene, ethabond, silk), then the cremaster muscle is reapproximated around the spermatic cord. The layers are closed individually. Dressing applied.