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97 Cards in this Set
- Front
- Back
- 3rd side (hint)
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A device used to hold a reducible hernia in place
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Truss
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Protrusion of the stomach upward around the stomach
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Hiatal Hernia
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Incisional hernia is one type...
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Ventral hernia
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Congenital (born with) defect in children characterized by protrusion of the peritoneum through the umbilical ring...
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Unbilical hernia
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Congenital hernia protruding through the internal ring...
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Indirect inguinal
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Hernia more commonly found in women
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Femoral hernia
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A part (knuckle) of bowel is strangulated
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Richter's hernia
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Hernia originating from within Hesselbach's Triangle
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Direct Inguinal
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Contents of the hernia are irreducible or 'trapped.'
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Incarcerated hernia
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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.
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An irreducible hernia that lacks blood supply leading to necrosis...
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Strangulated hernia
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Think, it's being stangled,therefore losing blood supply
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Hernia contents can be returned to the normal cavity by external manipulation (pushing it back in).
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Reducible hernia
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Also called an intramuscular hernia. is uncommon and difficult to diagnose...
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Spigelian Hernia
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Think spy... hidden ...in the muscle.
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What is the difference between a direct and indirect hernia??
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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.
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Abe's was indirect.
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An abnormal protrusion of the peritoneal lined sac through the musculoaponeuronic covering of the abdomen (rupture portion of a structure)
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Hernia
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List common weak places in the abdominal inguinal wall...
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Spermatic cord in men
Round ligament in women |
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List any weak places in the femoral wall...
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below the pelvis where arteries go into the legs, mostly occurs in women (femoral ring).
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List weak places of the umbilical wall...
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congenital (born with) or accrued (acquired) by lifting or chronic cough.
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Hernia caused by failure of an incision to heal properly
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Incisional hernia
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Epigastric =
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Above the stomach
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Umbilical hernia
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Occurs through a congenital defect in the stomach
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Femoral hernia occurs through the...
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femoral ring
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Indirect Inguinal Hernia occurs through...
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The inguinal ring
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Direct Inguinal ring occurs through...
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Areas of weakness
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Most common hernia
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Indirect Hernia
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Most common spt for a hernia
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Right side
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Term commonly used by patients for hernia
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Rupture
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What is the mass of the herna composed of?
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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.
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Contents of the hernia sac can be eturned to the normal intraabdominal position by manipulation (putting back in place with your hand)...
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Reducible
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Sometimes wrn to put pressure on the area to keep the area reduced....works like a girdle...
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Truss
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Content cannot be put back into the normal position, same as incarcerated...
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Irreducible hernia
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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).
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Strangulate Hernia
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Protrudes into the inguinal canal through the internal ring
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Indirect hernia
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Presents laterally to the deep epigastric (above the stomach) vessels.
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Indirect
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Usually results from heavy lifting or other strenuous activity
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Direct hernia
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represents a weakness or tear in the transversalis fascia....
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Indirect
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More frequently found in men than women
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Indirect
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hernia sac found in the scrotum
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Indirect
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Repair necessary for pantaloon hernia
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Indirect
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A defect in the transversalis fascia
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Direct
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Most common type of hernia in men due to the tract of the decent of the testes...
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Indirect
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Difference between direct and indirect inguinal hernia is.....
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Direct inguinal hernia occurs through an area of muscle weakness and indirect inguinal hernia occurs through the inguinal ring.
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When both direct and indirect hernias occur the defect is called aa _____ hernia
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Pantaloon hernia
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Because the double hernia looks like pants
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Occurs laterally to the deep epigastric vessels
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internal ring weakness (indirect)
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Are congenital or acquired weaknesses in the transversalis fascia
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Indirect Inguinal Herrnias
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Protrudes through the internal ring and pass down the inguinal canal, possibly even the scrotum.
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Indirect inguinal hernia
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Appears more frequently in men
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Indirect inguinal hernia
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Ar caused by a weakness in the floor (transversalis Fasica)of the inguinal canal causing a bulge 'directly' forward
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Direct hernia
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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.
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Indirect hernia
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The defect for both direct and indirect inguinal hernia is...
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Transversalis fascia
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What percentage of all hernas occur in the groin area?
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75%
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The inguinal canal is about ___ cm long and lies obliquely parallel to the groin crease.
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4
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What is contained in the inguinal canal in men?
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Spermatic cord, Vas Deferens, nerve, artery and vein and premaster mas.
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The inguinal canal in women contains....
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The round ligament
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The major supporting structure of the posterior inguinal "floor" is the
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Transversalis fascia
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The 'roof' of the inguinal canal is formed by the aponeuarosis of which muscle?
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external oblique
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What is the answer or culprit to most hernia problems?
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Transversalis Fascia
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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.
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Transversalis fascia
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The floor of the inguinal canal is the
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Transversalis fascia
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The roof of the inguinal canal is the
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External oblique
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The entrance to the inguinal canal (from the abdomen) is the
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Internal ring and the exit is the external ring
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The external oblique aponeurosis thickens forming the inguinal ligament also known as the _____ ligament.
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Poupart Ligament
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Another ligament, the ____ ligament anchors the transversalis fascia to teh symphasis pubis.
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Cooper Ligament or
pectinal Ligament |
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A subcutaneous fascia in the inguinal area found directly under the skin...
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Scarpa's Fascia
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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...
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Cremaster muscle
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The area medial to the inguinal canal is called the _____.
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Hesselbach's Triangle
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On the right and left side
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What is the answer or culprit to most hernia problems?
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Transversalis Fascia
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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.
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Transversalis fascia
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The floor of the inguinal canal is the
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Transversalis fascia
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The roof of the inguinal canal is the
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External oblique
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The entrance to the inguinal canal (from the abdomen) is the
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Internal ring and the exit is the external ring
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The external oblique aponeurosis thickens forming the inguinal ligament also known as the _____ ligament.
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Poupart Ligament
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Another ligament, the ____ ligament anchors the transversalis fascia to teh symphasis pubis.
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Cooper Ligament or
pectinal Ligament |
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A subcutaneous fascia in the inguinal area found directly under the skin...
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Scarpa's Fascia
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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...
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Cremaster muscle
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The area medial to teh inguinal canal is called the _____.
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Hesselbach's Triangle
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On the right and left side
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What is the answer or culprit to most hernia problems?
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Transversalis Fascia
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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.
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Transversalis fascia
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The floor of the inguinal canal is the
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Transversalis fascia
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The roof of the inguinal canal is the
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External oblique
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The entrance to the inguinal canal (from the abdomen) is the
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Internal ring and the exit is the external ring
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The external oblique aponeurosis thickens forming the inguinal ligament also known as the _____ ligament.
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Poupart Ligament
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Another ligament, the ____ ligament anchors the transversalis fascia to teh symphasis pubis.
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Cooper Ligament or
pectinal Ligament |
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A subcutaneous fascia in the inguinal area found directly under the skin...
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Scarpa's Fascia
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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...
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Cremaster muscle
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The area medial to teh inguinal canal is called the _____.
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Hesselbach's Triangle
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On the right and left side
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The boundaries of Hesselbachs triangle are.....
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-Laterally deep epigastric arteries and veins.
- inferiorally- inguinal ligament - medially- |
Doesn't include the internal ring
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They are acquired weaknesses in the transversalis fascia usually from heavy lifting, coughing or straining. Occurs within Hesselbach's Triangle.
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Direct Hernia
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An Indirect hernia would escape through the triangle.
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A self-retaining retractor such as ______ could facilitate exposure.
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Weithlander Adson Celebrum
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Kittners are used for
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Blunt dissection or 4x4 sponge
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A penrose drain is used for what purpose??
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Retract vessels in the spermatic cord, dip in saline
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What position is the client placed in for a herniorrapy?
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Supine
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What area should be prepped?
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Belly button to mid thigh and genital region. The drape is the same for laparotomy
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What type of technique should be used for hernia repair?
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Clean, unless have to do a bowel resection, and then it would be classified as clean contaminated.
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What are the highlights of inguinal hernia procedure??
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! 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. |
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How long is the incision usually?
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6 cm and is oblique
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What areas must be entered before getting to the spermatic cord??
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The Scarpus fascia
External Oblique Aponeurosis Cremaster Muscle |
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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 ____.
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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.
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