Surgery Exam 4

Front 1

cutaneous nerves to the abdomen arise from where?

Back 1

intercostal nerves (T7- L1)

supply anterior and posterior abdominal walls in a dermatomal manner

Front 2

injury to which nerves duirng hernia repair can lead to permanent paraesthesias?

Back 2

1. ilioinguinal
2. iliohypogastric
3. genital branch of the gentiofemoral nerve

Front 3

on the skin what are the lines called that you want to cut along?

Back 3

langer's lines

Front 4

fibrous tissue that lines or envelops muscles

Back 4

fascia

Front 5

nonmuscular fiber containing portions of muscle present at insertion points

Back 5

aponeurosis

Front 6

band of tissue that connects bones or supports viscera

Back 6

ligament

Front 7

superficial fascial later is known as?

Back 7

camper's fascia

Front 8

name the abdominal layer:
cover perineum and genitalia, dartos mm of the scortum, more superficial, fattier

Back 8

camper's fascial, superficial fascial layer

Front 9

name the layer:
deeper, more fibrous, continues into the perinuem.

Back 9

second fascial layer = scarpas' fascia

Front 10

what are the fascial layers from outside in?

Back 10

1. superficial fascia
2. campers fascia
3. scarpa's fascia
4. deep fascia
5. Transversalis fascia
6. Subserous fascia

Front 11

forms the inguinal ligament. layer of abdnomina mm. angles like jean pockets

Back 11

exteranal oblique mm

Front 12

originates from iliac crest and forms a broad wheat meeting at the midline

Back 12

internal oblique mm

Front 13

deepest of three mm layers in the abdomen,. fuses medially to form rectus sheath and linea alba

Back 13

transversus abdominis mm

Front 14

thin layer of tissue between the transversus abdomens and the extraperitoneal fat

Back 14

transversais fascia

Front 15

serous membrane that lines the peritoneal cavity. during embryologic descent of the testes, part of the peritoneum is pulled into the scotum. = tunica vaginalis of the testis.

Back 15

peritoneum

Front 16

what is it called when the testes descend abnormally and allows communication between the peritoneum and the tunica vaginalis?

Back 16

patent process vaginalis

Front 17

what is the MC groin hernia?

Back 17

indirect inguinal hernia

Front 18

are most hernias inguinal or femoral?

Back 18

inguinal!96%

Front 19

who is more likely to get a femoral hernia?

Back 19

women

Front 20

______ hernia results from a persistent process vaginalis which leaves the abdomen at the internal ring and passes within the spermatic cord- congenital.

Back 20

indirect inguinal hernia

Front 21

______ hernia is caused by a defect or weakness through floor of inguinal canal (transversalis fascia) and protrudes through Hesselbach’s triangle- most often acquired

Back 21

direct inguinal hernia

Front 22

Protrudes directly through Hesselbach’s triangle
Medial to inferior epigastric vessels
Weak area where fascia not enforced by overlying muscle

Back 22

direct inguinal hernia

Front 23

what is the weakest part of the abdominal wall?

Back 23

hesselbach's traingle

Front 24

what is another name for the inguinal ligament?

Back 24

pouparts

Front 25

strangulation occurs more frequently with what kind of hernias?

Back 25

femoral, indirect, and umbilical

Front 26

what do we call an inflammation of the spermatic cord?

Back 26

funiculitis

Front 27

what is the MC hernia in women?

Back 27

indirect hernia

Front 28

who usually gets femoral hernias?

Back 28

women, older

Front 29

what is the second MCC of bowel obstruction?

Back 29

incarcerated hernia

Front 30

N/V, fevers, chills, pian, erythema of overlying skin, elevated WBC, eleveated lactic acid. -- can lead to intestinal necrosis and perforation. true surgical emergency

Back 30

strangulated hernia

Front 31

what are you feeling when palpating a hernia?
1. granular feel
2. elastic feel

Back 31

1. granular = omentum
2. elastic = intestine

Front 32

what is the classification system used to grade groin hernias?

Back 32

Nyhus Classification

Front 33

what is the name of the device used for palliative hernia treatment?

Back 33

a truss
reserved for patients with circumstances that make them unable to tolerate surgical intervention

Front 34

what are the 4 basic tenets of repair for inguinal hernias?

Back 34

1. reduce intrabdominal contents to the abdominal cavity
2. reinforce internal ring
3. create a tension-free inguinal floor
4. obliterate the hernia sac

Front 35

open mesh “tension-free” repair for hernias.

Back 35

open lichtenstein repair

Front 36

if doing an open hernia repair, what is the most likely method?

Back 36

Shouldice repair

Front 37

name the hernia repair:
used in small hernias, basically tightens up the transversus aponerosis around the cord

Back 37

Marcy Repair

Front 38

name the hernia repair:
transversus abdominins aponeurosis + transversalis fascia --> inguinal ligament with nonasborbabale interrupted sutures

Back 38

Bassini repair (the italian surgeon)

Front 39

useful for indirect and direct inguinal and femoral hernias. Tries to restore the posterior inguinal wall to anatomic correctness. name the procedure

Back 39

McVay repair

Front 40

similar to mcvay except for placement of speramtic cord

Back 40

Halsted Repair

Front 41

Name the hernia repair:
no mesh - anatomic closure, high success rate and low rate of recurrence "canadian repair"

Back 41

Shouldice repair

Front 42

if you damage this nerve your scrotum will be numb

Back 42

genitofemoral nerve

Front 43

if you damage this nerve your inner thigh will be numb

Back 43

ilioinguinal nerve

Front 44

what are the 13 post-operative complications of hernia repair?

Back 44

"THIS COURT WHIM"
1. Testicular atrophy
2. Hydrocele
3. Ischemic orchitis
4. Seroma*
5. Chronic groin pain
6. Osteitis pubis
7. Urinary retention
8. Recurrence
9. Trocar site hernia
10. Wound infection
11. Hematoma *
12. Infertility
13. Mesh infection

Front 45

Umbilical hernias are congential defects that occur at the umbilical fibromuscular ring, which usually obliterates by what age?

Back 45

2 yo

Front 46

do we repair umblical hernias in kids?

Back 46

many kids have them until 2-4 yo .Before then, don't do anything. REpair is only indicated if they persist in children older than 2-4 yo

Front 47

icisional hernias used to be quite common, what do we do differently now that has reduces their incidence?

Back 47

newer repair techniques have reduced them a lot having do to with the use of mesh

Front 48

Combines a direct and an indirect hernia
Two hernia sacs divided by the epigastric vessels

Back 48

Pantaloon hernia

Front 49

A portion of the hernia sac is composed of a wall of an intraabdominal organ, such as cecum or sigmoid colon

Back 49

sliding hernia

Front 50

The anti-mesenteric border of the bowel herniates through the fascial defect and lies within the hernia sac

Back 50

Richter's Hernia

Front 51

Occurs at the site of a previous surgical incision or operative site anywhere on the body

Back 51

incisional hernia

Front 52

Occurs through the semilunar line (lateral margin of the rectus muscle)
Prone to incarceration
Occur males> females

Back 52

Spigelian Hernia

Front 53

bordered by the 12th rib, external oblique and erector mm of the spine. what is the triangle called? what hernia do we see here?

Back 53

Superior lumbar upside down triangle.
Grynfeltts hernia

Front 54

bordered by the iliac crest, external oblique and latissimus dorsi. what is the name of the traingle and what hernia do we see here?

Back 54

inferior lumbar triangle
Petits Hernia seen here

Front 55

any groin hernia that contains a Meckel’s diverticulum

Back 55

Littres Hernia

Front 56

Any groin hernia containing an appendix

Back 56

Amyand's hernia

Front 57

follows the path of the obturator nerve and muscles
Occurs with a female-to-male ratio of 6:1 most often in the 7th and 8th decades of life
Presents more commonly as a bowel obstruction

Back 57

Obturator hernia

Front 58

Presents with intermittent bowel obstruction and paresthesias on the anterolateral aspect of the thigh due to compression of the obturator nerve

Back 58

obturator hernia

Front 59

what is the name of the sign for pain along the medial aspect of the thigh?

Back 59

Howship-Romberg sign

Front 60

Hernia of a loop of intestine through the cribriform fascia presenting lateral to femoral artery

Back 60

Hesselbach's hernia

Front 61

the major blood supply of the small bowel is?

Back 61

the superior mesenteric artery

Front 62

mcc of SBO in the US is?
MCC of SBO in the world is?

Back 62

In the use = adhesions
In the world = hernias

Front 63

Small-bowel obstruction (SBO) leads to __________ dilatation of the intestine secondary to swallowed air and continued gastrointestinal secretions

Back 63

proximal

Front 64

when might you see a step ladder pattern?

Back 64

in sbo

Front 65

seen on x-ray. Air in wall of the intestines. highly suggestive of necrotizing entercolitis

Back 65

pneumotosis intestinalis

Front 66

you are doing a rectal exam on someone with a suspected SBO. if you find gross or occult blood what would that mean?
If you find a mass?

Back 66

strangulation or malignancy, pneumotosois?
mass = obturator hernia

Front 67

what sounds will be heard on PE of SBO?

Back 67

at first high pitched active bowel sounds as it tries to squeeze it along, then hypoactive bowel sounds when it gives up.

Front 68

what is the tx for SBO?

Back 68

1. ABC
2. NG tube - decompress, prevent aspiration
3. Lrg IV bore
4. Fluids - isotonic
5. FOley catheter to monitor U/O want >.5 ml/kg/hr
6. Abx - gram -/+ and anaerobes
7. correct lyte imbalance (will need K)
8. NPO
9. analgesia + antiemetics
10. early surgical consult
11. early monitorin, BP, caridac, ICU?

Front 69

what bowel sounds do we hear in ileus?

Back 69

decreased!!! or absent bowel sounds (think the bowel isn't moving so its not going to make any noise!)

Front 70

what bowel sounds do we hear in SBO?

Back 70

normal or increased bowel sounds at first and then absent bowel sounds?

Front 71

what are the two types of tissue in a meckels?

Back 71

gastric and pancreatic (hence it releases HCl!)

Front 72

what are possible complications from a meckels?

Back 72

Hemorrhage
Obstruction
Perforation
"hop"

Front 73

carcinoid tumors originate from ?

Back 73

Kulchitsky cells within the crypts of Liberkun

Front 74

carcinoid tumors greater than _____ have a 90% chance of metastasis

Back 74

2 cm

Front 75

what is the most common location of carcinoid tumors?
what is the most common location in the small intestine?

Back 75

the appendix!!
the illeus

Front 76

what is the rule of thumb when finding a carcinoid tumor of the appendix that is >2cm or <2cm?

Back 76

<2c = appendectomy done
>2cm = right colectomy done!
dont forget to look for a second primary tumor since there may be multicentric foci

Front 77

carcinoid syndrome is diagnosed by?

Back 77

increased 5-HIAA in urine (5 hydroxyindoleacetic acid)

Front 78

what to carcinoid syndrome tumors release?

Back 78

vasoactive peptides and serotonin

Front 79

mC bening tumor of the small bowel

Back 79

Leiomyomas (what kansas has)

Front 80

MC malignant tumor of small bowel

Back 80

Adenocarcinoma

Front 81

Small bowel tumors present with?

Back 81

abd. pain
weight loss
obstruction
perforation

Front 82

mesenteric ischemia can affect which arteries?

Back 82

SMA, IMA, celiac arteries

Front 83

Caused by occlusion of an artery . extreme pain out of proprotion to physical exam

Back 83

acute mesenteric ischemia

Front 84

what is the diagnostic test of choice for mesenteric ischemia

Back 84

CT angiogram