Clerkships: Surgery: Hernia, Urology

Front 1

Which nerve runs with the spermaticord?

Back 1

ilioinguinal (L1)

Front 2

Innervation of cremaster muscle in the spermaticord?

Back 2

genitofemoral nerve (L1, L2)

Front 3

L1 nerve divides into which two nerves?

Back 3

- ilioinguinal nerve: skin over the root of the penis and upper part of scrotum
- iliohypogastric nerve

Front 4

Innervation of external oblique muscle.

Back 4

intercostal branches

Front 5

What does this patient have?

- tender, irreducible abdominal mass, reddish/bluish tingle to overlying skin
- toxicity, fever, dehydration
- no bowel sounds over the mass
- leukocytosis

Back 5

strangulated hernia
- ischemic hernia sac, nonviable
- treatment: fluid resuscitation, antibiotics, followed by surgery. Never reduce the ischemic hernia

Front 6

How to treat strangulated hernia?

Back 6

- fluid resuscitation
- antibiotics
- surgery
* never reduce the ischemic hernia

Front 7

What is this diagnosis?

- tense and irreducible hernia
- distended abdomen
- high pitched bowel sounds with frequent rushes
- xray: dilated loops of bowel with air-fluid levels, distal paucity of gas

Back 7

small bowel obstruction caused by hernia
- reduction of hernia
- resuscitation

Front 8

What type of hernia is this?

- painful nodule in upper midline abdomen (through linea alba)

Back 8

epigastric hernia
- due to defect in linea alba
- most contain only preperitoneal fat
- repair by reducing preperitoneal fat and simple defect closure

Front 9

Management of this type of hernia.

- incisional hernia less than 3cm

Back 9

primary closure with nonabsorbable suture

Front 10

Management of this type of hernia.

- incisional hernia greater than 3cm

Back 10

tension free mech repair

Front 11

Give some factors leading to poor results in hernia repair.

Back 11

- preexisting comorbidities
- debilitation from cancer
- morbid obesity
- steroid use
- chemotherapy
- tension on repair
- placing stoma lateral to rectus sheath (parastomal hernias)

Front 12

Management of this type of hernia.

- parastomal hernia

Back 12

3 types of repair
1) fascial repair: primary closure of defect
2) stomal relocation: indicated for skin excoriation and suboptimal construction.
3) prosthetic repair

Front 13

What is the name of this hernia?

- protrudes through weak area lateral to rectus sheath just below semilunar line

Back 13

Spigelian hernia
- treatment
transverse incion over mass
split external oblique muscle
appoximate transverse and internal oblique muscle

Front 14

What is the name of this hernia?

- protrude through space between latissimus dorsi, serratus posterior inferior, and internal oblique posterior boarder

Back 14

superior lumbar hernia of grynfelt

Front 15

What is the name of this hernia?

- protrude through space between latissimus dorsi, iliac crest and external oblique posterior boarder

Back 15

inferior lumbar hernia of petit

Front 16

What is the name of this hernia?

- mass palpable in upper medial thigh with hip flexed, abducted, and external rotated.
- associated with laxity of pelvic floor

Back 16

obturator hernia
- protrudes through obturator canal with obturator vessels and nerves
- manage with transperitoneal repair

Front 17

What is the name of this hernia?

- swelling on buttock
- may involve sciatic nerve or obstruction of ureter

Back 17

sciatic hernia
- herniation of peritoneal sac through major or minor sciatic foramen
- managed with transperitoneal or transgluteal repair

Front 18

What is the name of this hernia?

- groin hernia containing Meckel diverticulum

Back 18

Littre hernia

Front 19

What is the name of this hernia?

- labial or lateral vaginal wall swelling

Back 19

perineal hernia

Front 20

What is the name of this hernia?

- herniate through lacunar ligament

Back 20

Laugier hernia

Front 21

What is the name of this hernia?

- herniate through pectineal fascia (ligament of cooper)

Back 21

Cloquet hernia

Front 22

What is the name of this hernia?

- lateral to femoral artery and anterior

Back 22

Hesselbach hernia

Front 23

What is the name of this hernia?

- lateral to femoral artery and posterior

Back 23

Patridge hernia

Front 24

What is the name of this hernia?

- posterior to femoral vessels

Back 24

Serafini hernia

Front 25

What is the name of this hernia?

- anterior to femoral vessels and behind the inguinal ligament

Back 25

Velpeau hernia

Front 26

What is the name of this hernia?

- at any location in which the antimesenteric wall of the bowel is partially incarcerated

Back 26

Richter hernia

Front 27

What is the name of this hernia?

- portion of the hernia is made up of an intra-abdominal organ, most commonly sigmoid, bladder, cecum, or ovary

Back 27

sliding hernia

Front 28

What to do next?

- bilateral undescended testes

Back 28

- chorioic gonadotropin for 1 month
- operation before age 1 if still not descended

Front 29

What to do next?

- renal stone > 1.5 cm

Back 29

- IVP
- shock wave lithotripsy (ESWL) or ureteroscopy

Front 30

What to do next?

- renal stone < .5 cm

Back 30

- hydration and analgesics

Front 31

Treatment for testicular torsion.

Back 31

bilateral orchiopexy

Front 32

What is this disease?

- hematuria
- pyuria
- no bacteriuria

Back 32

genitourinary TB
- managed by chemotherapy

Front 33

What is the name of this hernia repair?

- joins the conjoined tendon and transversalis fascia to the inguinal ligament

Back 33

Bassini repair

Front 34

What is the name of this hernia repair?

- sews the transverse aponeurosis to the Cooper ligament

Back 34

McVay repair

Front 35

What is the name of this hernia repair?

- combined McVay and Bassini repair
- places a piece of mesh over the defect in the retroperitoneal space

Back 35

Shouldice repair

Front 36

What is the name of this hernia repair?

- uses a piece of mesh in an open repair

Back 36

Lichtenstein repair