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SB82 Hernias

SB82 Anatomy of hernias ABSITE review

The embyologic cause of indirect inguinal hernia Failure of processus vaginalis to close
Abdominal muscle layer that forms the inguinal ligament Inferior edge of external oblique which runs from ASIS to pubic tubercle
Borders of Hesselbach's triangle Inguinal ligament (inferolateral), Inferior epigastric vessels (superolateral), and lateral border of the rectus abdominis muscle (medial)
Significance of Hesselbach's triangle Direct inguinal hernias herniate through a defect in the inguinal floor (transversalis fascia) of this triangle
Borders of the femoral canal Superior - Inguinal ligament, Inferior - Cooper's ligament, Medial - lacunar ligament, Lateral - femoral vein
Definition of Cooper's ligament Thickening in transversalis fascia attached to linea terminalis, which fuses to periosteum of superior pubic ramus
Significance of Cooper's ligament Forms floor of femoral ring and inferior border of femoral canal orifice, and acts as insertion site of iliopubic tract
Nerve running anterior to spermatic cord Ilioinguinal nerve
Effect of disruption of ilioinguinal nerve Numbness of scrotum and medial thigh
Contents of spermatic cord Vas deferens and associated vessels, testicular vessels, genital branch of genitofemoral nerve, lymphatics, autonomic nerves
Source of cremasteric muscle fibers Internal oblique
Female equivalent of male spermatic cord Round ligament of the uterus, usually divided during herniorrhaphy
Definition of neurovascular plane Space between internal oblique and transversus abdominis wherein the intercostal nerves run
Course of the femoral nerve Arises at lateral border of psoas, descends in groove between psoas and iliacus muscles, and enters femoral triangle deep to inguinal ligament
Femoral nerve is _____________ in relation to femoral vessels Lateral
Muscles supplied by femoral nerve Knee extensors
Orientation of femoral vessels and nerve inferior to inguinal ligament NAVEL: Nerve, artery, vein, empty space, lymphatics
Femoral hernia Herniation of abdominal contents inferior to inguinal ligament through "empty space"
Course of the obturator nerve Descends through psoas and pierces fascia to pass lateral to internal iliac vessels and ureter; then leaves pelvise via obturator foramen
Muscles supplied by obturator nerve Thigh adductors
Definition of obturator hernia Herniation of bowel through obturator forament (R>L)
Howship-Romberg sign Pain along medial thigh with abduction/extension/internal rotation due to irritation of obturator nerve by obturator hernia
Three structure forming the covering of spermatic cord Internal spermatic fascia, cremaster and its fascia, and external spermatic fascia
Structure connecting the testicle to the scrotum Gubernaculum
Cause of testicular torsion Incomplete attachment of gubernaculum, allowing the testicle to twist around its blood supply
Location of obturator foramen Between body of ischium and pubic rami
Structures passing through obturator foramen Obturator nerve, artery, vein
Two major types of congenital diaphragmatic hernias Morgagni (anterior) and Bochdalek (lateral, R
Etiology of Morgagni hernia Failure of formation of septum transversum
Etiology of Bochdalek hernia Failure of formation of pleuroperitoneal membranes
Structure that forms floor of inguinal canal Transversalis fascia
Lacunar ligament The splaying-out of the inguinal ligament to insert on the pubis
Ileopubic tract Portion of transversalis fascia running inferior to inguinal ligament from ASIS to pubis
Conjoint tendon The joining of the internal oblique fascia to the transversus abdominis fascia
Pantaloon hernia Has components of both direct and indirect hernias
Pediatric hernias are usually _________ (direct/indirect) Indirect
Lichtenstein repair of inguinal hernia Uses mesh and has lower rate of recurrence due to decreased tension
Bassini repair of inguinal hernia Approximation of the conjoint tendon and transversalis fascia superiorly to the inguinal ligament inferiorly
McVay repair of inguinal hernia Approximation of the conjoint tendon and transversalis fascia superiorly to Cooper's ligament inferiorly
Caveat to McVay repair Requires a "relaxing incision" in the external oblique fascia
Indications for laparoscopic hernia repair Bilateral inguinal hernias, recurrent inguinal hernia
Most common early complication following hernia repair Urinary retention
Cause of testicular atrophy after hernia repair Thrombosis of spermatic cord veins after vessel disruption caused by dissection of distal components of hernia sac
Testicular atrophy following herniorrhaphy is more common with _____________ (direct hernia/indirect hernia) Indirect hernia
Most common cause of pain after herniorrhaphy Damage to ilioinguinal nerve
Sequelae of ilioinguinal nerve injury Loss fo cremasteric reflex, numbness of ipsilateral penis/scrotum/thigh
Sequelae of injury to genital branch of genitofemoral nerve Loss of cremasteric reflex and sensation to scrotum
Sequelae of injury to femoral branch of genitofemoral nerve Loss of sensation to upper lateral thigh
Cord lipomas _____________ (should/should not) be removed Should
Trapezoid of doom Femoral branch of genitofemoral nerve, lateral cutaneous nerve, femoral artery
Femoral hernias are more common in _________ (males/females) Males
Clinical sign of femoral hernia Characteristic bulge on anteromedial thigh below inguinal ligament
Repair of femoral hernia Inguinal approach with McVay or Bassini repair
Umbilical hernias are more common in ___________ (Caucasians/African-Americans/Asians) African-Americans
Risk of incarceration in umbilical hernias is more common in ____________ (adults/children) Adults
Hernia through linea semilunaris lateral to rectus muscle, usually inferior to semicircularis, through area between muscle fibers of internal oblique and line of insertion of external oblique aponeurosis into rectus sheath is called a ________ hernia Spigelian
Noncircumferential incarceration of antimesenteric bowel wall is called a _______'s hernia Richter
Petit's hernia Through lumbar triangle in posterolateral abdominal wall
Borders of lumbar triangle Bounded anteriorly by the free margin of external oblique muscle, posteriorly by the latissimus dorsi and inferiorly by the iliac crest
Herniation through superior lumbar triangle is called _______________ hernia Grynfeltt
Borders of superior lumbar triangle Quadratus lumborum muscle, twelfth rib, and internal oblique muscle
Incarcerated Meckel's diverticulum is called a _________ hernia Littre
Sciatic hernia Through greater sciatic foramen; high rate of strangulation
Most common cause of incisional hernia Inadequate closure
Treatment for true peristomal hernia Remove and place in rectus muscle
Treatment for prolapse of stoma Fix mesentery to prevent prolapse
Treatment for pseudo-peristomal hernia Move to rectus (is usually in oblique when this occurs)
Spigelian hernia Hernia through linea semilunaris lateral to rectus muscle, usually inferior to semicircularis, through area between muscle fibers of internal oblique and line of insertion of external oblique aponeurosis into rectus sheath
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