His or Hernia
Spigelian
hernia through semilunaris
Structures that form Hesselbach's Triangle
Medial: Rectus Abdominus
Lateral: Inf. Epigastric
Inferior: Inguinal Ligament
A 35-year-old man is referred to the clinic for repair of his ventral hernia. He currently smokes every day and has a BMI of 34 kg/m2. He has a medical history of DM type 2, which is controlled with injectable insulin. His last HbA1c was 7.2%. Abdominal examination reveals a large, reducible, and nontender ventral hernia. Which of the following is the best next step in management?
Counsel on smoking cessation for a minimum of 4 weeks before repair.
Richter? Darn near kilter
Antimesenteric bowel wall
Boundaries of Myopectineal Orifice
Superior: internal oblique/transverusus abdominus
Medial: rectus sheath
Lateral: iliopsoas
Inferior: Cooper's ligament
A 58-year-old patient is referred to your clinic for evaluation of a recurrent right inguinal hernia. The hernia has been enlarging and is now causing him daily discomfort that prevents him from working. His surgical history includes right totally extraperitoneal inguinal hernia repair with mesh and open appendectomy. On exam, you appreciate a reducible right inguinal hernia but find no evidence of a left inguinal hernia. Which management approach is most appropriate?
Open repair with mesh
Littre
Structure that passes through deep inguinal ring
Spermatic cord
After repair of a traumatic diaphragmatic hernia, you note that the patient’s chest x-ray has an elevated hemidiaphragm on the side of repair. What is the cause of the elevation?
Phrenic nerve injury
superior lumbar triangle
Boundaries of Femoral Canal
Anterior: inguinal ligament
Posterior: Cooper's ligament
Lateral: femoral vein
Medial: lacunar ligament
A patient with a large recurrent ventral hernia with loss of domain is currently in the OR. As the fascial layer is being closed, peak ventilator pressures increase, but the patient remains hemodynamically stable. Six hours postoperatively, the urine output has decreased significantly. An EKG and serum troponin are normal. What is the most likely cause of this condition?
Abdominal compartment syndrome
Bochdalek
congenital posterolateral diaphragmatic hernia
Boundaries of Triangle of Doom
Medial: vas deferens
Lateral testicular vessels
Apex: external iliac
A 90-year-old woman is brought in from a nursing facility with abdominal pain, nausea, and vomiting. On examination, she is cachectic with a softly distended abdomen that is mildly tender to palpation diffusely. Computed tomography imaging reveals a small bowel obstruction from an incarcerated obturator hernia. At exploration, you find an incarcerated segment of ischemic ileum that is difficult to reduce from the obturator hernia defect. What is the most appropriate next step in operative management?
Incise the obturator membrane to help reduce the hernia.