quizlet 2

• What is an eventration of the diaphragm?

  pathological condition characterized by the permanent elevation of the immobile hemi-diaphragm which, as a result, cannot participate actively in respiration.
• True or False: The peripheral muscular attachments and diaphragmatic apertures are all abnormal and there is interruption in the pleural or peritoneal layers on a diaphragm with eventration.

  False.
• What are the anatomical dysfunctions in eventration of diaphragm?

  failure of the muscularization of the dome of the diaphragm.

  dysfunction of the phrenic functions.
• What is the clinical presentation of patients with eventration of the diaphragm?

  most adults are asymptomatic.

  symptoms are related to inadequate ventilation.

  chest pain.

  epigastric pain.
• How is the eventration of the diaphragm diagnosed?

  dullness of the involved hemi-thorax.

  marked elevation of diaphragm on chest X-ray fluoroscopy or ultrasound can be used to assess whether the diaphragm moves with respiration or not.

  paradoxical motion is observed.
• What are the indications of treatment in eventration of diaphragm?

  progressive respiratory distress.

  failure to wean off ventilator.

  operative repair which can be done open or laparoscopically.
• hat is the treatment procedure of choice in eventration of the diaphragm?

  plication.
• What are the characteristics of trauma injury to the diaphragm?

  positive intra-abdominal pressure.

  negative intra-thoracic pressure.

  constant movement of the diaphragm and this prevents spontaneous healing.
• Discuss the diagnosis of traumatic injury to the diaphragm.

  defect is big in blunt trauma.

  intra-abdominal organs herniate into the chest.

  decreased breath sounds, dullness to chest percussion, bowel sounds in chest, chest pain.

  chest X-ray will reveal gastric bubble/NG tube in left chest.

  CT scan is more accurate.

  diagnostic laparoscopy is useful in penetrating trauma.

  asymptomatic if defect is small.
• What is the treatment of traumatic injury to diaphragm?

  acute herniation - laparotomy and repair.

  chronic herniation. thoracotomy and repair.
• What are the three types of para-oesophageal herniations?

  sliding.

  para-oesophageal.

  combined.
• Which type of para-oesophageal hernias is the most common?

  sliding para-oesophageal hernia.
• What happens in a sliding para-oesophageal herniation?

  A portion of the gastric cardia slides through the hiatus into lower chest.

  oesophago-gastric junction lies above the diaphragm.

  laparoscopic repair preferred because of shorter hospital stays and less demand.
• What happens in aa para-oesophageal hernia?

  the oesophago-gastric junction is fixed in place and the fundus of the stomach rises into lower chest.
• What are the investigations of para-oesophageal herniations?

  barium swallow.

  gastroscopy.

  manometry.

  pH monitoring studies.
• What is the medical treatment of para-oesophageal herniations?

  proton pump inhibitors.
• What is the surgical treatment of para-oesophageal herniations?

  Nissen fundoplication, open or laparoscopic.
• True or False: men are 25 times more likely to have groin hernia than women.


  True
• Which hernias are more common in women?

  femoral and umbilical hernias.
• What is a hernia?

  an abnormal protrusion of an organ or tissue through a defect in its surrounding walls.
• Where do abdominal hernias occur?

  at sites where the aponeurosis and fascia are not covered by striated muscle.

  these sites are commonly femoral, inguinal, umbilical, linea alba and sites of previous incision.
• What are reducible hernias?


  when all the contents can be replaced within the abdominal cavity.
• What are irreducible or incarcerated hernias?

  contents cannot be reduced/replaced within the abdominal cavity usually due to adhesions within the sac.
• What can incarcerated hernia lead to?

  intestinal obstruction
• What is a Richter hernia?

  when a small portion of the antimesenteric wall of the intestine gets trapped within the hernia and strangulation occurs without intestinal obstruction.
• Where is the neck or orifice of a hernia located?

  innermost musculo-apponeurotic layer through which the hernia sac leaves the abdominal cavity.
• What part of a hernia forms a peritoneal wrap around its contents?

  the sac
• What are the four types of groin hernias?


  indirect

  direct

  external vesical

  femoral
• What are the components of the spermatic cord?


  cremasteric muscle fibres

  testicular artery and vein

  genital branch of genitofemoral nerve

  vas deferens

  lymphatic vessels
• What forms the anterior boundary of the inguinal canal?

  aponeurosis of the external and internal oblique muscles.
• What is the posterior boundary of the inguinal canal?

  laterally by the aponeurosis of the transversalis muscle and the transversalis fascia.
• What is the superior boundary of the inguinal canal formed by?

  arched fibers of the lower edge of the internal oblique muscles and the transversus abdominis muscle and aponeurosis.
• What is the inferior border of the inguinal canal formed by?

  lower border of the inguinal ligament.
• What is an indirect inguinal hernia?

  herniation takes place through the deep ring and the sac may follow the spermatic cord in males and the round ligament in females.
• What is a direct hernia?

  herniation occurs through the ring in the medial inguinal fossa in the triangle of Hesselbach.

  the hernial sac passes through the floor of the inguinal canal.
• What is a femoral hernia?

  protrusion of pre-peritoneal fat or viscus through the femoral canal.
• What is the anterior boundary of the femoral canal?

  the inguinal canal.
• What is the posterior boundary of the femoral canal?

  pectineal ligament (Cooper) and fascia iliaca.
• What is the lateral boundary of the femoral canal?

  a connective tissue septum and the femoral vein.
• What is the medial boundary of the femoral canal?

  the aponeurotic insertion of the transversus abdominis muscle and transversalis.