Surgery, A case based clinical review – Section I

What is the differential for masses in the groin?
Malformation, infection, neoplasm, trauma

Most often, a mass in the inguinal region represents what?
Enlarged lymph nodes

Inguinal lymph nodes that are large, tender, and limited to the inguinal region suggest what?
Syphillis, chancroid, lymphogranuloma venereum

Inguinal lymphondes that are large, non-tender, and limited to the inguinal region?
Metastatic cancer from local source (melanoma, anal, or genital cancer)

Large non-tender inguinal lymph nodes that are associated with diffuse lymphadenopathy suggests what?
Systemic process (TB, sarcoid, lymphoma, leukemia, HIV)

What are some history findings which can predispose to hernia?
Anything that will increase straining (chronic cough, constipation, urinary straining, lifting heavy objects at work, physical exertion)

Why is a small abdominal wall defect potentially more problematic ?
Because there is a higher likeliehood that the bowel will become incarcerated once it passes through the defect

What type of hernia has the greatest risk of incraceration?
Femoral hernia

Describe the contents of the femoral canal from medial to lateral?
NAVEL (nerve, artery, vein, empty space, ligament)

Umbilical hernias are prevalent in children with what condition?
Congenital hypothyroidism

What is a predisposing factor for femoral hernias?
Multiple pregnancies dilate femoral veins and widen femoral canal

Indirect inguinal hernias are caused by what?
Persistent (patent) processus vaginalis

Indirect hernias pass through which rings?
Superficial and deep rings

Direct hernias pass through which rings?
Superficial ring only

What are the borders of Hasselbach’s triangle?
Lateral = inferior epigastric vessels, medial border = rectus sheath, base = posterior wall of the inguinal ligament

What is a sliding hernia?
Indirect hernia that occurs when a retroperitoneal organ (colon or bladder) typicaly herniates with the sac and essentialy makes up the posterior wall of the sac

What is the recommended management of an umbilical hernia in a newborn?
Most will close spontaneously by age 2 – should be managed surgically if persist beyond age 4, greater than 2 cm, strangulation, or progressive enlargement after 1-2 years

Damage to the genital branch of the genitofemoral nerve will cause what?
Loss of cremasteric reflex, loss of sensation in the anterior scrotum or labia majora

What are some complications of using mesh for repair of hernias?
Mesh infection, adhesions, pain, and erosion into the bowel

How to diagnose hernia when physical exam is unclear (morbidly obese)?
CT scan

Ogilvie’s syndrome occurs in what patients?
Debilitated hospitalized medical or surgical patients

Severe abdominal pain and localized tenderness in association with a small bowel obstruction is suggestive of what?
Complicated/strangulated small bowel obstruction

What is pneumobilia?
Air within the biliary tree (seen with gallstone ileus)

“Target sign” suggests what?

“Omega sign” suggests what?

What labs are important to order for small bowel obstruction?
CBC, chemistry panel, serum lactate

Imaging studies preferred for small bowel obstruction?
GI series followed by an abdominal/pelvic CT with contrast

Common causes of large bowel obstruction?
Colon cancer, diverticular disease, volvulus

Why is early placement of a nasogastric tube important in small bowel obstruction?
decompression will decrease nausea/vomting/distension/risk of aspiration

The adrenal medulla is most commonly a site of metastasis from where? The lungs and the breast What is the hallmark of hyperaldosteronism? Hypertension with hypokalemia WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR …

Abdominal peritoneum the serous membrane lining the walls of the abdominal cavity direct inguinal hernia a hernia that results from weakness in the inguinal floor WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY …

C As a physician examining the inguinal region of a patient, the inguinal ligament will be a key landmark. This structure is a feature derived from which of the following? A. Superficial fascia B. Fascia lata of the thigh C. …

Hernia is A protrusion of tissue under the skin through a weakened area of the body wall. Hernias are classified as Reducible Irreducible or incarcerated Strangulated Indirect Direct WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR …

Absorption To take in or soak up Anastomosis Joining together of two hollow structures WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE Write my sample Ascites Abnormal collection of fluid in the …

Anterior lamina of of rectus sheath above arcuate line Formed by fused aponeuroses of external and internal abdominal oblique muscles Posterior lamina of rectus sheath above arcuate line Formed by fused aponeuroses of internal abdominal oblique and transversus abdominis muscles …

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