Questions in clinical surgery
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Questions in clinical surgery
من طرف Shamsology الثلاثاء سبتمبر 07, 2010 3:10 am
ORAL
QUESTIONS IN CLINICAL SURGERY" is a book for CLINICAL SURGERY, I found
while searching on internet so , I hoped you ge benefit from ... Just I
hope !!!!!
Q. What is your diagnosis?
A. Subcutaneous lipoma.
Q. Why this is a lipoma?
A. Because it is a very slowly growing swelling which is soft, pseudofluctuant with a slippery edge.
Q. Why the edge of the lipoma is slippery ?
A. Because it is present within a very loose capsule so that pressure on one edge moves the swelling within the capsule.
Q. Why the lipoma is pseudofluctuant ?
A. Because the fat globules constituting the lipoma are very soft in consistency.
Q. How do you elicit fluctuation in a very small swelling ?
A.
By Paget's test; the swelling is fixed by the index and thumb of the
left hand and pressure is applied on the center of the swelling by the
index of the right hand. If there is yeilding in the center of the
swelling, it is considered fluctuant.
Q. Why this is a subcutaneous and not a subfascial lipoma ?
A.
Because it is attached to the skin at multiple sites while in
subfascial lipoma the skin is not attached to the swelling at all. Also,
making the fascia tense does not make the swelling smaller.
Q. How did you detect the skin attachment ?
A. There are two methods to detect skin attachment; either by pinching or by gliding
Q. Mention the different sites of lipoma ?
A. 1. Subcutaneous lipoma
2. Subfascial lipoma,
3. Intermuscular lipoma
4. Intramuscular lipoma
5. Subperiosteal,
6. Subserous lipoma,
7. Extradural lipoma
8. Retroperitoneal lipoma
9. Subsynovial
10. Intraglandular
Q. Which site is famous for being precancerous ?
A. Retroperitoneal lipoma.
Q. What are the multiple skin swellings ?
A. 1. Multiple Lipomata
2. Multiple Sebaceous Cysts
3. Multiple Naevi
4. Multiple Haemangiomata
5. Multiple Lymphangiomata
6. Multiple Neurofibromata
7. Multiple Papillomata
8. Multiple Warts
9. Multiple Keloids
10. Multiple Boils
11. Multiple Skin Metastases
Q. What is the commonest multiple skin swelling ?
A. Multiple naevi.
Q. How do you treat this patient ?
A.
The treatment of lipoma is usually conservative. Excision is indicated
if 1) cosmetically annoying the patient , 2) complicated, 3) painful,
or 4) causing pressure on a surrounding structure.
Q. What are the complications of a lipoma ?
A.
Pressure on a surrounding structure e.g. a retroperitoneal lipoma
compressing the ureters, hindering the movement of a nearby joint,
calcification, myxomatous degeneration, and very rarely malignant
transformation (liposarcoma).
Q. What is Dercum's disease ?
A. It is a painful lipoma, also called "adiposa dolorosa".
[b]Case 2. HAEMANGIOMA
[b]Q. What is your diagnosis ?
A. Cavernous haemangioma of the ......(mention the site).........
Q. Why this is a haemangioma ?
A. Because it is a skin swelling dating since birth (may be shortly after), it is pink in color and compressible.
Q. Why the haemangioma is compressible ?
A.
Haemangioma consists of multiple blood-filled vascular spaces. These
spaces communicate with the surrounding veins. Haemangioma is
compressible because its contained blood empties into the veins
communicating with the haemangioma.
Q. What are the compressible swellings you know ?
A.
Haemangiomas, lymphangiomas, aneurysms, pharyngeal pouch, saphena
varix, varicocoele, pneumatocoele, laryngeocoele, tracheocoele and
hernias.
Q. What is the commonest site of a haemangioma ?
A. The head and neck region.
Q. Does it affect internal organs ?
A. Yes, for example the liver and spleen.
Q. What are the different types of haemangioma you know ?
A. The different types of haemangioma are :
1. Capillary Haemangioma :
Port wine stain, Strawberry angioma, Salmon patch, Spider naevi
2. Venous Haemangioma (Cavernous haemangioma)
3. Arterial Haemangioma (Circoid aneurysm)
Q. What is the commonest complication of a haemangioma ?
A. Haemorrhage.
Q. What is the treatment of a cavernous haemangioma ?
A. The different lines of treatment are :
1. Injection of a sclerosant material
2. Embolization injection
3. Surgical excision
4. Laser radiation
Q. As regards injection sclerotherapy, what is the commonest material to be used ?
A. Ethanolamine oleate.
Q. What do you mean by embolization injection ?
A.
That is the injection of some material into the feeding artery of the
haemangioma through angiography to produce occlusion of this artery and
so necrosis of the haemangioma.
Q. What are the famous materials to be used in this regard ?
A. Gelfoam, alcohol foam and silicon particles.
Q. What is a hamartoma ?
A.
A hamartoma is "a developmental tumour-like malformation characterized
by being formed of the same tissues particular to the part of their
origin and these tissues are arranged in a haphazard fashion. It is also
characterized by a rate of growth similar to the surrounding
structures".
Q. Mention the different types of hamartomas you know ?
A.
1. Haemangiomas 2. Lymphangiomas
3. Neurofibromas 4. Benign naevi.
Q. What are the types of lymphangioma ?
A. There are two types :
1. Capillary lymphangioma (lymphangioma circumscriptum)
2. Cavernous lymphangioma (cystic hygroma)
Q. What is the commonest site of a cystic hygroma ?
A. The neck.
Q. Is lymphangioma compressible or not ?
A. Lymphangioma is partially compressible.
Q. A cavernous lymphangioma in the neck has a character that differentiates it from other neck cysts, what is this character ?
A. It is the only translucent neck cyst.
Q. When does it become opaque ?
A. When it becomes infected
Q. What are the types of neurofibroma ?
A.1. Solitary neurofibroma
2. Generalized neurofibromatosis (von Recklinghausen's disease of nerves)
3. Molluscum fibrosum
4. Plexiform neurofibroma (pachydermatocoele)
5. Elephantiasis neuromatosa
Q. Mention the types of benign pigmented naevi (moles) ?
A. Benign pigmented naevi include the following types :
1. Intradermal naevus
2. Junctional naevus
3. Compound naevus
4. Blue naevus
5. Juvenile naevus
6. Congenital giant naevus
7. Halo naevus
8. Spindle cell naevus
9. Naevus of Ota
10. Naevus of Spilus
11. Lentigo
Q. At what age do benign pigmented naevi start to appear ?
A. They present in childhood and adolescence, rarely they present at birth.
Q. What are the characteristic features of congenital giant naevus ?
A.
It is present since birth, may occupy very large areas of the body,
usually hairy, and what is more important is that it is precancerous in
about 15% of the cases
QUESTIONS IN CLINICAL SURGERY" is a book for CLINICAL SURGERY, I found
while searching on internet so , I hoped you ge benefit from ... Just I
hope !!!!!
Q. What is your diagnosis?
A. Subcutaneous lipoma.
Q. Why this is a lipoma?
A. Because it is a very slowly growing swelling which is soft, pseudofluctuant with a slippery edge.
Q. Why the edge of the lipoma is slippery ?
A. Because it is present within a very loose capsule so that pressure on one edge moves the swelling within the capsule.
Q. Why the lipoma is pseudofluctuant ?
A. Because the fat globules constituting the lipoma are very soft in consistency.
Q. How do you elicit fluctuation in a very small swelling ?
A.
By Paget's test; the swelling is fixed by the index and thumb of the
left hand and pressure is applied on the center of the swelling by the
index of the right hand. If there is yeilding in the center of the
swelling, it is considered fluctuant.
Q. Why this is a subcutaneous and not a subfascial lipoma ?
A.
Because it is attached to the skin at multiple sites while in
subfascial lipoma the skin is not attached to the swelling at all. Also,
making the fascia tense does not make the swelling smaller.
Q. How did you detect the skin attachment ?
A. There are two methods to detect skin attachment; either by pinching or by gliding
Q. Mention the different sites of lipoma ?
A. 1. Subcutaneous lipoma
2. Subfascial lipoma,
3. Intermuscular lipoma
4. Intramuscular lipoma
5. Subperiosteal,
6. Subserous lipoma,
7. Extradural lipoma
8. Retroperitoneal lipoma
9. Subsynovial
10. Intraglandular
Q. Which site is famous for being precancerous ?
A. Retroperitoneal lipoma.
Q. What are the multiple skin swellings ?
A. 1. Multiple Lipomata
2. Multiple Sebaceous Cysts
3. Multiple Naevi
4. Multiple Haemangiomata
5. Multiple Lymphangiomata
6. Multiple Neurofibromata
7. Multiple Papillomata
8. Multiple Warts
9. Multiple Keloids
10. Multiple Boils
11. Multiple Skin Metastases
Q. What is the commonest multiple skin swelling ?
A. Multiple naevi.
Q. How do you treat this patient ?
A.
The treatment of lipoma is usually conservative. Excision is indicated
if 1) cosmetically annoying the patient , 2) complicated, 3) painful,
or 4) causing pressure on a surrounding structure.
Q. What are the complications of a lipoma ?
A.
Pressure on a surrounding structure e.g. a retroperitoneal lipoma
compressing the ureters, hindering the movement of a nearby joint,
calcification, myxomatous degeneration, and very rarely malignant
transformation (liposarcoma).
Q. What is Dercum's disease ?
A. It is a painful lipoma, also called "adiposa dolorosa".
[b]Case 2. HAEMANGIOMA
[b]Q. What is your diagnosis ?
A. Cavernous haemangioma of the ......(mention the site).........
Q. Why this is a haemangioma ?
A. Because it is a skin swelling dating since birth (may be shortly after), it is pink in color and compressible.
Q. Why the haemangioma is compressible ?
A.
Haemangioma consists of multiple blood-filled vascular spaces. These
spaces communicate with the surrounding veins. Haemangioma is
compressible because its contained blood empties into the veins
communicating with the haemangioma.
Q. What are the compressible swellings you know ?
A.
Haemangiomas, lymphangiomas, aneurysms, pharyngeal pouch, saphena
varix, varicocoele, pneumatocoele, laryngeocoele, tracheocoele and
hernias.
Q. What is the commonest site of a haemangioma ?
A. The head and neck region.
Q. Does it affect internal organs ?
A. Yes, for example the liver and spleen.
Q. What are the different types of haemangioma you know ?
A. The different types of haemangioma are :
1. Capillary Haemangioma :
Port wine stain, Strawberry angioma, Salmon patch, Spider naevi
2. Venous Haemangioma (Cavernous haemangioma)
3. Arterial Haemangioma (Circoid aneurysm)
Q. What is the commonest complication of a haemangioma ?
A. Haemorrhage.
Q. What is the treatment of a cavernous haemangioma ?
A. The different lines of treatment are :
1. Injection of a sclerosant material
2. Embolization injection
3. Surgical excision
4. Laser radiation
Q. As regards injection sclerotherapy, what is the commonest material to be used ?
A. Ethanolamine oleate.
Q. What do you mean by embolization injection ?
A.
That is the injection of some material into the feeding artery of the
haemangioma through angiography to produce occlusion of this artery and
so necrosis of the haemangioma.
Q. What are the famous materials to be used in this regard ?
A. Gelfoam, alcohol foam and silicon particles.
Q. What is a hamartoma ?
A.
A hamartoma is "a developmental tumour-like malformation characterized
by being formed of the same tissues particular to the part of their
origin and these tissues are arranged in a haphazard fashion. It is also
characterized by a rate of growth similar to the surrounding
structures".
Q. Mention the different types of hamartomas you know ?
A.
1. Haemangiomas 2. Lymphangiomas
3. Neurofibromas 4. Benign naevi.
Q. What are the types of lymphangioma ?
A. There are two types :
1. Capillary lymphangioma (lymphangioma circumscriptum)
2. Cavernous lymphangioma (cystic hygroma)
Q. What is the commonest site of a cystic hygroma ?
A. The neck.
Q. Is lymphangioma compressible or not ?
A. Lymphangioma is partially compressible.
Q. A cavernous lymphangioma in the neck has a character that differentiates it from other neck cysts, what is this character ?
A. It is the only translucent neck cyst.
Q. When does it become opaque ?
A. When it becomes infected
Q. What are the types of neurofibroma ?
A.1. Solitary neurofibroma
2. Generalized neurofibromatosis (von Recklinghausen's disease of nerves)
3. Molluscum fibrosum
4. Plexiform neurofibroma (pachydermatocoele)
5. Elephantiasis neuromatosa
Q. Mention the types of benign pigmented naevi (moles) ?
A. Benign pigmented naevi include the following types :
1. Intradermal naevus
2. Junctional naevus
3. Compound naevus
4. Blue naevus
5. Juvenile naevus
6. Congenital giant naevus
7. Halo naevus
8. Spindle cell naevus
9. Naevus of Ota
10. Naevus of Spilus
11. Lentigo
Q. At what age do benign pigmented naevi start to appear ?
A. They present in childhood and adolescence, rarely they present at birth.
Q. What are the characteristic features of congenital giant naevus ?
A.
It is present since birth, may occupy very large areas of the body,
usually hairy, and what is more important is that it is precancerous in
about 15% of the cases
Shamsology- مـشــرف عــام
- عدد المشاركات : 1191
تاريخ التسجيل : 16/07/2010
المود :
رد: Questions in clinical surgery
من طرف Shamsology الثلاثاء سبتمبر 07, 2010 3:14 am
Oral Questions on a Case of Hernia
Case 1. INGUINAL HERNIA
Q. What is your diagnosis ?
A. Rt. oblique inguinal hernia, uncomplicated, containing intestine (omentum), no other hernias, no predisposing factors.
Q. Why this is a hernia ?
A.
Because 1) It is a swelling, 2) At the anatomical site of a hernia, 3)
Gives an impulse on cough, and 4) It is (or was) reducible on lying
down and by the patient fingers.
Q. Why inguinal and not a femoral hernia ?
A.
Because 1) the hernia is above the inguinal ligament and not below it,
and 2) the neck of the hernia is above and medial to the pubic
tubercle and because the hernia descends into the scrotum.
Q. Why oblique and not direct ?
A.
Because 1) it descends into the scrotum, 2) On doing the internal ring
test, there was no swelling to appear on coughing, and 3) the patient
is a young male.
Q. Describe how did you do the internal ring test ?
A.
After reduction of the hernia, the patient is asked to stand while
occluding the internal ring (by pressing the finger 1/2 an inch above
the mid inguinal point), the patient is then asked to cough, observing
the appearance of any inguinal swelling.
Q. Why you did not do the external ring test ?
A. Because it is painful.
Q. Can a direct hernia descend into the scrotum ?
A. A direct hernia can reach the scrotum very rarely.
Q. Where is the defect in oblique inguinal hernia ?
A. In the internal ring.
Q. Where is the defect in direct inguinal hernia ?
A. The posterior wall of the inguinal canal (Hasselbach's triangle).
Q. What are the boundaries of Hasselbach's triangle ?
A.
Lateral border of the rectus abdominis muscle medially, the inferior
epigastric artery laterally and the inguinal ligament inferiorly.
Q. What are the subdivisions of the Hasselbach's triangle ?
A. Hasselbach's triangle is subdivided into medial and lateral parts by means of the medial umbilical ligament.
Q. What are the common contents of a hernia in general ?
A. Intestine, omentum and fluid.
Q. Mention the clinical types of oblique inguinal hernias ?
A. 1) Bubonocoele, 2) Funicular type and 3) Scrotal (complete) type [/size]
A. Hydrocoele of the hernial sac : Part of the sac near its neck becomes encysted by a piece of omentum and accumulates fluid.
A.
Hernia of hydrocoele : In cases of vaginal hydrocoele, a defect occurs
in the dartos fascia of the scrotum through which a part of the
hydrocoele herniates.
Q. What are the causes of residual swelling after reducing the hernia ?
A.
1) Sliding hernia , 2) incomplete reducibility due to adhesions
between the contents and the sac , 3) hydrocoele of the hernial sac and
4) associated lipoma of the cord
Q. How would you clinically differentiate between obstructed and strangulated hernias ?
A.
An enterocoele can be obstructed and can be strangulated while an
omentocoele can only be strangulated as it has no lumen to be
obstructed.
Q. What are the conditions that you may find strangulation without obstruction ?
A. If the content of the hernia is one of the following :
1. Omentum
2. Part of the circumference of the intestinal lumen (Richter's hernia)
3. Michael's diverticulum (Littre's hernia)
4. Fallopian tube & ovary
5. Intestine, but there is an associated mesenteric vascular occlusion
Q. What is the treatment of this case of oblique inguinal hernia ?
A.
A. Inguinal herniotomy, that is excision of the hernial sac. They do not need repair as they have very good muscles
Q. What is the principle of operation for O.I.H. in adults?
A. Excision of the sac + repair of the defect
Q. What are the principles of such repair ?
A. Repair of the defect is done either by the local tissues (herniorrhaphy) or by adding a graft of tissue (hernioplasty).
The principles in both herniorrhaphy and hernioplasty, in general, are the following ;
1. Narrowing the internal ring,
2. Repair of the fascia transversalis, and;
3. Reinforcement of the posterior wall of the inguinal canal.
Q. What is the most popular type of repair ?
A. Bassini repair.
Q. What is its principle ?
A. Suturing the conjoined muscle to the inguinal ligament.
Q. What are the causes of recurrence of a hernia ?
A.
Q. What is your diagnosis ?
A. Paraumilical hernia, uncomplicated.
Q. What are the types of umbilical hernias you know ?
A.
1. True umbilical hernias :
i) Congenital umbilical hernia (exomphalos major and minor)
ii) Infantile umbilical hernia (from weak umbilical cicatrix)
iii) Adult umbilical hernia (from increased intrabdominal pressure)
2. Paraumilical hernias : due to defect in linea alba close to umbilicus:
1) Supraumbilical
2) Infraumbilical
Q. Is it common for patients with PUH to complain of dyspepsia ?
A. Yes.
Q. Why ?
A. Due to traction on the greater omentum which is commonly the content of such a hernia.
Q. What is the commonest complication of paraumbilical hernia ?
A. Irreducibility, due to marked adhesions between the contents.
Q. What is the danger of such irreducibility ?
A. It predisposes to obstruction and strangulation.
Q. What is the treatment of this case ?
A. Herniorrhaphy.
Q. What type of repair do you do ?
A. It varies according to the size of the defect as follows :
A.
In paraumbilical hernia, the defect is close to the umbilicus so that
the umbilicus forms a crescent at the edge of the sac, while in
epigastric hernia, there is a bridge of normal abdominal muscles between
the defect and the umbilicus. Besides, epigastric hernia could be
multiple
Q. What are the causes of incisional hernia
A. There are;
Case 1. INGUINAL HERNIA
Q. What is your diagnosis ?
A. Rt. oblique inguinal hernia, uncomplicated, containing intestine (omentum), no other hernias, no predisposing factors.
Q. Why this is a hernia ?
A.
Because 1) It is a swelling, 2) At the anatomical site of a hernia, 3)
Gives an impulse on cough, and 4) It is (or was) reducible on lying
down and by the patient fingers.
Q. Why inguinal and not a femoral hernia ?
A.
Because 1) the hernia is above the inguinal ligament and not below it,
and 2) the neck of the hernia is above and medial to the pubic
tubercle and because the hernia descends into the scrotum.
Q. Why oblique and not direct ?
A.
Because 1) it descends into the scrotum, 2) On doing the internal ring
test, there was no swelling to appear on coughing, and 3) the patient
is a young male.
Q. Describe how did you do the internal ring test ?
A.
After reduction of the hernia, the patient is asked to stand while
occluding the internal ring (by pressing the finger 1/2 an inch above
the mid inguinal point), the patient is then asked to cough, observing
the appearance of any inguinal swelling.
Q. Why you did not do the external ring test ?
A. Because it is painful.
Q. Can a direct hernia descend into the scrotum ?
A. A direct hernia can reach the scrotum very rarely.
Q. Where is the defect in oblique inguinal hernia ?
A. In the internal ring.
Q. Where is the defect in direct inguinal hernia ?
A. The posterior wall of the inguinal canal (Hasselbach's triangle).
Q. What are the boundaries of Hasselbach's triangle ?
A.
Lateral border of the rectus abdominis muscle medially, the inferior
epigastric artery laterally and the inguinal ligament inferiorly.
Q. What are the subdivisions of the Hasselbach's triangle ?
A. Hasselbach's triangle is subdivided into medial and lateral parts by means of the medial umbilical ligament.
Q. What are the common contents of a hernia in general ?
A. Intestine, omentum and fluid.
Q. Mention the clinical types of oblique inguinal hernias ?
A. 1) Bubonocoele, 2) Funicular type and 3) Scrotal (complete) type [/size]
- Bubonocoele = Hernia is only in the groin.
- Funicular type = Hernia descends into the scrotum but the testis is felt separate from the hernial sac.
- Scrotal
(complete) type = Hernia descends into the scrotum and the hernial sac
surrounds the testis which is not felt through the contents of the
hernia.
A. Hydrocoele of the hernial sac : Part of the sac near its neck becomes encysted by a piece of omentum and accumulates fluid.
A.
Hernia of hydrocoele : In cases of vaginal hydrocoele, a defect occurs
in the dartos fascia of the scrotum through which a part of the
hydrocoele herniates.
Q. What are the causes of residual swelling after reducing the hernia ?
A.
1) Sliding hernia , 2) incomplete reducibility due to adhesions
between the contents and the sac , 3) hydrocoele of the hernial sac and
4) associated lipoma of the cord
Q. How would you clinically differentiate between obstructed and strangulated hernias ?
A.
- # This is difficult because both are very acute conditions with the hernia being painful, irreducible & tender.
- # Impulse on cough is preserved in obstructed but is lost in strangulated hernias.
- # The hernia is tense in strangulation but not in obstruction.
- # Symptoms and signs of intestinal obstruction are present in obstructed hernias and maybe present in strangulated hernis
- # The degree of shock and toxaemia are more severe in strangulated hernias.
- #
However, both conditions are considered surgical emergencies and
necessitate an urgent interference to relieve the cause of
strangulation and to deal with the contents.
An enterocoele can be obstructed and can be strangulated while an
omentocoele can only be strangulated as it has no lumen to be
obstructed.
Q. What are the conditions that you may find strangulation without obstruction ?
A. If the content of the hernia is one of the following :
1. Omentum
2. Part of the circumference of the intestinal lumen (Richter's hernia)
3. Michael's diverticulum (Littre's hernia)
4. Fallopian tube & ovary
5. Intestine, but there is an associated mesenteric vascular occlusion
Q. What is the treatment of this case of oblique inguinal hernia ?
A.
- O.I.H. in children and adolescents -----------> Inguinal herniotomy
- O.I.H. in adults --------------------------> Inguinal herniorrhaphy
- O.I.H. in elderly and recurrent cases --------> Inguinal hernioplasty
A. Inguinal herniotomy, that is excision of the hernial sac. They do not need repair as they have very good muscles
Q. What is the principle of operation for O.I.H. in adults?
A. Excision of the sac + repair of the defect
Q. What are the principles of such repair ?
A. Repair of the defect is done either by the local tissues (herniorrhaphy) or by adding a graft of tissue (hernioplasty).
The principles in both herniorrhaphy and hernioplasty, in general, are the following ;
1. Narrowing the internal ring,
2. Repair of the fascia transversalis, and;
3. Reinforcement of the posterior wall of the inguinal canal.
Q. What is the most popular type of repair ?
A. Bassini repair.
Q. What is its principle ?
A. Suturing the conjoined muscle to the inguinal ligament.
Q. What are the causes of recurrence of a hernia ?
A.
- 1.
Untreated preoperative condition : Chronic straining (asthmatic
bronchitis, prostatic enlargement ....etc.), debility, obesity - 2. Intraoperative causes: Improper haemostasis, tense repair, lax repair, repair with absorbable suture material
- 3. Postoperative causes : Haematoma, infection, early return to hard work
Q. What is your diagnosis ?
A. Paraumilical hernia, uncomplicated.
Q. What are the types of umbilical hernias you know ?
A.
1. True umbilical hernias :
i) Congenital umbilical hernia (exomphalos major and minor)
ii) Infantile umbilical hernia (from weak umbilical cicatrix)
iii) Adult umbilical hernia (from increased intrabdominal pressure)
2. Paraumilical hernias : due to defect in linea alba close to umbilicus:
1) Supraumbilical
2) Infraumbilical
Q. Is it common for patients with PUH to complain of dyspepsia ?
A. Yes.
Q. Why ?
A. Due to traction on the greater omentum which is commonly the content of such a hernia.
Q. What is the commonest complication of paraumbilical hernia ?
A. Irreducibility, due to marked adhesions between the contents.
Q. What is the danger of such irreducibility ?
A. It predisposes to obstruction and strangulation.
Q. What is the treatment of this case ?
A. Herniorrhaphy.
Q. What type of repair do you do ?
A. It varies according to the size of the defect as follows :
- Very small defect ---------> Anatomical repair
- Small to Moderate defect ---------> Mayo's repair
- Moderate to Large defect ---------> Hernioplasty (prolene mesh graft)
A.
In paraumbilical hernia, the defect is close to the umbilicus so that
the umbilicus forms a crescent at the edge of the sac, while in
epigastric hernia, there is a bridge of normal abdominal muscles between
the defect and the umbilicus. Besides, epigastric hernia could be
multiple
Q. What are the causes of incisional hernia
A. There are;
- 1.
Untreated preoperative condition : Chronic straining (asthmatic
bronchitis, prostatic enlargement ....etc.), debility, obesity - 2. Intraoperative causes: Improper haemostasis, tense repair, lax repair, repair with absorbable suture material
- 3. Postoperative causes : Haematoma, infection, early return to hard work
Shamsology- مـشــرف عــام
- عدد المشاركات : 1191
تاريخ التسجيل : 16/07/2010
المود :
مواضيع مماثلة» Questions in clinical surgery
» oral questions in clinical surgery
» EMQS and Data Interpretation Questions in Surgery
» Clinical Surgery in General
» Videos Of CLINICAL EXAMINATION IN SURGERY
» oral questions in clinical surgery
» EMQS and Data Interpretation Questions in Surgery
» Clinical Surgery in General
» Videos Of CLINICAL EXAMINATION IN SURGERY
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