This Presentation describes the historical background of ALMOST ALL types of hernia that general surgery resident can face, along with the rationale of why each type of hernia is so named.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
In this playlist you can watch everything about Scrotal swellings. I have discussed introduction, hydrocele, torsion testis, epididymal cyst, varicocele and testicular tumors. If you watch all these videos together you will become cofident in dealing with the problem of Scrotal Swellings.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
In this playlist you can watch everything about Scrotal swellings. I have discussed introduction, hydrocele, torsion testis, epididymal cyst, varicocele and testicular tumors. If you watch all these videos together you will become cofident in dealing with the problem of Scrotal Swellings.
Femoral hernia is the third common hernia after inguinal and incisional hernias. The swelling in femoral hernia is below and lateral to pubic tubercle. It is more common in females. Strangulation is very common in this hernia.
Disclaimer: A lot from this slides were taken also from https://www.slideshare.net/babysurgeon/scrotal-swellings-1 (Dr Selvaraj Balasubramani)
This covers only :
ANATOMY
CAUSES
TORSION OF TESTIS
EPIDIDYMO-ORCHITIS
HYDROCELE
EPIDIDYMAL CYST
VARICOCELE
Inguinal Hernia is the commonest problem in General surgery. All medical students should know everything about this common problem. In this ppt presentation I have covered all the details regarding Inguinal hernia thoroughly.
OPEN RIGHT HEMICOLECTOMY- STEP BY STEP OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openrighthemicolectomy #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• In this video today, I have discussed Open Right Hemicolectomy .
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch all my teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
HEMORRHOIDECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #hemorrhoidectomy #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• In this video today, I have discussed Hemorrhoidectomy- Barron’s banding, open and closed hemorrhoidectomy, Stapler hemorrhoidectomy and THD- Transanal Hemorroidal Dearterialisation. So, it is a 4in1 video.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
European hernia society guidelines: Adult Inguinal Hernia (Post operative car...Jibran Mohsin
This presentation gives general overview of European Hernia Society (EHS) guidelines regarding post operative care and complications in adult inguinal hernia.
Femoral hernia is the third common hernia after inguinal and incisional hernias. The swelling in femoral hernia is below and lateral to pubic tubercle. It is more common in females. Strangulation is very common in this hernia.
Disclaimer: A lot from this slides were taken also from https://www.slideshare.net/babysurgeon/scrotal-swellings-1 (Dr Selvaraj Balasubramani)
This covers only :
ANATOMY
CAUSES
TORSION OF TESTIS
EPIDIDYMO-ORCHITIS
HYDROCELE
EPIDIDYMAL CYST
VARICOCELE
Inguinal Hernia is the commonest problem in General surgery. All medical students should know everything about this common problem. In this ppt presentation I have covered all the details regarding Inguinal hernia thoroughly.
OPEN RIGHT HEMICOLECTOMY- STEP BY STEP OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openrighthemicolectomy #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• In this video today, I have discussed Open Right Hemicolectomy .
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch all my teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
HEMORRHOIDECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #hemorrhoidectomy #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• In this video today, I have discussed Hemorrhoidectomy- Barron’s banding, open and closed hemorrhoidectomy, Stapler hemorrhoidectomy and THD- Transanal Hemorroidal Dearterialisation. So, it is a 4in1 video.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
European hernia society guidelines: Adult Inguinal Hernia (Post operative car...Jibran Mohsin
This presentation gives general overview of European Hernia Society (EHS) guidelines regarding post operative care and complications in adult inguinal hernia.
Closure of elective midline abdominal incision: European Hernia Society 2014 ...Jibran Mohsin
This presentation includes the latest(2014) European Hernia Society (EHS) guidelines regarding the optimal technique and suture material for the closure of elective mid-line abdominal incisions in order to decrease the frequencies of complications especially incisional hernia, wound dehiscence and burst abdomen.
La tromboangeítis obliterante es una enfermedad segmentaria, inflamatoria y oclusiva, que afecta de forma predominante a las arterias y venas de mediano y pequeño calibre de las extremidades.
Experiential Learning through the lens of Communities of Practice (CoP) theoryJibran Mohsin
Individual Presentation on "Experiential Learning through the lens of Communities of Practice (CoP) theory"
Advanced Level Course on Teaching and Learning 1
Master of Health Professions Education
Department for Educational Development
The Aga Khan University
Tuesday, February 07, 2023
Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomized, open-label, phase 3 trial
CURRICULUM ON RESIDENCY PROGRAM FOR FCPS MOLECULAR PATHOLOGYJibran Mohsin
CURRICULUM ON RESIDENCY PROGRAM FOR FCPS MOLECULAR PATHOLOGY (Advanced Level Course on Curriculum Development in Health Professions Education, Department for Educational Development, The Aga Khan University)
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
3. Parts of Hernia
• Sac
– diverticulum of peritoneum with mouth, neck, body and fundus.
– Neck is narrow in indirect sac but wide in direct sac
• Hernia without neck: Those hernias with larger mouth lack neck, e.g.
direct hernia, incisional hernia
– Body of the sac is thin in infants, children and in indirect sac but
is thick in direct and long standing hernia.
– Hernia without sac:
• Epigastric hernia—it is protrusion of extra-peritoneal pad of fat
• Covering
– layers of the abdominal wall through which the sac passes
4. Parts of Hernia
• Contents
– Omentum—Omentocele (Epiplocele). Difficult to reduce the sac later, initially it can be
reduced easily.
– Intestine—Enterocele— commonly small bowel, but sometimes even large bowel.
Difficult to reduce the sac initially.
– Richter’s hernia: A portion of circumference of bowel is the content.
– Urinary bladder may be the content or part of the posterial wall of the sac—cystocele.
– Ovary, often with fallopian tube.
– Meckel’s diverticulum—Littre’s hernia
– Fluid:
• secreted from congested bowel or omentum or
• infected fluid or
• ascitic fluid or
• blood from the strangulated sac.
5. Clinical Classification
• Reducible hernia
– Reduced on its own or by patient or by surgeon
– Expansile cough impulse positive
• Irreducible hernia
– Contents can’t be returned to abdomen due to
• narrow neck,
• adhesions(incarcerated),
• overcrowding
– Predisposes to strangulation
Enterocele Reduces with gurgling difficult to reduce 1st portion
Omentocele doughy difficult to reduce last portion
6. Clinical Classification
• Obstructed hernia
– Lumen of gut present in the hernial sac gets obstructed like any intestinal
obstruction
– NOT seen in omentocele or richter’s hernia
• Inflamed hernia
– Inflammation of contents of sac
– e.g. appendicitis and salpingitis
– Tender but NOT tense with red and edematous overlying skin
• Strangulated hernia
– Compromised blood supply
– Tense as well as tender with no cough impulse
– Associated with obstruction in case of enterocele (exception: Richter’s hernia)
7. • Garrey’s Stricture
– Constriction due to ischemic narrowing of small
bowel which has reduced from an obstructed
hernia
8. Richter’s Hernia
• Portion of antimesenteric border of gut gets
incarcerated and eventually strangulated
without obstruction of lumen in the hernial
orifice
• segment of the engaged bowel is nearly
always the lower portion of the ileum
– but any part of the intestinal tract, from the
stomach to the colon, including even the appendix
9. Richter’s Hernia
• Precondition for the formation of this
particular hernia, as stated by Richter, is
determined by the size and consistency of the
hernial orifice
– big enough to ensnare the bowel wall, but small
enough to prevent protrusion of an entire loop of
the intestine
– margin of the hernial ring must be firm or, in
Richter’s words, “possess strong spring-force.
10. Richter’s Hernia
• Tend to progress more rapidly to gangrene than
ordinary strangulated ones
– firm constricting ring that exerts direct pressure on the
bowel wall
– free border of the intestine opposite the mesentery with
the predominance of terminal arterioles that is involved
– late diagnosis or even misdiagnosis, thus allowing time for
bowel necrosis to develop.
• Also seen at site of laparoscopy port site
– Thus incidence might increase with time
– Especially if fascia not closed at 10 mm port site
11. Richter’s Hernia
• first description of a case of Richter’s hernia was
made by Fabricius Hildanus (1560–1634) in 1606
– illustrates a typical clinical presentation of a
perforated Richter’s hernia
• In his famous Treatise on the Ruptures in 1785,
August Gottlob Richter (1742–1812) gave the first
comprehensive description of hernias in which
only part of the circumference of the bowel is
strangulated, and termed them “the small
ruptures.”
12. Richter’s Hernia
• The nomenclature of this hernia subsequently
resulted in confusion
• Only 100 years later, in 1887, did the famous London
surgeon Sir Frederick Treves distinguish these types of
hernias from herniation of a Meckel diverticulum, which
was classically described by Littre.
• Treves credited Richter with the distinction of having given
the first scientific description of this particular lesion and
suggested the term Richter’s hernia,
– “(partly) because with Richter must rest the main credit of
establishing the individuality of this lesion.”
Sir Frederick Treves
(1853–1923)
13. Richter’s Hernia
• 10% of strangulated hernias are Richter’s hernias (5–15%)
• 60 to 80 years old
– but cases have been described even in infants
• In whites, the most common site is the femoral ring (36–
88%),
– followed by the inguinal canal (12–36%) and abdominal wall
incisional hernia (4–25%).
– Rare sites, such as
umbilical, Obturator, supravesical, spigelian, triangle of
Petit,sacral foramen, Morgagni, internal,or (traumatic)
diaphragmatic hernias
14. Richter’s Hernia
• since the first description of a Richter’s-type
herniation through a laparoscopy incision in
1977
– similar case reports have increasingly been
published
15. Busoga Hernia
• variety of direct inguinal hernia common in the Busoga
area of Uganda and some other African countries,
including South Sudan and Ghana where it particularly
occurs in women.
• caused by a narrow defect in the conjoint tendon or
transversalis fascia and consequently there is a risk of
strangulation.
– The neck of the sac is small, so that when strangulation
occurs, often only part of the circumference of the gut is
involved causing what is known as a Richter's hernia
16. Littre’s Hernia
(persistent omphalomesenteric duct hernia)
• Alexis de Littre (1700) reported ileal diverticula and
attributed them to traction.
– report three cases of incarcerated femoral hernia containing a
small bowel diverticulum
• August Gottlieb Richter (1785) defined them as preformed,
and
• Johann Friedrich Meckel (1809) postulated their
embryologic origin.
• Sir Frederic Treves (1897) distinguished between Littre and
Richter hernia (partial enterocele)
Johann Friedrich Meckel (1781–1833),
German anatomist
17. Litre’s Hernia
• also described the mucous urethral
glands of the male urethra (littre’s
gland)
• first to suggest the possibility of
performing a lumbar colostomy for
an obstruction of the colon
• Jean Louis Petit was one of his
students. So was Jacques-Bénigne
Winslow in 1707
Alexis Littré
(1654 – 1726)
French physician and
anatomist
18. • Meckel's diverticulum an out-pouching of the ileum, part of
the small intestine, and found in approximately 2% of the
population.(1809)
• Meckel's cartilage A cartilaginous bar from which
the mandible is formed. Described in 1820.
• A syndrome – Meckel syndrome – is also named after him.
This condition was described in 1822.
• A protein – mecklin – the gene for which is found
on chromosome 8 (8q21.3-q22.1) is named after him.
19. Amyand Hernia
• rare form of inguinal hernia in which the
vermiform appendix is located within the
hernial sac.
• Seen in < 1% of inguinal hernia
• Claudius Amyand (1681-1740), French born English
surgeon
– performed the first successful appendectomy in 1735, on
an 11-year-old boy who presented with an inflamed,
perforated appendix in his inguinal hernia sac
20. De Garengeot Hernia
• appendix-containing incarcerated
femoral hernia
• Akopian and Alexander, named this hernia
after the 18th century Parisian surgeon Rene
Jacques Croissant de Garengeot(1688-1759).
– He is quoted in the surgical literature as the first
to describe this situation in 1731.
21. Maydl's hernia (Hernia-in-W)
• hernial sac contains two loops of bowel with another
loop of bowel being intra-abdominal
– loop of bowel in the form of 'W lies in the hernial sac and
the centre portion of the 'W loop may become
strangulated, either alone or in combination with the
bowel in the hernial sac
– more often seen in men, and predominantly on the right
side
• Postural or manual reduction of the hernia is contra-
indicated as it may result in non-viable bowel being
missed
Karel Maydl (1853 –1903)
Austrian surgeon
22. Gibbon’s Hernia
Hernia with Hydrocele
Edward Gibbon
(1737–1794)
English historian and Member of Parliament
Suffered from hydrocele;
Due to in fashion close fit clothing his conditions lead to chronic and disfiguring inflammation
followed by numerous surgeries, last 3 of which lead to peritonitis and eventually death
23. Berger’s Hernia
Hernia in pouch of Douglas
(Cul-de-sac)
______________________________________________________________________________
Berger(’s) Disease/syndrome ( IgA Nephropathy/nephritis)
-associated with Henoch Schonlein Purpura(HSP)
Buerger(’s) Disease (Thromboangiitis Obliterans/Presenile Gangrene)
(Winiwarter–Buerger syndrome)
24. History of Berger Disease
• In 1801, William Heberden, English Physician (1710-1801) first
described the disease
– in a 5-year-old child with abdominal pain, hematuria, hematochezia
and legs purpura
• In 1837, Johann Lukas Schönlein*, German naturalist and
professor of medicine (1793-1864) described
– purpura rheumatica (Schönlein's disease) an allergic non-
thrombopenic purpura rash(now HSP)
.
___________________________________________________________________
*also discovered the parasitic cause of ringworm or favus (Trichophyton schönleinii)
*also attributed with naming the disease, Tuberculosis, in 1839
(Prior to Schönlein's designation, Tuberculosis had been called
"consumption“)
25. History of Berger Disease
• In 1868, Eduard Heinrich
Henoch, German physician (1820 –1910)
– a student of Schönlein's,
– further associated colic bloody diarrhea, painful joints
and renal involvement
• Jean Berger (1930–2011)
– Pioneering French Nephrologist and Pathologist
– in 1968, were the first to describe IgA deposition in
this form of glomerulonephritis
28. History of Buerger Disease
• In 1876, Carl Friedländer*, German pathologist and microbiologist (1847–
1887)
– referred to it as "arteritis obliterans".
• In 1879, Felix von Winiwarter, Austrian Physician (1852 -1931)
– 57-year old male patient who had an unusual obliteration of
the arteries and veins of the leg
– attributed this disorder to new growth of tissue from the intima, and
– proposed the name "endarteritis obliterans" for the disease
• In 1908, Leo Buerger, Austrian American Pathologist, Surgeon & Urologist
(1879–1943)
– called it "presenile spontaneous gangrene" after studying amputations in 11
patients.
– in 1924 published a monograph based on analyses taken from 500 patients
*died a premature death, aged 39 or 40, after a brief stint with a respiratory
disease, believed to be caused by his discovered infectious organism,
the Friedlander's Bacillus (Klebsiella pneumoniae )
30. Pouch of Douglas*
• Also called
– Rectouterine pouch/excavation
– Rectovaginal/Ehrhardt-Cole Recess
– Douglas pouch/cavity/space/cul-de-sac (cavum
Douglasi)
* Scottish anatomist Dr. James Douglas (1675–1742)
Three other nearby anatomical structures are also named for him –
the Douglas fold, the Douglas line and the Douglas septum
31. • Douglas fold
– A fold of peritoneum forming the lateral boundary of
Douglas' pouch.
• Douglas line
– The arcuate line of the sheath of the rectus
abdominis muscle.
• Douglas septum
– The septum formed by the union of Rathke's folds,
forming the rectum of the fetus
33. Pantaloon Hernia
(Double/Dual Hernia, Saddle Hernia & Romberg
Hernia)
Italian Pantalone
(Pan:all Leone: Lion)
(Greek: Παντελεήμων [Panteleímon], "all-compassionate")
• After San Pantalone (Saint Pantaleon; died 303 AD)
– Roman(venetian) Physician & Martyr
• Character in Commedia Dellarte(16th century)
– Skinny old dotard ( foolish merchant- venetian) who wears
spectacles, slippers & tight fitting combination of trousers
& stockings (Baggy trousers)
34. 13th Century Icon of Saint Panteleimon, including scenes from his life,
from the Monastery of St. Katherine on Mount Sinai.
35.
36. Pantaloon Hernia
(Double/Dual Hernia, Saddle Hernia & Romberg Hernia)
• Buffoon in pantomimes
– Foolish vicious absurd old man
– Stock character
– Accomplice/butt of clown’s jokes/tricks
• Wide breeches worn especially in England
during reign of Charles II
– Extending from waist to ankle
37. Pantaloon Hernia
(Double/Dual Hernia, Saddle Hernia & Romberg Hernia)
• Close fitting trousers usually having straps
passing under instep & worn especially in 19th
century
• Loose fitting usually shorter than ankle length
trousers
• Garment’s brand name
38.
39. Etymology
saddle (n.)
Old English sadol "seat for a rider," from Proto-Germanic *sathulaz (cognates: Old
Norse söðull, Old Frisian sadel, Dutch zadel, zaal, German Sattel "saddle"), from PIE *sed- (1)
"to sit" (cognates: Latin sedere "to sit," Old Church Slavonic sedlo "saddle;" see sedentary)
. Figurative phrase in the saddle "in an active position of management" is attested from
1650s. Saddle stitch (n.) was originally in bookbinding (1887).
saddle (v.)
Old English sadolian "to put a riding saddle on;". The meaning "to load with a burden" is first
recorded 1690s. Related: Saddled; saddling.
41. Obturator Hernia
• Hernia through the obturator foramen/canal
Obturator comes from the Latin obturare, to close up/obstruct. The obturator foramen of
the os coxa, completely covered by a membrane, was named by the great French surgeon
AmbroiseParé in 1550,
Ambroise Paré
(1510 – 1590)
French barber surgeon
42. Howship–Romberg sign
( Romberg sign)
• Obturator nerve neuropathy due to
compression of it by an obturator hernia
– pain and paresthesia along the inner aspect of the
thigh, down to the knee(referred pain through
geniculate branch of obturator nerve)
– inner thigh pain on internal rotation of the hip
John Howship Moritz Heinrich Romberg
(1781 –1841) (1795-1873)
English surgeon German Physician
(died of leg abscess)
43. Lumbar Hernia
• New Latin lumbaris, from Latin lumbus loin
• In tetrapod anatomy,
– lumbar is an adjective
– that means of or pertaining to the abdominal
segment of the torso, between the diaphragm and
the sacrum (pelvis)
48. Retrovascular hernia (Narath’s hernia) The hernial sac emerges from the
abdomen within the femoral sheath but
lies posteriorly to the femoral vein and
artery, visible only if the hip is
congenitally dislocated
Velpeau hernia The hernia sac lies in front of the femoral
blood vessels in the groin
External femoral hernia of Hasselbach and
Cloquet
The neck of the sac lies lateral to the
femoral vessels.
Transpectineal femoral hernia of Laugier The hernia sac transverses the lacunar
ligament or the pectineal ligament of
Cooper
Callisen’s or Cloquets hernia The hernial sac descends deep to the
femoral vessels through the pectineal
fascia
Béclard's hernia The h ernia sac emerges through the
saphenous opening carrying the
cribriform fascia with it
De Garengeot's hernia This is a vermiform appendix trapped
within the hernial sac.
49. Retrovascular Hernia
• Narath’s Hernia
– Behind femoral artery in congenital dislocation of
hip
• Serofini’s Hernia
– Behind femoral vessels
Albert Narath
(1864 –1924)
Austrian surgeon & anatomist
51. Velpeau
• Provides 1st accurate description of leukemia in 1827
• Velpeau Bandage
– A wrapping used to immobilize the arm to the chest wall
• Velpeau's disease
– Hidradenitis suppurativa
• Velpeau's canal
– Inguinal canal
• Velpeau's fossa
– Ischiorectal fossa
52. External femoral hernia of Hasselbach and Cloquet
(Hesselbach Hernia)
neck of the sac lies lateral to the femoral vessels
Franz Kaspar Hesselbach
(1759 – 1816)
German surgeon & anatomist
53. Hesselbach
• Cribriform fascia
– Hesselbach's fascia
• Interfoveolar ligament
– Hesselbach's ligament
• Inguinal triangle
– Hesselbach's triangle
54. Cloquet’s (Callisen’s) Hernia
femoral hernia perforating the aponeurosis of
the pectineus (Pectineal fascia) and insinuating
itself between this aponeurosis and the muscle,
lying therefore behind the femoral vessels
Jules Germain Cloquet
(1790 –1883)
French physician and surgeon
55. Cloquet’s
– Cloquet canal(Hyaloid Canal)
• minute canal running through the vitreous from the discus
nervi optici to the lens.
– Cloquet's septum(Femoral Septum)
• Fibrous membrane bounding the annulus femoralis at the
base of the femoral canal
– Cloquet's gland/node
• 1 of the deep inguinal lymph nodes located in or adjacent to
the femoral canal
• Also called Rosenmuller node/gland
56. Béclard's hernia
Hernia sac emerges through the saphenous
opening carrying the cribriform fascia with it
Pierre Augustin Béclard
(1785 – 1825)
French anatomist and surgeon
57. Beclard’s
• Béclard's nucleus
– core of ossification in the cartilage of the
distal epiphysis of the femur during the latter part of
fetal life
– Use in forensic medicine to determine the age of
a fetus or newborn infant
• Beclard's anastomosis(arcus raninus)
– Anastomosis between the right and the left end-
branch of the deep lingual artery
58. Beclard’s
• Béclard's triangle
– Area whose boundaries are the posterior border
of the hyoglossus, the posterior belly of
the digastric muscle and the greater horn of
the hyoid bone
59. Transpectineal femoral hernia of Laugier
(Laugier’s Hernia)
Hernia sac transverses the lacunar ligament or
the pectineal ligament of Cooper
Stanislas Laugier
(1799 - 1872)
French surgeon
Laugier sign
In fracture of the lower portion of
the radius, the styloid processes of the
radius and of the ulna are on the same
level
60.
61. Phantom Hernia
• a muscular bulge as a result of local muscular
paralysis due to interference with nerve
supply of the affected muscles, like
poliomyelitis.
– common in lumbar region
– often seen in lower abdomen
Phantom:
Something apparently seen, heard, or sensed, but having no physical reality
62. Phantom
• Phantom limb
– feeling of pain in amputated toe or limb
• Phantom tumour
– tumour like lesion in lung like interlobar pleural
effusion
63. Gluteal & Sciatic Hernia
• protrusion of the peritoneal sac through the greater or
lesser sciatic foramen
• Classified based on their relationship to the pyriformis
muscle and ischial spine.
– 1. Suprapyriformis. Through greater sciatic foramen
– 2. Infrapyriformis. (Gluteal Hernia)
– 3. Subpyriformis. Sciatic Hernia
• Sac lies deep to gluteus maximus.
– Large hernias protrude below the buttock crease.
64. Interparietal (Interstitial) Hernia
• Herniation through parietal peritoneum into various layers of the
abdominal wall
• Common in Down’s syndrome, Prune Belly syndrome
• Often it can attain large size
• May mimic abdominal wall lipoma; haematoma
• As neck of the sac is often narrow, can present with irreducibility or
obstruction
• Commonly it is deep to external oblique aponeurosis
65. • Types
– Preperitoneal - between peritoneum and transversus
abdominis muscle – 20%
– Interparietal / intermuscular-between external
oblique and internal oblique; commonest – 60%.
• It is commonly associated with inguinal hernia
– Extraparietal (inguino superficial) – herniates through
external oblique aponeurosis into subcutaneous plane
– 20%
66. Spigelian Hernia
(Lateral Ventral Hernia)
• type of interparietal hernia occurring at the
level of arcuate line through spigelian point
• Hernial sac lies either deep to the internal
oblique or between external and internal
oblique muscles
• common between arcuate line to umbilicus
67. Spigelian Hernia
• a hernia through the spigelian fascia, which is
the aponeurotic layer between the rectus
abdominis muscle medially, and the semilunar
line laterally
• occur through spigelian’s line or spigelian’s
fascia which runs along the outside edge of
each of the rectus abdominis (6 pack) muscles
68. Anatomy of abdominal wall.
1: Linea semilunaris (spigelian;
semilunar line/zone)
9th Costal cartilage
pubic tubercle
2: rectus abdominis muscle;
3: transversus abdominal muscle;
4: spigelian aponeurosis/fascia
5: linea semicircularis(arcuate
line; Douglas Line)
69. Spigelian Hernia
• Although named after Adriaan van der
Spieghel (1578 – 1625; Belgian anatomist)
– he only described the semilunar line (linea
Spigeli) in 1645 (publised 20 years after his death)
• It was Josef Klinkosch (name long forgotten!)
in 1764 who first defined the spigelian hernia
as a defect, hole or hernia in the semilunar
line.
70. • common misconception that they protrude below the
arcuate line owing to deficiency of the posterior rectus
sheath at that level, but in fact the defect is almost
always above the arcuate line
• Spigelian Fascia/aponeurosis
– refers either to the combined aponeuroses of the external
abdominal oblique muscle, the internal abdominal oblique
muscle and transversus abdominis muscle, or just the
aponeurosis of the transversus abdominis
• caudate lobe of the liver is also known as Spiegel's lobe
72. Spigelian Hernia Belt
• majority of Spigelian hernias are found in a
transverse band lying 0-6 cm cranial to a line
running between both anterior superior iliac
spines referred to as the Spigelian hernia belt.
73. Epigastric Hernia
(Fatty Hernia of Linea Alba)
• 10% common.
• 20% of epigastric hernias are multiple—Swisscheese like.
• It occurs usually through a defect in the decussation of the fibres of
linea alba, any where between xiphoid process and umbilicus.
• Extraperitoneal fat protrudes through the defect as fatty hernia of
the linea alba presenting like a swelling in the upper midline with an
impulse on coughing.
• It is sacless hernia.
– Later protrusion enlarges and drags a pouch of peritoneum,
presenting as a true epigastric hernia.
74. Epigastric Hernia
• often associated with peptic ulcer and so pain
may be due to peptic ulcer.
– gastroscopy is done to rule out acid peptic
disease.
75. Parameter Epigastric Hernia Para Umbilical Hernia
Site Midline raphe(linea alba) anywhere
between xiphoid process and umbilicus
(usually midway)
Through thinned and atttenuated
linea alba
Pathology Initially transverse split in linea alba-
elliptical defect
Rounded defect with well defined
fibrous margin
Etiology Small BVs pierce linea alba
Abnormal decussation of aponeurtoic
fibres related to heavy physcial activity
Stretching and thinning of linea
alba
Gender Common in muscular men( fit healthy
males 25-40 years)
M:F (1:5) overweighted men or
multipara female
Risk Factors manual labourers • Obesity
• Multiple pregnancies
• Flabby abdominal wall
• Liver Cirrhosis
Number 20 % multiple(swiss cheese like)
It is sacless hernia. Later protrusion
enlarges and drags a pouch of
peritoneum, presenting as a true
epigastric hernia
Overlying dermatitis
Crescent shaped umbilicus
76. Para Umbilical Hernia Epigastric hernia
Incision Transverse Vertical midline
Very small(< 1 cm) Figure-of-eight suture
Darn repair
1-2 cm Mayo’s Repair
>2 cm Mesh Repair
77. Ventral* Hernia
• Hernias of anterior abdominal wall
• EXCEPTIONs to above definition
– Inguinal and femoral hernias not included even
though they are ventral
– Lumbar Hernia included despite being dorsolateral
*Latin "venter" meaning belly
78. Indirect Inguinal Hernia
• Bubonocele
• from Greek boubōn groin + kēlē tumour/swelling
• Funicular
– funicular, also known as an inclined plane or cliff railway, is
a cable railway in which a cable attached to a pair of tram-like
vehicles on rails moves them up and down a steep slope
– the ascending and descending vehicles counterbalance each
other.
OR
– having the form of or associated with a cord usually under
tension
80. Sliding inguinal Hernia
( NOT sliding hiatal Hernia)
• posterior wall of the sac is not only formed by the
parietal peritoneum, but also by sigmoid colon on
left side; caecum on right side and often with
portion of the bladder (Both sides)
• Rarely small bowel sliding hernia or sacless sliding
hernia can occur.
• Sliding hernia occurs exclusively in males. Mainly
on the left side
81. Mery’s Hernia
(Perineal Hernia)
Postoperative Perineal Hernia Through perineal scar (excicion of rectum)
Median sliding Perineal Hernia Complete rectal prolapse
Anterolateral Perineal Hernia Swelling of labium majus
Posterolateral Perineal Hernia Pass through levator ani to enter ischiorectal fossa
82. Holthouse’s hernia
Inguinal hernia that has turned outwards into
the groin.
Inguinal hernia with extension of the loop of
intestine along the Poupart ligament.
Carsten Holthouse,
English surgeon
1810-1901
83. Barth’s Hernia
Hernia between abdominal wall and persistent
vitello-intestinal duct.
Jean Baptiste Philippe Barth
French physician (1806-1877)
85. Morgagni (Retrosternal/parasternal)
Hernia
• rare anterior defect of the diaphragm
• 2% of all CDH cases
• characterized by herniation through
the foramina of Morgagni which are located
immediately adjacent and posterior to
the xiphoid process of the sternum
86. Foramina of Morgagni
• Also called
– sternocostal hiatus/triangle
– Larrey's triangle
• Small zones lying between costal and sternal
attachments of thoracic diaphragm
• Contents
– superior epigastric arteries as terminations of the
internal thoracic arteries, with accompanying veins
and lymphatics.
87. Giovanni Battista Morgagni
(1682 – 1771)
Italian anatomist
Father of modern anatomical pathology
Eponymous structures
• Aortic sinus ("sinus of Morgagni")
• Columns of Morgagni
• Foramina of Morgagni
• Hydatid of Morgagni
• Morgagni's hernia
88. Bochdalek hernia
• also known as a postero-lateral diaphragmatic
hernia
• >95 % of CDH
• 80-85 % left sided
Vincent Alexander Bochdalek
(1801 – 1883)
Bohemian anatomist
89. Associated Eponyms
• Bochdalek's cyst
– congenital cyst at the root of the tongue
• Bochdalek's flower basket
– part of the choroid plexus of the 4th ventricle protruding through the
lateral bursa (recessus lateralis) of the 4th ventricle (Luschka's
foramen).
• Bochdalek's foramen
– congenital defective opening through the diaphragm, connecting
pleural and peritoneal cavities
• Bochdalek's ganglion
– ganglion of dental nerve in the jaw (maxilla) above the root of the
canine teeth.
90. Associated Eponyms
• Bochdalek's hernia
– Congenital diaphragmatic hernia which allows protrusion of abdominal viscera
into the chest.
• Bochdalek's triangle
– Lumbocostal triangle, a triangle-shaped slit in the muscle plate between
lumbar or sternal part in the diaphragm and the 12th rib.
• Bochdalek's valve
– fold of membrane in the lacrimal duct near the punctum lacrimale.
– Also called Foltz' valvule;French ophthalmologist Jean Charles Eugène Foltz
(1822–1876) )
• Vater's duct
– a duct that in the embryo connects the thyroid diverticulum and the posterior
part of the tongue.
91. Hiatus/Hiatal Hernia
• Type I (sliding) hernia
– characterized by an upward herniation of the cardia and GE junction in
the posterior mediastinum. The most common one. (C)
• Type II (rolling or paraesophageal) hernia (PEH)
– characterized by an upward herniation of the gastric fundus alongside
a normally positioned cardia. The GE junction is in its normal place (D).
• Type III (combined sliding-rolling or mixed) hernia
– characterized by an upward herniation of both the cardia and the
gastric fundus.
• Type IV hiatal hernia
– is declared in some taxonomies, when an additional organ, usually the
colon, herniates as well.
92. Parameters Gastroschisis (Belly Cleft) EXOMPHALOS (Omphalocele)
Etiology defect of the anterior abdominal
wall just lateral to the umbilicus
failure of all or a part of the gut to
return to
the coelomic cavity during early
foetal life
Sac coverings Nil
Umbilicus is normal. The defect is
almost always to right of an intact
umbilical cord.
Thin, consists of three
layers—outer amniotic membrane,
middle Wharton’s
jelly and inner peritoneal layer
Non-rotation and intestinal
atresia are common associations.
Cardiac anomaly is not common
as in omphalocele.
often associated with congenital
anomalies
of cardiac and genitourinary system
- 70%.
93. Etymology
• -Schisis
– Ancient Greek σχίσις (schisis)
– breaking up of attachments or adhesions
– Fissure
– denoting a cleft or cleavage
– <gastroschisis> <cranioschisis> <palatoschisis>
94. Etymology
• Gastric(gas-trik)
– Greek gastr-, gastēr, (stomach)
– alteration of *grastēr, from gran to gnaw, eat
• Epi-
– a prefix occurring in loanwords from Greek,
– where it meant “upon,” “on,” “over,” “near,” “at,”
“before,” “after”
95. • Omphalos
– a religious stone artifact, or baetylus
– Greek, means "navel“
• In Greek lore, Zeus (God of sky & thunder) sent two eagles across
the world to meet at its center, the "navel" of the world.
– Omphalos stones marking the centre were erected in several places
about the Mediterranean Sea; the most famous of those was at Delphi
• Omphalos is also the name of the stone given to Cronus
• In the ancient world of the Mediterranean, it was a powerful
religious symbol
96. • Omento-
– Latin for Apron
• Epiploic-
– Related/associated with omentum
• Entero-
– refers to the intestine (from Greek ἔντερον, enteron)
98. • It is protrusion of abdominal wall muscles
during leg rising test as weak, soft, supple,
swelling,
– signifies poor abdominal muscle tone.
– also concludes that particular hernia requires
mesh repair (hernioplasty)
– Common in old age, obese patient.
Malgaigne bulging
Joseph-François Malgaigne
(1806 – 1865)
French surgeon and medical historian
99.
100. Associated eponyms
• Malgaigne's ( Subastragalar) amputation
– Amputation of the foot in which the astragalus is conserved
• Malgaigne's fracture
– Vertical pelvic fracture with bilateral sacroiliac dislocation and fracture of the
pubic rami
• Malgaigne's hernia
– Infantile inguinal hernia prior to the descent of the testis
• Malgaigne's luxation (Nursemaid’s Elbow)
– Partial dislocation of the head of the radius within the elbow joint
• Malgaigne's triangle/Fossa
– Also known as the superior carotid triangle
101. Rectus abdominis diastasis
(diastasis recti, abdominal separation)
(Divarication of rectus abdominus Muscles-DRAM)
• a separation of the two rectus abdominis muscle
pillars
• results in the characteristic bulging of the
abdominal wall in the epigastrium
• sometimes mistaken for a ventral hernia
– despite the fact that the midline aponeurosis is intact
and no hernia defect is present
102. Rectus abdominis diastasis
(diastasis recti, abdominal separation)
(Divarication of rectus abdominus Muscles-DRAM)
• Congenital
– as a result of a more lateral insertion of the rectus
muscles to the ribs and costochondral junctions
• Acquired
– advancing age
– obesity, or
– Post-partum
• advanced maternal age
• after multiple or twin pregnancies
• high-birth-weight infants Diastasis: Greek Separation
103.
104. Internal Hernia
• Occur when the intestine (the ‘viscus’) passes beneath a constricting band or
through a peritoneal window (the ‘defect’) within the abdominal cavity or in the
diaphragm.
• They present as
– Acute intestinal obstruction, with or without intestinal ischaemia, perforation and peritonitis,
or
– Chronic recurrent abdominal pain and vomiting due to incomplete and intermittent intestinal
obstruction.
• Sites of internal herniation include
– (i) the paraduodenal and paracaecal fossae,
– (ii) the lesser sac through the epiploic foramen (foramen of Winslow) or a defect in the
transverse mesocolon,
– (iii) beneath congenital bands or adhesions,
– (iv) through defects in the small bowel mesentery,
– (v) between the lateral abdominal walls and intestinal stomas, and
– (vi) through defects in the diaphragm (hernias of Bochdalek and Morgagni).