11. Epigastric Hernia

Question 1

PATHOLOGY and TYPES of Epigastric Hernia

Answer 1

1. Fatty hernia of the linea alba

2. True Epigastric hernia

Question 2

Pathogenesis of Fatty hernia of the linea alba in PATHOLOGY and TYPES of Epigastric Hernia

Answer 2

The hernia starts as a protrusion of the extraperitoneal fat through a defect in the supraumbilical part of the linea alba

Question 3

Pathogenesis of True Epigastric hernia in PATHOLOGY and TYPES of Epigastric Hernia

Answer 3

As the protrusion enlarges, the extraperitoneal fat pulls a small peritoneal sac through the defect which may contain intestine or omentum.

Question 4

The defect in the linea in Pathogenesis of True Epigastric hernia in PATHOLOGY and TYPES of Epigastric Hernia

Answer 4

• Alternative name

* Structures Passing through

Question 5

Alternative name for The defect in the linea in Pathogenesis of True Epigastric hernia in PATHOLOGY and TYPES of Epigastric Hernia

Answer 5

Foramen of Egres

Question 6

Structures Passing through The defect in the linea in Pathogenesis of True Epigastric hernia in PATHOLOGY and TYPES of Epigastric Hernia

Answer 6

Paramedian vessels and nerves

Question 7

Difference between True epigastric hernia and fatty hernia of linea alba

Answer 7

No expansile impulse with cough with fatty hernia of linea alba

Question 8

Difference between fatty hernia of linea alba and Lipoma

Answer 8

Can not be differentiated from lipoma except intraoperative

Question 9

CLINICAL PICTURE of Epigastric Hernia

Answer 9

• Associated symptoms

* Examination

Question 10

Associated symptoms in CLINICAL PICTURE of Epigastric Hernia

Answer 10

Dyspepsia and epigastric pain

Question 11

Pathogenesis of Dyspepsia and epigastric pain

Answer 11

may be due to traction on the lesser omentum or the stomach

Question 12

Examination in CLINICAL PICTURE of Epigastric Hernia

Answer 12

• Soft epigastric swelling
• Frequently irreducible
• Gives expansile impulse on cough.

Question 13

TREATMENT of Epigastric Hernia

Answer 13

• Exclusion of similar diseases first

* Repair

Question 14

Exclusion of similar diseases first in TREATMENT of Epigastric Hernia

Answer 14

• Exclude first peptic ulcer or gallbladder disease by endoscopy or abdominal U.S
• if there is continuous dyspepsia & epigastric pain

Question 15

Repair in TREATMENT of Epigastric Hernia

Answer 15

1) Hernioplasty.
2) Anatomical repair.
3) Mayo’s repair (vertical)