Abd Hernia/intestinal obstruction Flashcards
Abd hernia
general
Protrusion of the abdominal contents through an acquired or congenital area of weakness or defect in the wall
Common medical condition
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Classification:
Abdominal wall hernia
Umbilical hernia
Epigastric hernia
Spigelian hernia
Incisional hernia – 10-15%
Groin hernia
Inguinal hernia – 75%
Femoral hernia
abd hernia
Reducible
Contents of the hernia can be manipulated back into their original position through the defect from which they emerge
abd hernia
Incarcerated hernia(irreducible)
Hernia is compressed by the defect causing it to be irreducible (unable to be pushed back into its original position)
Abd hernia
Obstructed hernia
Refers mainly to hernias containing bowel, where the contents of the hernia are compressed to the extent that the bowel lumen is no longer patent and causes bowel obstruction
abd hernia
Strangulated hernia
Compression around the hernia prevents blood flow into the hernial contents causing ischemia of the tissues and associated pain
Umbilical hernia
general
Protrusions through the umbilical ring
Rarely strangulate
Types:
Congenital
Infants
Most resolve spontaneously within a few years
Large defects may require elective surgery after age 5
Acquired
Adults secondary to obesity, ascites, pregnancy, or chronic peritoneal dialysis
Cosmetic concern and can be surgically repaired
Epigastric hernia
general
Protrusion in the midline of the abdomen through the rectus abdominis muscle
Occurs between the xiphoid process and umbilicus
Typically asymptomatic
Spigelian hernia
general
Also known as a lateral ventral hernia
Protrusion through the spigelian fascia which is comprised of the transverse abdominis and internal oblique aponeuroses
Occurs in the lower abdomen
Least common of all hernias
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High risk for complications – bowel obstruction, incarceration, and strangulation
Incisional hernia
general
Protrusion that occurs at the site of a previous abdominal surgery
Tend to be large and painful
Anatomy of the Inguinal Canal
Inguinal ligament runs between theanterior superior iliac spine(ASIS) and thepubic tubercle(PT)
Inguinal canal is a tube-like structure runs within the ligament (spermatic cordand round ligament)
Deep inguinal ring: entry point from the abdominal cavity into the canal; found just above the midpoint of the inguinal ligament
Superficial inguinal ring: exit point from the canal; found just above and lateral to the pubic tubercle
Inguinal hernia
general
Occur above the inguinal ligament and medial to the pubic tubercle
Presents as a bulge in the groin
Types:
Indirect
Traverses the internal inguinal ring into the inguinal canal
Direct
Extend directly forward and do not pass through the inguinal canal
Hesselbach’s Triangle
Femoral hernia
general
Protrusion into the femoral canal that runs below the inguinal ligament and lateral to the pubic tubercle
Most common in elderly women
High risk for strangulation and obstruction
Abd hernia
Tx
Treatment:
Surgical repair
Open or laparoscopically
Elective or urgent basis
BO
SBO
Left: Supine abdominal x-ray showing obstruction of the small bowel. Dilated loops of small bowel should be noted.
Right: Upright abdominal x-ray showing obstruction of the small bowel. Multiple air-fluid levels should be noted.
SBO
The small bowel is dilated and filled with air and fluid. Oral contrast is seen in some of the loops but has not traveled down to the distal small bowel. The collapsed cecum and sigmoid colon should be noted (arrows). A specific point of obstruction (transition point) cannot always be seen on CT, but the dilated proximal bowel and collapsed distal bowel are highly suggestive of the diagnosis.
Small or Large Bowel Obstruction?
small
notice the increased fluid (large intestine takes out fluids)
and not a lot of gas in abd, gas is ususally proximal to obstruction
