Abdomen: Hernias Flashcards
Cause: It may occur due to failure of the midgut to return to the abdomen early in fetal life, and it occurs as a protrusion of the bowel through the natural weak spot or defect at the umbilicus.
Fact: It’s more common in girls, low birth weight babies, and premature babies (preemies). Acquired umbilical hernias are most common in women and obese people.
Presentation: discomfort, noticeable bulge that gets bigger when straining, coughing, or crying.
Treatment: It usually shrinks and closes spontaneously by 3 years of age, but if it doesn’t or if the hernia is incarcerated or strangulated, surgery may be necessary.
What type of hernia is it?
Umbilical hernia
It’s a protrusion of extraperitoneal fat or a small piece of greater omentum through a defect in the linea alba above the umbilicus and may contain a small portion of intestine, which may become trapped w/in the hernia, leading to strangulation or incarceration.
It occurs in the midline betw. the xiphoid process and the umbilicus.
Fact: it tends to occur in people 40 yrs of age or older, and is usually associated with obesity.
Presentation: Nausea, vomiting, and discomfort because of nerves and tissue being irritated or stretched.
What is the hernia?
Epigastric hernia
It’s a hernia through the spigelian fascia, which is the aponeurotic layer betw. the rectus abdominis m. medially and the semilunar line laterally. They always develop at or below the arcuate line, because of the lack of post. rectus sheath.
Fact: it tends to occur in people 40 yrs of age or older, and is usually associated with obesity.
Presentation: Intermittent mass, localized pain, or signs of bowel obstruction.
Treatment: Surgical repair
What is the hernia?
Spigelian (AKA semilunar) hernia
It occurs superior to the inguinal ligament and medial to the pubic tubercle. It is more common in males than in females. It’s derived from persistence of the processus vaginalis, which forms the tunica vaginalis.
There are 2 types direct and indirect
What is the hernia?
Inguinal hernia
Acquired or congenital: Acquired
Predisposing factor: Weakness of ant. abdominal wall in inguinal triangle (e.g., owing to distended superficial ring, narrow inguinal falx, or attenuation of aponeurosis in males over 40 yrs of age.
Frequency: It occurs in 1/3rd to 1/4 of inguinal hernias
Exit from abdominal cavity: peritoneum plus transversalis fascia, it lies outside the inner one or two fascial coverings of cord.
Course: It passes through or around the inguinal canal, usually traversing only medial third of canal, external and parallel to vestige of processus vaginalis.
Exit from ant. abdominal wall: Via superficial ring, lateral to cord.
It rarely enters the scrotum.
What is the hernia?
Direct inguinal hernia
Acquired or congenital: Congenital
Predisposing factor: Patency of processus vaginalis (complete or at least sup. part) in younger persons, the great majority of which are males.
Frequency: 2/3rd to 3/4s of inguinal hernias. It is more common than direct inguinal hernia. It’s often found on the right side in men.
Exit from abdominal cavity: Peritoneum of persistent processus vaginalis plus all three fascial coverings of cord/round ligament. It is covered by the peritoneum and coverings of the spermatic cord.
Course: Traverses inguinal canal (entire canal if it is of sufficient size) within processus vaginalis. It passes through the deep inguinal ring, inguinal canal, and superficial inguinal ring and descends into the scrotum. It lies lateral to the inf. epigastric vessels.
Exit: Via superficial ring inside the cord commonly passing into scrotum/labium majus.
What type of hernia is it?
Indirect inguinal hernia
It’s a protrusion of part of the stomach into the mediastinum through the esophageal hiatus of the diaphragm. It occurs most often in people after middle age, possibly because of weakening of the muscular part of the diaphragm and widening of the esophageal hiatus.
There are 2 main types:
- paraesophageal ____ hernia
- Sliding ___ hernia
What type of hernia is it?
Hiatal hernia
It’s the less common hiatal hernia. In this type of hiatal hernia the cardia remains in its normal position, but a pouch of peritoneum, often containing part of the fundus, extends through the esophageal hiatus ant. to the esophagus. Usually no regurgitation of gastric contents occurs because the cardia orifice is in its normal position.
What type of hernia is it?
Paraesophageal hiatal hernia.
In this type of hiatal hernia the abdominal part of the esophagus, the cardia, and parts of the fundus of the stomach slide superiorly through the esophageal hiatus into the thorax, especially when the pt. lies down or bends over. Some regurgitation of the stomach contents into the esophagus is possible b/c the clamping action of the right crus of the diaphragm on the inferior end of the esophagus is weak.
What type of hernia is it?
Sliding hiatal hernia
