Abdominal Hernia, Pyloric Stenosis, Meckel Diverticulum, and Hiatal Hernia Flashcards
Umbilical hernia
Incisional hernia
Epigastric hernia
Spigelian hernia
Diastasis recti
Through umbilic ring
Sites where prev incision made
ALong linear alba above umb
Alog semi lunar line where no sheath behind rectus muscel
Widening of linea alba due to fascila weakness but aponeurosis remians intact
Femoral hernia
Direct inguinal hernia
Indirect inguinal
Through femoral ring which is interior to inguinal ligament, medial to femoral vien and lateral to lacunar ligament
In Hesselbachs triangle (inguinal lig inf, inf epigastric lat, and rectus medially)
Develops throug inguinal ring
Pathophys of hernia
Congenital inguinal due to indirect that devleop due to faired closures of processus vaginialis
COnge unmbicial bc of failure of umbilical ring to close
Acquired hernies due to weakneing offibromuscular tissues of muscular wall …most develop due to chornic wall injury or overstretching (obesity, cirrhosis with ascities, pregancy or COPD)…acute inc in intra-ab can also precipitate
Regardless of oringin, once a suff size develops viscera cnap rotrude through and reduce venous and lymph flow leading to swelling….this can lead to incrceration…eventually strnagulation occurs
Epi of hernia
Inguinla and groin are most common
Umbiclical - common cong in infants
INcisional - increase if wound infection develops
Cong inguinal - inc if premature
CM of hernias
Bulge aggravated by couging or straning
Direct inguinal - above inguinal ligament, directly through external inguinal ring, palpable in inguinal canal and CANNOT palplate in scrotum
Indirect inguinal - above ing ligment, exits throguh external inguinal ring, palpable in inguinal canala and palapable in scrotum
Femoral - below inguinal ligament and not palp in scortum
Reducible - sac is soft and easily replaced
incarc - sac painful and cannot be manipulated
Strang - very apinful and erythematous
Strang can also be associated iwth systemic sx
Dx mg and prognosis of hernia
Clinical findings and US
If incarc or strnagulaiton, then undergo hernia repair
Can undergo elective is sx that limit fxn
Shold watch unless femoral
Prognosis - most cong umb regress…risk of incarc and strangulation are low with most unless femoral
Pyloric stensosi path and epi
Hypertrophy of pylorus in early infancy
High risk with maternal smoking and exposure to macrolide antibiotics
More in males and pre-term
CM, dx, and mg of pyloric stejossi
Post-prandial vomiting at -6 weeks of age
Vomiting is projectile and only of formula or milk
Frequently hungry immediately afterwards
May gain weight but inability is a key sign of dz
Labs - hypokalemia, hypochloremia and met alkalosis bc of large losses of gastric aicd
US is test of choice that shows target sign
Surgical repair
Meckel diverticulum path and epi
True diverticulum (herniation of interestinl wall layers) and represents a presistent remnant of omphalomesenteric duct
Normally this duct connects midgut to yolk sac and involutes at 6 weeks
Lined with ileal mucosa and 1/2 will contain heterotropic mucosa that can secrete acid
Most common cong malformation
CM, dx, and mg of diverticulum
Most incidentally
Most common is painless bleeding…due to presence of heterotropic gastric mucosa
Acid production leads to ulcers of small bowel
25% with ileocoloni intussusception
20% with diverticulitis
Dx - surgical visualization…if bleeding can get Meckel scan which is nuclear med
Surgical resection
Hiatal Hernia path
Displacmeent of GE junction
Weakening of phrenoesopahgeal ligament that attavches the GE jxn to the diaphragm
As a result, GE jxn and gastric cardia through diaphragm into medastimum
Epi, dx, and mg of hiatal hernia
Most asx but eventually look like GE reflux disease
Typically dx by imaging studies for another reaosn
Sx control with PPI
