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GI 2 > Clin Med - Hernias > Flashcards

Clin Med - Hernias Flashcards

1
Q

what is a hernia?

A

protrusion of intra-abdominal tissue through a fascial defect in the abdominal wall

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2
Q

risk factors for hernias

A
  • hx of hernia or prior hernia repair
  • older age
  • male
  • caucasian
  • chronic cough
  • chronic constipation
  • abdominal wall injury
  • smoking
  • fam hx
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3
Q

what is a hernia composed of?

A
  • covering tissues (skin, subcutaneous tissues, etc)

- a peritoneal sac and any contained viscera

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4
Q

“neck” of the hernia

A
  • if the neck is narrow where it emerges from the abdomen, the bowel may be obstructed or strangulated or incarcerated
  • better to have wider neck
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5
Q

what happens if a hernia is not repaired early?

A

the defect may enlarge and repair becomes more complicated

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6
Q

reducible hernia

A

contents of the sac return to the abdomen spontaneously or w/ manual pressure

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7
Q

irreducible (incarcerated) hernia

A
  • contents cannot be returned to abdomen - trapped by narrow neck
  • incarceration does not mean obstruction but is necessary for obstruction to occur
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8
Q

strangulated hernia

A
  • compromise of blood supply

- gangrene of contents can occur

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9
Q

what type of hernia has has a higher incidence of strangulation?

A

femoral hernia

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10
Q

Richter hernia

A
  • uncommon but dangerous

- only part of the circumference of the bowel is incarcerated/strangulated in the facial defect

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11
Q

what is the risk of a Richter hernia in surgery?

A
  • it may spontaneously reduce and the gangrenous piece could be overlooked
  • bowel may subsequently perforate resulting in peritonitis
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12
Q

where is the Richter hernia most common?

A

femoral canal

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13
Q

What are the abdominal wall hernias?

A
  • epigastric
  • spigelian
  • incisional
  • umbilical
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14
Q

epigastric hernia

A
  • protrudes through the linea alba above the umbilicus
  • often < 1cm in diameter
  • M>F
  • bowel incarceration/strangulation is RARE
  • only repair symptomatic pts
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15
Q

diastasis recti

A
  • NOT a true hernia
  • failure of the linea alba to approximate
  • doesn’t need tx
  • no increased morbidity/mortality
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16
Q

spigelian hernia

A
  • occur along the semilunar line (outside of posterior rectus sheath)
  • relatively rare
  • HIGH incidence of incarceration (up tp 20% already incarcerated on presentation)
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17
Q

spigelian hernia symptom

A
  • pain localized to the hernia
  • aggravated by increased intra-abdominal pressure
  • over time pain may become more diffuse
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18
Q

diagnosis of spigelian hernia

A
  • easy if there is a mass (disappears w/ pressure)
  • but may not be palpable (no mass)
  • should be tender over hernia orifice
  • US or CT to confirm
  • repair can be open or laparoscopic
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19
Q

incisional hernia

A
  • 10% of abdominal incisions (23% if post-op wound infection)
  • upper abdominal incisions > lower
  • often multiple hernias present at incision (swiss cheese)
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20
Q

tx for incisional hernia

A

almost always surgery w/ mesh

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21
Q

etiology of incisional hernias

A
  • poor surgical technique

- failure to close laparoscopic trocar sites (>10mm in size)

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22
Q

risk factors for incisional hernias

A
  • older age
  • debility, chronic dz, compromised nutrition
  • obesity
  • increased intra-abdominal pressure
  • pulm. compilcations (coughing)
  • drains or stomas
  • blood loss during operation
  • collagen defects
23
Q

umbilical hernias in children

A
  • often noted at birth
  • will usually close by age 2 if <1/2 inch
  • need surg if doesn’t close by 2-4 yrs
  • not painful
24
Q

umbilical hernias in adults

A
  • most often acquired
  • associated w/ intra-abdominal pressure: multiple pregnancies w/ prolonged labor, ascites, obesity, lg tumors, distention
25
Q

females vs males umbilical hernias

A
  • 3:1 W:M

- men tend to present incarcerated

26
Q

s/s of umbilical hernias in adults

A
  • omental strangulation can cause chronic abdominal wall pain
  • usually not tender unless palpated
  • surgery if symptomatic
27
Q

more on umbilical hernias in adults

A
  • does not usually obliterate spontaneously
  • increase steadily in size
  • usually contain omentum
  • often require emergency repair (neck is usually narrow)
28
Q

What are the hernias of the groin?

A
  • inguinal
  • femoral
  • obturator
29
Q

how do all groin hernias occur?

A

-by protruding through a weakness/defect in the transversalis fascia

30
Q

indirect inguinal hernias pass through . . .

A

-the internal inguinal ring into the inguinal canal

31
Q

direct inguinal hernias extend . . .

A

-directly forward and DO NOT pass through the inguinal canal

32
Q

indirect hernias

A
  • congenital
  • any age
  • through inguinal ring (where spermatic cord in males exits abdomen or where round ligament exits abdomen in females)
33
Q

what side are indirect hernias more frequent?

A

right side

34
Q

direct hernias

A
  • acquired
  • more medial than indirect hernias
  • “bulge” in groin
  • d/t weakness in the floor of the inguinal canal
  • rarely protrude into scrotum
  • middle aged and elderly
  • difficult to distinguish from testicle pain
35
Q

sx of inguinal hernias

A
  • lumps/swelling in groin
  • “dragging” sensation
  • sudden pain and bulge that occurred while lifting/straining
36
Q

where does indirect hernia pain radiate to?

A

scrotum

37
Q

which hernia, direct or indirect, produce fewer sx?

A
  • direct

- they are less likely to become incarcerated

38
Q

PE of inguinal hernias

A
  • mass that may or may not be reducible
  • examine supine and standing - have them cough/strain
  • invaginate the scrotum and palpate w/ index finger
  • tissue must protrude into the inguinal canal during coughing to diagnose hernia
39
Q

obturator hernia

A
  • rare
  • elderly women
  • abdominal contents protrude through obterator foramen
40
Q

common pts that could have obturator hernia

A
  • chronically increased intrabdominal pressure
  • COPD
  • acites
  • cough
  • suspect in any elderly debilitate woman w/o previous abdominal operation who presents w/ small bowel obstruction
41
Q

presentation of obturator hernia

A
  • small bowel obstruction
  • palpable proximal thigh mass (rare)
  • groin pain radiating medially to knee (nerve compression)
  • ecchymoses of the thigh (if necrosis has occurred)
42
Q

What is the most lethal of all abdominal hernias?

A

obturator

43
Q

femoral hernia

A
  • descends through the femoral canal beneath the inguinal ligament
  • narrow neck - prone to incarceration
  • bulge just below the inguinal crease
  • W>M (usually slender women)
44
Q

symptoms of femoral hernia

A
  • colicky abdominal pain and signs of intestinal obstruction
  • NO discomfort/pain/tenderness in the femoral region
  • often hx of previous inguinal hernia repair
45
Q

signs of femoral hernia

A
  • if small and uncomplicated: appears as small bulge in upper medial thigh just below level of inguinal ligament
  • can be confused w/ inguinal hernia
46
Q

What are the 2 kinds of diaphragmatic hernias?

A
  • congenital: embryological defect in the diaphragm

- acquired: usually by trauma

47
Q

common location of diaphragmatic hernias

A

left side > right side

hepatic protection

48
Q

PE of diaphragmatic hernias

A
  • market respiratory distress
  • decreased breath sounds on effected side
  • bowel sounds in chest (eek)
  • movement of abdomen w/ breathing
  • diffuse abdominal pain
49
Q

diaphragmatic hernias

A
  • surgery
  • tx associated issues
  • laparotomy for acquired
50
Q

What are the 2 kinds of hiatal hernias?

A
  • sliding

- paraesophageal

51
Q

sliding hiatal hernias

A
  • GE junction above diaphragm
  • 95% of hiatal hernias
  • most are asymptomatic
  • tx: refulx med if symptomatic
52
Q

paraesophageal hiatal hernias

A
  • upward dislocation of gastric fundus
  • usually asymptomatic or vague symptoms
  • MC sx: epigastric or substernal pain
  • surgery is not frequently needed
53
Q

tx of hiatal hernias

A
  • trusses
  • abdominal binders
  • herniorrhaphy
54
Q

when to consider surgery for hiatal hernias

A
  • sx are present
  • potential for bowel incarceration
  • if hernia is between 1-8cm (8 is too big)
  • sufficient size to complicate dressing or activities of daily living

GI 2 (11 decks)

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