GI Disorders - Herniation Flashcards
What is a hernia?
Organ protrusion thru muscle or fascia caused by increased intra-abdominal pressure
Where are hernias located normally?
In abdominal cavity
Patho for Hernia
- weak area that retain or support structures
- increase intra-abdominal pressure
What is a fascia?
Connective tissues that surrounds and hold internal structures in place.
Are majority of Hernias acquired or congenital? Give examples of both.
Majority of hernias are acquired.
Acquired Examples: form of injury, surgical procedure, weightlifting without protection, and degenerative change from aging.
Congenital Examples: born with weak abdominal structures.
Why does obesity and pregnancy more prone to herniation?
Both increase intra-abdominal pressure and contains weakened retaining structure
What are the two major type of Hernias?
- Hiatal
2. Inguinal
What is Hiatal Hernia?
a part of the stomach protrudes into the thoracic cavity thru the weakened/enlarged hiatus d/t increase intra-abdominal pressure
What is a Hiatus?
Hiatus = a break or an opening (*aperture) of a sequence
If hiatus weakens, it may lead to herniation
eg where esophagus goes thru the diaphragm
Is Hiatal Hernia located in the superior or inferior of the body cavity?
superior
In Hiatal Hernia, a part of the ___ protrudes into the ___ ___
Stomach, thoracic cavity
What are the two types of Hiatal Hernia?
- sliding or axial hernia
2. paraesophageal/rolling or nonaxial hernia
___% are Sliding Hernia and remaining ___% are Rolling Hernia
95%, 5%
What is happening in Sliding Hernia? Is the stomach above or below diaphragm?
The GEJ and part of the upper stomach slides up into the thoracic cavity thru hiatus and result in a bell-shaped protrusion.
The stomach portion is above diaphragm
3 Symptoms of Sliding Hernias. WHY?
- chest pain r/t abdominal structures pushing into TC
- heartburn d/t gastric reflux on esophageal lining
- reflux d/t gastroesophageal reflux (content from stomach pushing up into esophagus)
What is happening in Rolling Hernia? Is stomach/GEJ above or below the diaphragm***? What part of the stomach protrudes??
The non-upper part of the stomach (fundus) protrudes into the thoracic cavity.
The GEJ is below the diaphragm.
3 symptoms of Rolling Hernia. WHY?
- pain = herniated fundus can compress esophagus and impede passage of food
- dyspnea = fundus protrudes into the left side of the thoracic cavity and decrease the volume of air and left lung is unable to inflate fully
- fullness = d/t decrease vol of stomach and when some content gets into the pocket, the stretch receptors signals the brain giving a false sense of fullness
Why is there no reflux in Rolling Hernia?
There is no reflux because there is no constriction or added pressure to push content in the stomach up to the esophagus
Treatment of Hernias (3)
- lifestyle modifications: behavioural and dietary
- drugs (Antacids, PPIs, H2RA)
- sx if required
What are some lifestyle modifications both dietary and behavioural? (5)
- small frequent meals
- avoid foods that increase acid secretion
- sit down and bend at knees (not hips)
- raised HOB
- avoid smoking, caffeine, and food intake couple hours before bedtime
What are the actions of Antacids, PPIs, and H2RA?
Antacids - neutralize acids in stomach and increase pH
PPIs - decrease acid secretion in stomach
H2RA - interfere with formation of HCl t/f less acid produced
What is the surgery to fix Hiatal Hernias?
- Fundoplication: fundus of stomach is wrapped around the GEJ to increase pressure to prevent reflux and make area larger so the weakened hiatus is not push onto
What is Inguinal Hernia? Which sex is affected more?
Bowel protrudes into the inguinal canal.
Male
Function of Inguinal Canal? What does it contain?
Function = communication between the scrotum and abdominal cavity
Contents = contains blood vessels, nerves, and vas deferens
Function of Inguinal Canal in men and in women
Men = allows struc. of spermatic cord to pass and form the testis to the abdomen
Women = allows round ligament to pass from uterus to labia majora
In inguinal Hernia, what is the opening and what protrudes in aperture?
Opening = inguinal canal
Parts of the intestines
What is a direct inguinal hernia and indirect inguinal hernia
Direct Hernia = an organ or part of an organ protrudes thru the abdominal wall and near the inguinal canal
Indirect Hernia = organ or part of an organ protrudes thru abdominal wall and into the inguinal canal
What is the herniated part in Inguinal Hernia? (3 struc.)
The PERITONEUM (the covering of abdominal cavity) forms a herniated sac with the INTESTINE and OMENTUM
What is the omentum? Fxn?
fatty tissues that hangs down from stomach and liver and wrapped around the intestines.
Fxn: immune regulations and tissue regeneration `
Symptom of Inguinal Hernia. WHY
INTENSE PAIN = caused by anatomic change
Large structure is moving into the inguinal canal which already contains blood vessels, nerves, and vas deferens
Treatment of Inguinal Canal (1)
Surgical repair to control pain
