GI Disorders - Herniation

Question 1

What is a hernia?

Answer 1

Organ protrusion thru muscle or fascia caused by increased intra-abdominal pressure

Question 2

Where are hernias located normally?

Answer 2

In abdominal cavity

Question 3

Patho for Hernia

Answer 3

• weak area that retain or support structures

- increase intra-abdominal pressure

Question 4

What is a fascia?

Answer 4

Connective tissues that surrounds and hold internal structures in place.

Question 5

Are majority of Hernias acquired or congenital? Give examples of both.

Answer 5

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.

Question 6

Why does obesity and pregnancy more prone to herniation?

Answer 6

Both increase intra-abdominal pressure and contains weakened retaining structure

Question 7

What are the two major type of Hernias?

Answer 7

1. Hiatal

2. Inguinal

Question 8

What is Hiatal Hernia?

Answer 8

a part of the stomach protrudes into the thoracic cavity thru the weakened/enlarged hiatus d/t increase intra-abdominal pressure

Question 9

What is a Hiatus?

Answer 9

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

Question 10

Is Hiatal Hernia located in the superior or inferior of the body cavity?

Answer 10

superior

Question 11

In Hiatal Hernia, a part of the ___ protrudes into the ___ ___

Answer 11

Stomach, thoracic cavity

Question 12

What are the two types of Hiatal Hernia?

Answer 12

1. sliding or axial hernia

2. paraesophageal/rolling or nonaxial hernia

Question 13

___% are Sliding Hernia and remaining ___% are Rolling Hernia

Answer 13

95%, 5%

Question 14

What is happening in Sliding Hernia? Is the stomach above or below diaphragm?

Answer 14

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

Question 15

3 Symptoms of Sliding Hernias. WHY?

Answer 15

1. chest pain r/t abdominal structures pushing into TC
2. heartburn d/t gastric reflux on esophageal lining
3. reflux d/t gastroesophageal reflux (content from stomach pushing up into esophagus)

Question 16

What is happening in Rolling Hernia? Is stomach/GEJ above or below the diaphragm***? What part of the stomach protrudes??

Answer 16

The non-upper part of the stomach (fundus) protrudes into the thoracic cavity.

The GEJ is below the diaphragm.

Question 17

3 symptoms of Rolling Hernia. WHY?

Answer 17

• 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

Question 18

Why is there no reflux in Rolling Hernia?

Answer 18

There is no reflux because there is no constriction or added pressure to push content in the stomach up to the esophagus

Question 19

Treatment of Hernias (3)

Answer 19

• lifestyle modifications: behavioural and dietary
• drugs (Antacids, PPIs, H2RA)
• sx if required

Question 20

What are some lifestyle modifications both dietary and behavioural? (5)

Answer 20

1. small frequent meals
2. avoid foods that increase acid secretion
3. sit down and bend at knees (not hips)
4. raised HOB
5. avoid smoking, caffeine, and food intake couple hours before bedtime

Question 21

What are the actions of Antacids, PPIs, and H2RA?

Answer 21

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

Question 22

What is the surgery to fix Hiatal Hernias?

Answer 22

1. 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

Question 23

What is Inguinal Hernia? Which sex is affected more?

Answer 23

Bowel protrudes into the inguinal canal.

Male

Question 24

Function of Inguinal Canal? What does it contain?

Answer 24

Function = communication between the scrotum and abdominal cavity

Contents = contains blood vessels, nerves, and vas deferens

Question 25

Function of Inguinal Canal in men and in women

Answer 25

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

Question 26

In inguinal Hernia, what is the opening and what protrudes in aperture?

Answer 26

Opening = inguinal canal

Parts of the intestines

Question 27

What is a direct inguinal hernia and indirect inguinal hernia

Answer 27

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

Question 28

What is the herniated part in Inguinal Hernia? (3 struc.)

Answer 28

The PERITONEUM (the covering of abdominal cavity) forms a herniated sac with the INTESTINE and OMENTUM

Question 29

What is the omentum? Fxn?

Answer 29

fatty tissues that hangs down from stomach and liver and wrapped around the intestines.

Fxn: immune regulations and tissue regeneration `

Question 30

Symptom of Inguinal Hernia. WHY

Answer 30

INTENSE PAIN = caused by anatomic change

Large structure is moving into the inguinal canal which already contains blood vessels, nerves, and vas deferens

Question 31

Treatment of Inguinal Canal (1)

Answer 31

Surgical repair to control pain