GI: Hernia Flashcards
Describe areas of potential weakness in the abdominal wall
- Inguinal canal
- Femoral canal
- Umbilicus
- Previous incisions
What is the inguinal canal and where does it pass in males and females?
Oblique passage through lower part of the abdominal wall
Males
-Structures pass through abdomen to testis
Females
-Round ligament goes through Uterus - Labium majus
Distinguish direct and indirect inguinal hernias
Indirect
- Lateral to the inferior epigastric vessels
- Goes through deep ring, inguinal canal and superficial ring
Direct Inguinal Hernia
- Bulges through Hesselbach’s triangle
- Medial to inferior epigastric vessels
- Goes through the inguinal canal and superficial ring
Where can the deep and superficial ring be found?
- Deep ring in the posterior wall of inguinal canal
- Superficial ring in the anterior wall of inguinal canal
Describe the structure of a hernia
Sac - Pouch of peritoneum
Contents of the Sac - Commonly loops of bowel, omentum but other structures as well
Covering of the Sac - Layers of abdominal wall through which the hernia has passed.
What can occur if the processus vaginalis doesn’t close after the gubernaculum causes the testis to descend?
- Inguinal hernia (indirect)
- Scrotal hernia
What are the borders of the inguinal canal?
Floor
- Inguinal ligament
- Lacunar ligament medially
Roof
- Internal oblique
- Transverse abdominus
Posterior wall
- Transversalis fascia
- Conjoint tendon medially
Anterior wall
-Aponeurosis of external oblique
Why are femoral hernias more common in females?
- Pelvic anatomy different. Femoral ring entrance is bigger in females
- Can get easily stuck
- If Stuck, can lead to strangulation of the hernia due to loss of blood supply. Ischaemia can result.
What are the borders of the femoral canal?
Medial border – Lacunar ligament.
Lateral border – Femoral vein.
Anterior border – Inguinal ligament.
Posterior border – Pectineal ligament, superior ramus of the pubic bone, and the pectineus muscle
What is an omphalocele?
- Congenital umbilical hernia
- Content herniate into umbilical cord
- Has peritoneal covering
What an acquired infantile hernia?
- Type of umbilical hernia
- Contents herniate through weakness in scar of umbilicus
What is an acquired adult hernia?
- Type of umbilical hernia
- Herniation through linea alba in region of umbilicus
- More in females than males
What is an epigastric hernia?
- Occurs through linea alba
- Occurs between Xiphoid process to umbilicus
- Usually start with small hernia
- Chronic straining forces more fat out which can eventually pull peritoneum through
What are symptoms of hernias?
Varied. Based around what happens if loops of bowel get trapped
- Pain
- Vomiting
- Sepsis
What cell cover the surface of the stomach and extend into gastric pits/glands?
- Parietal cells
- Mucous cells
- Chief cells
- G cells
How does the stomach continue digestion?
Acidic conditions
- Helps unravel protein
- Activates proteases (pepsinogen to pepsin)
- Disinfects stomach contents
What does the stomach secrete?
- HCl
- Intrinsic factor
- Mucus/HCO3-
- Pepsinogen
What are the regions of the stomach proximal to distal?
- Cardia (below LOS)
- Fundus (Upper region)
- Body
- Pylorus
How is HCl production in the stomach controlled?
Parietal cells stimulated by
- Gastrin
- Histmaine
- ACh
How is gastrin production controlled?
G cells in antrum stimulated by
- Peptides/amino acid in stomach lumen
- Vagal stimulation by acetyl choline and GRP
What are examples of things that breach stomach defences?
- Alcohol dissolves the mucus layer
- Helicobacter pylori which can cause chronic active gastritis
- NSAIDS inhibit prostaglandin
What is gastrooesophageal reflux disease?
-Reflux of stomach contents into the oesophagus
What are the symptoms of gastro-oesophageal reflux?
- Heart burn
- Cough
- Sore throat
- Dysphagia
What are causes of gastro-oesophageal reflux?
- Lower oesophageal problems
- Delayed gastric emptying
- Hiatus hernia
- Obesity
What are complications that arise from gastro-oesophageal reflux disease?
- Barrett’s oesophagus which is metaplasia of squamous epithelium to columnar. Increased risk of developing adenocarcinoma
- Oesophagitis
- Strictures
What is the treatment for gastro-oesophageal reflux disease?
-Lifestyle modifications
Pharmacological
- Antacids
- H2 antagonists (block histamine)
- Proton Pump Inhibitors
Surgery(rare)
