GI Section 1: Luminal (Hernias) Flashcards
Spigelian Hernia - lateral border of teh rectus
Also referred to as a
“lateral ventral hernia”
for the purpose of fucking with you.
SPigelian hernia location
Along the Semilunar line (“s” for “s”)
lateral border of the rectus muscles
but most commonly they are at or slightly above the arcuate line (horizontal dotted line with the black arrows).
Above and Below the arcuate line difference
Two types of lumbar hernia
Superior
and
Inferior
Grynfeltt-Lesshaft
Superior Lumbar
Petit
Inferior Lumbar
Superior Lumbar Hernia
Inferior lumbar
Hernia with a Meckel Diverticulum in it.
Littre Hernia
Hernia with the Appendix in it.
Amyand Hernia
Contains only one wall of bowel and therefore does not obstruct.
Richter Hernia
Richter Hernia have higher risk of this condition
These are actually at higher risk for strangulation.
Old lady + Ascites, COPD - chronic cough, pregnancy)
Obturator Hernia:
Bowel herniating between the obturator and the pectineus muscles
Obturator Hernia
Obturator hernia can cause paresthesia along the innder thigh, due to?
Compression of the obtrurator nerve
“Howship-Romberg Sign ”
Obturator Hernia
Compression of the obturator nerve
most common manifestation of internal Hernia
Closed loop obstruction (often with stranguation)
This is a herniation of viscera through the peritoneum or mesentery.
Internal hernia
Where does internal hernia take place?
through a known anatomic foramina or recess - created post op
The most common type of internal hernias
Paraduodenal hernias
Paraduodenal hernias occur through these congenital defects
Lanzer and Waldeyer
Lanzer - more common
post prandial abdominal pain + gets better after belly rub
Paraduodenal hernias
a sac-like cluster of dilated small bowel loops (arrow) in the left anterior pararenal space, behind the IMV and the ascending left colic artery.
Lanzert paraduodenal hernia
“L”eft sided (75%)
through fossa of Lanzert in the descending colon mesentery / LUQ
sac of abnormal dilated small bowel loops (black arrow) on the right, below the part of the duodenum, and behind the SMA (white arrow) which gets displaced anteriorly.
Right sided (25%)
Fossa of Waldeyer in the ASCENDING colon/RLQ
Paraduodenal hernia associated with malrotation + normally rotated large bowel
Waldeyer (Right)
There are a bunch of other locations internal hernias can occur, but in gfeneral they have the same pattern -
sac- like cluster of dilated bowel loops with twisted mesenteric vessels in an abnormal location in a patient with symptoms of bowel obstruction.
seen in:
lesser sac /foramen of winslow, pericecal, sigmoid mesocolon, small bowel mesentery, post-gastric bypass surgery
