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GI Exam 2 > Hernias > Flashcards

Hernias Flashcards

1
Q

______: An organ or other body part protrudes through
the muscle or tissue that normally contains it

A

Hernia

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2
Q

Abdominal Wall Hernia: _____

A

Weakness or defect of the
connective tissue of the abdominal wall.

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3
Q

Reducible Hernias

A

Contents of hernia can be returned back
into abdominal cavity spontaneously or
with manual pressure

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4
Q

Irreducible Hernias

A

– Contents cannot be returned to abdominal cavity.
– Incarcerated - Another name for irreducible hernia, sometimes indicates obstruction is present

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5
Q

Hernias - Obstructed vs. Strangulated

A
  • Obstructed: The lumen of the internal organ is blocked (eg. Bowel obstruction).
    This often leads to strangulation.
  • Strangulated: When the blood supply of the
    contents/organs are pinched off causing ischemia
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6
Q

Higher incidence of _____ with femoral hernias

A

Strangulation

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7
Q

Strangulated Hernia

A
  • Vascular compromise: Incarcerated hernia and toxic
  • Gangrene can occur
  • If the bowel ruptures, can lead to peritonitis and possible sepsis
    This is an acute surgical emergency
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8
Q

Potential hazard with reducing a strangulated hernia

A

If there is any concern for strangulation, do not attempt hernia reduction. The reintroduction of ischemic, necrotic bowel back into the peritoneal cavity can result in subsequent perforation and sepsis

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9
Q

Groin Hernias

A
  • Inguinal (Direct and Indirect)
  • Femoral
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10
Q

Ventral Hernias

A
  • Umbilical
  • Epigastric
  • Spigelian
  • Incisional
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11
Q

Pelvic Hernias

A
  • Perineal hernia
  • Sciatic hernia- sciatic foramen
  • Obturator hernia - obturator canal
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12
Q

Direct Inguinal Hernia

A
  • Weakness or defect in the transversalis
    fascia (Floor of Hesselbach’s)
  • Typically an acquired inguinal hernia
  • Circular, felt along external ring
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13
Q

Hesselbach’s Triangle

A
  • Inguinal Ligament
  • Inferior epigastric vessels
  • Lateral border rectus muscles
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14
Q

Indirect Inguinal Hernia

A
  • Due to a persistent processus vaginalis,
    meaning it remains patent or open
  • Hernial sac passes through internal
    inguinal ring
  • Nearly all inguinal congenital hernias
    are indirect
  • Can extend into the scrotum
  • May be more elongated or elliptical
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15
Q

Femoral Hernias

A
  • Passes beneath inguinal ring on to
    upper thigh
  • Less common hernia
  • More prone to strangulation
  • Typically acquired hernia
  • Female > male
  • Associated with pregnancy
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16
Q

Epigastric Hernia

A
  • Area of weakness in the linea alba
    above the umbilicus
  • Midline hernia
  • Worse with valsalva movement
  • US or CT can be used to identify
17
Q

Rectus abdominis diastasis (RAD)

A

Also known as Diastasis Recti. Can be confused with an epigastric hernia.
* Weakness in rectus muscles and
widening of linea alba
* Linear bulge
* No fascial defect
* Not a hernia
* Can be repaired, but not normally
needed

18
Q

T/F Rectus abdominis diastasis (RAD) is a type of hernia

A

F

19
Q

Umbilical Hernia

A

In children typically no repair needed unless:
– Incarcerated or persistent
– Failure of spontaneous closure by age 2-4
In adults
– Neck is usually narrow
– High risk of eventual incarceration/strangulation

20
Q

Risk factors for an Incisional Hernia

A

– Poor wound healing- Post-op Infection
– Smoking
– Obesity
– Immunosuppressive
– Wound tension, Poor technique
– Respiratory- vigorous cough
– Nutrition
– Connective tissue disorder

21
Q

Risk factors for Hernias

A

– Obesity
– Abdominal strain
– Chronic cough
– Constipation- straining at stool
– Cirrhosis with ascites
– Pregnancy
– Advancing age- weakness of transversalis fascia
* Prior abdominal surgery
* Chronic increase in intra-abdominal pressure

22
Q

Imaging for Hernias

A
  • CT Scan - Usually most helpful to confirm diagnosis
    – Complex ventral or incisional hernias
  • US - Less expensive than CT, no radiation
    – Occult inguinal hernias/femoral hernias
  • MRI - Differentiating inguinal from femoral hernias
23
Q

What is another complication of hernias?

A

Pressure ulcers

24
Q

Management for hernias - Lifestyle

A

Address the risk factors:
* Smoking, COPD, Asthma (Stop the cough!)
* Weight management (Decrease the pressure)
* Proper lifting technique, use a lifting belt,
avoid heavy lifting (change in profession?)
* Avoid and treat constipation
Lifestyle is not a definitive treatment

25
Q

Can attempt to reduce an incarcerated hernia if ____

A

no signs of strangulation are present

26
Q

Definitive treatment of hernias is _____

A

operative repair

27
Q

Management of Hernias - Surgery

A
  • Open or Laparoscopic
  • Recurrence can occur
  • Repaired with mesh
28
Q

Post-operative instructions for hernia repair

A
  • Avoid heavy lifting and sports for 4-6 wks
  • Sedentary worker could return in a few days
  • Possibility of chronic groin pain
29
Q

Flank (Lumbar) Hernias

A

Abdominal contents protrude into a nonanatomic location through fascial defects in the posterior abdominal wall musculature

30
Q

Internal hernias

A

bowel passes through acquired or
congenital defects in the mesentery

GI Exam 2 (6 decks)

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