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Section II General Surgery P203Surgical Recall Sixth > Hernias, C36 P209-223 > Flashcards

Hernias, C36 P209-223 Flashcards

1
Q

What is a hernia?

P209

A

(L. rupture) Protrusion of a peritoneal
sac through a musculoaponeurotic barrier
(e.g., abdominal wall); a fascial defect

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2
Q

What is the incidence?

P209

A

5%–10% lifetime; 50% are indirect
inguinal, 25% are direct inguinal, and
≈5% are femoral

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3
Q

What are the precipitating factors?

P209

A 
Increased intra-abdominal pressure:
straining at defecation or urination
(rectal cancer, colon cancer, prostatic
enlargement, constipation), obesity,
pregnancy, ascites, valsavagenic (coughing)
COPD; an abnormal congenital anatomic
route (i.e., patent processus vaginalis)
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4
Q

Why should hernias be repaired?

P209

A

To avoid complications of incarceration/

strangulation, bowel necrosis, SBO, pain

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5
Q

What is more dangerous:
a small or large hernia defect?
P209

A

Small defect is more dangerous because a
tight defect is more likely to strangulate if
incarcerated

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6
Q

Define the following descriptive terms:
Reducible
P209

A

Ability to return the displaced organ or
tissue/hernia contents to their usual
anatomic site

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7
Q

Define the following descriptive terms:
Incarcerated
P209

A

Swollen or fixed within the hernia sac (incarcerated = imprisoned); may cause intestinal obstruction (i.e., an irreducible hernia)

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8
Q

Define the following descriptive terms:
Strangulated
P210 (picture)

A 
Incarcerated hernia with resulting
ischemia; will result in signs and
symptoms of ischemia and intestinal
obstruction or bowel necrosis (Think:
strangulated = choked)
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9
Q

Define the following descriptive terms:
Complete
P210

A

Hernia sac and its contents protrude all

the way through the defect

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10
Q

Define the following descriptive terms:
Incomplete
P210

A

Defect present without sac or contents

protruding completely through it

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11
Q

What is reducing a hernia
“en masse”?
P210 (picture)

A

Reducing the hernia contents and

hernia sac

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12
Q

Define the following types of hernias:
Sliding hernia
P211 (picture)

A 
Hernia sac partially formed by the wall of
a viscus (i.e., bladder/cecum)
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13
Q

Define the following types of hernias:
Littre’s hernia
P211

A

Hernia involving a Meckel’s diverticulum

Think alphabetically: Littre’s Meckel’s = LM

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14
Q

Define the following types of hernias:
Spigelian hernia
P211

A

Hernia through the linea semilunaris
(or spigelian fascia); also known as
spontaneous lateral ventral hernia
(Think: Spigelian = Semilunaris)

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15
Q

Define the following types of hernias:
Internal hernia
P211

A

Hernia into or involving intra-abdominal

structure

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16
Q

Define the following types of hernias:
Petersen’s hernia
P211

A

Seen after bariatric gastric bypass—
internal herniation of small bowel
through the mesenteric defect from the
Roux limb

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17
Q

Define the following types of hernias:
Obturator hernia
P211

A

Hernia through obturator canal

females > males

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18
Q

Define the following types of hernias:
Lumbar hernia
P211

A

Petit’s hernia or Grynfeltt’s hernia

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19
Q

Define the following types of hernias:
Petit’s hernia
P211

A

(Rare) hernia through Petit’s triangle
(a.k.a. inferior lumbar triangle)
(Think: petite = small = inferior)

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20
Q

Define the following types of hernias:
Grynfeltt’s hernia
P211

A

Hernia through Grynfeltt-Lesshaft

triangle (superior lumbar triangle)

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21
Q

Define the following types of hernias:
Pantaloon hernia
P212 (picture)

A 
Hernia sac exists as both a direct and
indirect hernia straddling the inferior
epigastric vessels and protruding through
the floor of the canal as well as the
internal ring (two sacs separated by the
inferior epigastric vessels [the pant
crotch] like a pair of pantaloon pants)
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22
Q

Define the following types of hernias:
Incisional hernia
P212

A

Hernia through an incisional site; most

common cause is a wound infection

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23
Q

Define the following types of hernias:
Ventral hernia
P212

A

Incisional hernia in the ventral abdominal

wall

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24
Q

Define the following types of hernias:
Parastomal hernia
P212

A

Hernia adjacent to an ostomy (e.g.,

colostomy)

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25
Q

Define the following types of hernias:
Sciatic hernia
P212

A

Hernia through the sciatic foramen

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26
Q

Define the following types of hernias:
Richter’s hernia
P212 (picture)

A

Incarcerated or strangulated hernia
involving only one sidewall of the bowel,
which can spontaneously reduce, resulting
in gangrenous bowel and perforation within
the abdomen without signs of obstruction

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27
Q

Define the following types of hernias:
Epigastric hernia
P213

A

Hernia through the linea alba above the

umbilicus

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28
Q

Define the following types of hernias:
Umbilical hernia
P213

A

Hernia through the umbilical ring, in
adults associated with ascites, pregnancy,
and obesity

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29
Q

Define the following types of hernias:
Intraparietal hernia
P213

A

Hernia in which abdominal contents
migrate between the layers of the
abdominal wall

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30
Q

Define the following types of hernias:
Femoral hernia
P213

A

Hernia medial to femoral vessels (under

inguinal ligament)

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31
Q

Define the following types of hernias:
Hesselbach’s hernia
P213

A

Hernia under inguinal ligament lateral

to femoral vessels

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32
Q

Define the following types of hernias:
Bochdalek’s hernia
P213

A

Hernia through the posterior diaphragm,
usually on the left (Think: Boch da
lek = “back to the left” on the
diaphragm)

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33
Q

Define the following types of hernias:
Morgagni’s hernia
P213

A

Anterior parasternal diaphragmatic

hernia

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34
Q

Define the following types of hernias:
Properitoneal hernia
P213

A

Intraparietal hernia between the

peritoneum and transversalis fascia

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35
Q

Define the following types of hernias:
Cooper’s hernia
P213

A

Hernia through the femoral canal
and tracking into the scrotum or labia
majus

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36
Q

Define the following types of hernias:
Indirect inguinal
P213

A

Inguinal hernia lateral to Hesselbach’s

triangle

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37
Q

Define the following types of hernias:
Direct inguinal
P213

A

Inguinal hernia within Hesselbach’s

triangle

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38
Q

Define the following types of hernias:
Hiatal hernia
P213

A

Hernia through esophageal hiatus

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39
Q

Define the following types of hernias:
Amyand’s hernia
P213

A

Hernia sac containing a ruptured appendix

Think: Amyand’s = Appendix

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40
Q

What are the boundaries of
Hesselbach’s triangle?
P214

A
  1. Inferior epigastric vessels
  2. Inguinal ligament (Poupart’s)
  3. Lateral border of the rectus sheath
    Floor consists of internal oblique and the
    transversus abdominis muscle
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41
Q

What are the layers of the
abdominal wall?
P214

A 
Skin
Subcutaneous fat
Scarpa’s fascia
External oblique
Internal oblique
Transversus abdominus
Transversalis fascia
Preperitoneal fat
Peritoneum
Note: All three muscle layer aponeuroses
    form the anterior rectus sheath, with
    the posterior rectus sheath being
    deficient below the arcuate line
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42
Q

What is the differential
diagnosis for a mass in a
healed C-section incision?
P214

A

Hernia, ENDOMETRIOMA

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43
Q

GROIN HERNIAS
What is the differential
diagnosis of a groin mass?
P214

A

Lymphadenopathy, hematoma, seroma,
abscess, hydrocele, femoral artery
aneurysm, EIC, undescended testicle,
sarcoma, hernias, testicle torsion

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44
Q

GROIN HERNIAS
DIRECT INGUINAL HERNIA
What is it?
P214

A

Hernia within the floor of Hesselbach’s
triangle, i.e., the hernia sac does not
traverse the internal ring (think directly
through the abdominal wall)

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45
Q

GROIN HERNIAS
DIRECT INGUINAL HERNIA
What is the cause?
P214

A

Acquired defect from mechanical

breakdown over the years

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46
Q

GROIN HERNIAS
DIRECT INGUINAL HERNIA
What is the incidence?
P214

A

≈1% of all men; frequency increases

with advanced age

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47
Q 
GROIN HERNIAS
DIRECT INGUINAL HERNIA
What nerve runs with the
spermatic cord in the
inguinal canal?
P214
A

Ilioinguinal nerve

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48
Q

GROIN HERNIAS
INDIRECT INGUINAL HERNIA
What is it?
P215 (picture)

A

Hernia through the internal ring of the
inguinal canal, traveling down toward the
external ring; it may enter the scrotum
upon exiting the external ring (i.e., if
complete); think of the hernia sac traveling
indirectly through the abdominal wall
from the internal ring to the external ring

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49
Q

GROIN HERNIAS
INDIRECT INGUINAL HERNIA
What is the cause?
P215

A

Patent processus vaginalis (i.e., congenital)

50
Q

GROIN HERNIAS
INDIRECT INGUINAL HERNIA
What is the incidence?
P215

A

≈5% of all men; most common hernia in

both men and women

51
Q 
GROIN HERNIAS
INDIRECT INGUINAL HERNIA
How is an inguinal hernia
diagnosed?
P215
A

Relies mainly on history and physical
exam with index finger invaginated into
the external ring and palpation of hernia;
examine the patient standing up if
diagnosis is not obvious
(Note: if swelling occurs below the inguinal
ligament, it is possibly a femoral hernia)

52
Q 
GROIN HERNIAS
INDIRECT INGUINAL HERNIA
What is the differential
diagnosis of an inguinal hernia?
P215
A

Lymphadenopathy, psoas abscess, ectopic
testis, hydrocele of the cord, saphenous
varix, lipoma, varicocele, testicular torsion,
femoral artery aneurysm, abscess

53
Q

GROIN HERNIAS
INDIRECT INGUINAL HERNIA
What is the risk of strangulation?
P215

A

Higher with indirect than direct inguinal

hernia, but highest in femoral hernias

54
Q

GROIN HERNIAS
INDIRECT INGUINAL HERNIA
What is the treatment?
P216

A

Emergent herniorrhaphy is indicated
if strangulation is suspected or acute
incarceration is present; otherwise, elective
herniorrhaphy is indicated to prevent the
chance of incarceration/strangulation

55
Q

GROIN HERNIAS
INGUINAL HERNIA REPAIRS
Define the following procedures:

Bassini
P216

A 
Sutures approximate reflection of
inguinal ligament (Poupart’s) to the
transversus abdominis aponeurosis/
conjoint tendon
56
Q

GROIN HERNIAS
INGUINAL HERNIA REPAIRS
Define the following procedures:

McVay
P216

A

Cooper’s ligament sutured to transversus

abdominis aponeurosis/conjoint tendon

57
Q

GROIN HERNIAS
INGUINAL HERNIA REPAIRS
Define the following procedures:

Lichtenstein
P216

A

“Tension-free repair” using mesh

58
Q

GROIN HERNIAS
INGUINAL HERNIA REPAIRS
Define the following procedures:

Shouldice
P216

A

Imbrication of the floor of the inguinal

canal (a.k.a. “Canadian repair”)

59
Q

GROIN HERNIAS
INGUINAL HERNIA REPAIRS
Define the following procedures:

Plug and patch
P216

A

Placing a plug of mesh in hernia defect
and then overlaying a patch of mesh over
inguinal floor (requires few if any sutures
in mesh!)

60
Q

GROIN HERNIAS
INGUINAL HERNIA REPAIRS
Define the following procedures:

High ligation
P216

A

Ligation and transection of indirect
hernia sac without repair of inguinal floor
(used only in children)

61
Q

GROIN HERNIAS
INGUINAL HERNIA REPAIRS
Define the following procedures:

TAPP procedure
P216

A

TransAbdominal PrePeritoneal inguinal

hernia repair

62
Q

GROIN HERNIAS
INGUINAL HERNIA REPAIRS
Define the following procedures:

TEPA procedure
P216

A

Totally ExtraPeritoneal Approach

63
Q 
GROIN HERNIAS
INGUINAL HERNIA REPAIRS
What are the indications for
laparoscopic inguinal hernia repair?
P216
A
  1. Bilateral inguinal hernias
  2. Recurring hernia
  3. Need to resume full activity as soon as
    possible
64
Q 
GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
What is the first identifiable
subcutaneous named layer?
P216
A

Scarpa’s fascia (thin in adults)

65
Q 
GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
What is the name of the subcutaneous
vein that is ligated?
P217
A

Superficial epigastric vein

66
Q 
GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
What happens if you cut the
ilioinguinal nerve?
P217
A

Numbness of inner thigh or lateral

scrotum; usually goes away in 6 months

67
Q 
GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
From what abdominal
muscle layer is the cremaster
muscle derived?
P217
A

Internal oblique muscle

68
Q 
GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
From what abdominal
muscle layer is the inguinal
ligament (a.k.a. Poupart’s
ligament) derived?
P217
A

External oblique muscle aponeurosis

69
Q 
GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
To what does the inguinal
(Poupart’s) ligament attach?
P217
A

Anterior superior iliac spine to the pubic

tubercle

70
Q 
GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
Which nerve travels on the
spermatic cord?
P217
A

Ilioinguinal nerve

71
Q 
GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
Why do some surgeons
deliberately cut the
ilioinguinal nerve?
P217
A

First they obtain preoperative consent
and cut so as to remove the risk of
entrapment and postoperative pain

72
Q

GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
What is in the spermatic cord (6)?
P217

A
  1. Cremasteric muscle fibers
  2. Vas deferens
  3. Testicular artery
  4. Testicular pampiniform venous plexus
  5. ± hernia sac
  6. Genital branch of the genitofemoral
    nerve
73
Q

GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
What is the hernia sac made of?
P217

A

Peritoneum (direct) or a patent processus

vaginalis (indirect)

74
Q 
GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
What attaches the testicle to
the scrotum?
P217
A

Gubernaculum

75
Q 
GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
What is the most common
organ in an inguinal hernia
sac in men?
P217
A

Small intestine

76
Q 
GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
What is the most common
organ in an inguinal hernia
sac in women?
P217
A

Ovary/fallopian tube

77
Q 
GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
What lies in the inguinal
canal in the female instead
of the VAS?
P218
A

Round ligament

78
Q 
GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
Where in the inguinal canal
does the hernia sac lie in relation
to the other structures?
P218
A

Anteromedially

79
Q

GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
What is a “cord lipoma”?
P218

A

Preperitoneal fat on the cord structures
(pushed in by the hernia sac); not a real
lipoma; remove surgically, if feasible

80
Q 
GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
What is a small outpouching
of testicular tissue off of the
testicle?
P218
A 
Testicular appendage (a.k.a. the appendix
testes); remove with electrocautery
81
Q 
GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
What action should be
taken if a suture is placed
through the femoral artery
or vein during an inguinal
herniorrhaphy?
P218
A

Remove the suture as soon as possible
and apply pressure (i.e., do not tie the
suture down!)

82
Q 
GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
What nerve is found on top
of the spermatic cord?
P218
A

Ilioinguinal nerve

83
Q 
GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
What nerve travels within
the spermatic cord?
P218
A

Genital branch of the genitofemoral

nerve

84
Q 
GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
What are the borders of
Hesselbach’s triangle?
P218 (picture)
A
  1. Epigastric vessels
  2. Inguinal ligament
  3. Lateral border of the rectus
85
Q 
GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
What type of hernia goes
through Hesselbach’s
triangle?
P219
A

Direct hernia due to a weak abdominal

floor

86
Q

GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
What is a “relaxing incision”?
P219

A

Incision(s) in the rectus sheath to relax
the conjoint tendon so that it can be
approximated to the reflection of the
inguinal ligament without tension

87
Q

GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
What is the conjoint tendon?
P219

A

Aponeurotic attachments of the
“conjoining” of the internal oblique and
transversus abdominis to the pubic tubercle

88
Q

GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
Define inguinal anatomy
P219 (picture)

A
  1. Inguinal ligament (Poupart’s ligament)
  2. Transversus aponeurosis
  3. Conjoint tendon
89
Q 
GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
How tight should the new
internal inguinal ring be?
P219
A

Should allow entrance of the tip of a
Kelly clamp but not a finger (the new
external inguinal ring should not be tight
and should allow entrance of a finger)

90
Q 
GROIN HERNIAS
CLASSIC INTRAOPERATIVE INGUINAL HERNIA QUESTIONS
What percentage of the
strength of an inguinal floor
repair does the external
oblique aponeurosis
represent?
P219
91
Q

GROIN HERNIAS
FEMORAL HERNIA
What is it?
P219

A

Hernia traveling beneath the inguinal
ligament down the femoral canal medial
to the femoral vessels (Think: FM radio,
or Femoral hernia = Medial)

92
Q 
GROIN HERNIAS
FEMORAL HERNIA
What are the boundaries of
the femoral canal?
P220
A
  1. Cooper’s ligament posteriorly
  2. Inguinal ligament anteriorly
  3. Femoral vein laterally
  4. Lacunar ligament medially
93
Q 
GROIN HERNIAS
FEMORAL HERNIA
What factors are associated
with femoral hernias?
P220
A

Women, pregnancy, and exertion

94
Q 
GROIN HERNIAS
FEMORAL HERNIA
What percentage of all
hernias are femoral?
P220
95
Q 
GROIN HERNIAS
FEMORAL HERNIA
What percentage of patients
with a femoral hernia are
female?
P220
96
Q

GROIN HERNIAS
FEMORAL HERNIA
What are the complications?
P220

A

Approximately one third incarcerate

due to narrow, unforgiving neck

97
Q 
GROIN HERNIAS
FEMORAL HERNIA
What is the most common
hernia in women?
P220
A

Indirect inguinal hernia

98
Q 
GROIN HERNIAS
FEMORAL HERNIA
What is the repair of a
femoral hernia?
P220
A

McVay (Cooper’s ligament repair), mesh

plug repair

99
Q 
HERNIA REVIEW QUESTIONS
Should elective TURP or
elective herniorrhaphy be
performed first?
P220
100
Q 
HERNIA REVIEW QUESTIONS
Which type of esophageal
hiatal hernia is associated
with GE reflux?
P220
A

Sliding esophageal hiatal hernia

101
Q 
HERNIA REVIEW QUESTIONS
Classically, how can an
incarcerated hernia be
reduced in the ER?
P220
A
  1. Apply ice to incarcerated hernia
  2. Sedate
  3. Use the Trendelenburg position for
    inguinal hernias
  4. Apply steady gentle manual pressure
  5. Admit and observe for signs of
    necrotic bowel after reduction
  6. Perform surgical herniorrhaphy
    ASAP
102
Q 
HERNIA REVIEW QUESTIONS
What is appropriate if
you cannot reduce an
incarcerated hernia with
steady, gentle compression?
P221
A

Go directly to O.R. for repair

103
Q 
HERNIA REVIEW QUESTIONS
What is the major difference
in repairing a pediatric
indirect inguinal hernia and
an adult inguinal hernia?
P221
A

In babies and children it is rarely
necessary to repair the inguinal floor;
repair with “high ligation” of the hernia sac

104
Q

HERNIA REVIEW QUESTIONS
What is the
Howship-Romberg sign?
P221

A

Pain along the medial aspect of the
proximal thigh from nerve compression
caused by an obturator hernia

105
Q

HERNIA REVIEW QUESTIONS
What is the “silk glove” sign?
P221

A

Inguinal hernia sac in an infant/toddler
feels like a finger of a silk glove when
rolled under the examining finger

106
Q 
HERNIA REVIEW QUESTIONS
What must you do before
leaving the O.R. after an
inguinal hernia repair?
P221
A

Pull the testicle back down to the

scrotum

107
Q

ESOPHAGEAL HIATAL HERNIAS
Define type I and type II
hiatal hernias.
P221

A

Type I = sliding

Type II = paraesophageal

108
Q

ESOPHAGEAL HIATAL HERNIAS
SLIDING ESOPHAGEAL HIATAL HERNIA
What is it?
P221 (picture)

A

Both the stomach and GE junction
herniate into the thorax via the
esophageal hiatus; also known as type I
hiatal hernia

109
Q

ESOPHAGEAL HIATAL HERNIAS
SLIDING ESOPHAGEAL HIATAL HERNIA
What is the incidence?
P222

A

> 90% of all hiatal hernias

110
Q

ESOPHAGEAL HIATAL HERNIAS
SLIDING ESOPHAGEAL HIATAL HERNIA
What are the symptoms?
P222

A 
Most patients are asymptomatic, but the
condition can cause reflux, dysphagia
(from inflammatory edema), esophagitis,
and pulmonary problems secondary to
aspiration
111
Q

ESOPHAGEAL HIATAL HERNIAS
SLIDING ESOPHAGEAL HIATAL HERNIA
How is it diagnosed?
P222

A

UGI series, manometry,
esophagogastroduodenoscopy (EGD)
with biopsy for esophagitis

112
Q

ESOPHAGEAL HIATAL HERNIAS
SLIDING ESOPHAGEAL HIATAL HERNIA
What are the complications?
P222

A

Reflux → esophagitis → Barrett’s esophagus
→ cancer and stricture formation;
aspiration pneumonia; it can also result in
UGI bleeding from esophageal ulcerations

113
Q

ESOPHAGEAL HIATAL HERNIAS
SLIDING ESOPHAGEAL HIATAL HERNIA
What is the treatment?
P222

A 
85% of cases treated medically with
antacids, H(2) blockers/PPIs, head
elevation after meals, small meals, and no
food prior to sleeping; 15% of cases
require surgery for persistent symptoms
despite adequate medical treatment
114
Q

ESOPHAGEAL HIATAL HERNIAS
SLIDING ESOPHAGEAL HIATAL HERNIA
What is the surgical treatment?
P222

A

Laparoscopic Nissen fundoplication (LAP
NISSEN) involves wrapping the fundus
around the LES and suturing it in place

115
Q

ESOPHAGEAL HIATAL HERNIAS
PARAESOPHAGEAL HIATAL HERNIA
What is it?
P222 (picture)

A 
Herniation of all or part of the stomach
through the esophageal hiatus into the
thorax without displacement of the
gastroesophageal junction; also known as
type II hiatal hernia
116
Q

ESOPHAGEAL HIATAL HERNIAS
PARAESOPHAGEAL HIATAL HERNIA
What is the incidence?
P223

A

<5% of all hiatal hernias (rare)

117
Q

ESOPHAGEAL HIATAL HERNIAS
PARAESOPHAGEAL HIATAL HERNIA
What are the symptoms?
P223

A

Derived from mechanical obstruction;
dysphagia, stasis gastric ulcer, and
strangulation; many cases are asymptomatic
and not associated with reflux because of
a relatively normal position of the GE
junction

118
Q

ESOPHAGEAL HIATAL HERNIAS
PARAESOPHAGEAL HIATAL HERNIA
What are the complications?
P223

A

Hemorrhage, incarceration, obstruction,

and strangulation

119
Q

ESOPHAGEAL HIATAL HERNIAS
PARAESOPHAGEAL HIATAL HERNIA
What is the treatment?
P223

A

Surgical, because of frequency and

severity of potential complications

120
Q

ESOPHAGEAL HIATAL HERNIAS
PARAESOPHAGEAL HIATAL HERNIA
What is a type III hiatal hernia?
P223

A

Combined type I and type II

121
Q

ESOPHAGEAL HIATAL HERNIAS
PARAESOPHAGEAL HIATAL HERNIA
What is a type IV hiatal hernia?
P223

A

Organ (e.g., colon or spleen) +/-

stomach in the chest cavity

Section II General Surgery P203Surgical Recall Sixth (33 decks)

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