Herniation

Question 1

What is a Hernia?

Answer 1

A hernia is an organ protruding thru a retaining structure. This usually occurs in the abdominal wall.

Question 2

What are the two most common types of hernias?

Answer 2

Hiatal hernias, and Inguinal hernias.

Question 3

What is the pathophysiology behind hernias?

Answer 3

A weakend supporting structure (muscle wall of the abdomen,) which can be aquired or congenital, gives way when the patient experiences increased intra-abdominal pressure resulting in an organ herniating through the supporting structure.

Question 4

What is a Hiatal hernia?

Answer 4

A hiatal hernia is typically when the stomach protrudes through the esophageal opening in the diaphragm.

Question 5

Name the different types of Hiatal hernias? What percentage of cases are made up of each type?

Answer 5

Sliding haital hernia (95%), Paraesophageal or Rolling hernia (5%).

Question 6

What is the Gastroesophageal Junction (GEJ)?

Answer 6

The point when the distal esophagus joins the proximal stomach.

Question 7

What is a sliding hernia?

Answer 7

A sliding hernia is when the junction of the esophagus and stomach, known as the gastro-esphageal junction and part of the stomach protrudes through the apeture in the diaphragm.

Question 8

What is a para-esophageal hernia?

Answer 8

It is an uncommon type of hiatal hernia where the non-upper part of the stomach enters the thoratic cavity. The gastro-esophageal junction stays below the diaphragm (unlike sliding hernias).

Question 9

What are typical manifestation of a paraesophageal or rolling hernia?

Answer 9

Chest pain, dyspnea, fullness after meals.

Question 10

Why does a patient with a rolling hernia experience fullness after meals?

Answer 10

The hernia has actually caused the usable portion of the stomach to become reduced because it is impinched and herniated out of the abdominal cavity. Sufferers will feel full before they should.

Question 11

What is the treament for hernias?

Answer 11

Life-style modifications, Drugs, Surgery

Question 12

What is the first-line treatment for hernias? What are some examples?

Answer 12

First line treatments would be lifestyle modifications. Treatment revolves around symptoms. Example would be, no crouching/bending over, elevate the head of the bed, no meals before bed, diet modifications (no caffeine, chocolate).

Question 13

What drugs would be prescribed for stomach hernias?

Answer 13

Antacids (for reflux), H2 Receptor Antagonists, Proton Pump Inhibitors.

Question 14

What is an H2 Receptor Antagonist?

Answer 14

An H2 Receprot Antagonist (H2RA, or H2-blockers), are a class of medication that blocks the action of histamine at the histamine H2 receptors of the parietal cells in the stomach. This decreases the production of stomach acid.

Question 15

What is a Proton Pump Inhibitor?

Answer 15

A Proton Pump Inhibitor (PPI) is a group of drugs which main action is the pronounced and long-lasting reduction of gastric acid production. They are inhibitors of acid secretion.

Question 16

What is the name of the surgical procedure for esophegeal hernias?

Answer 16

Fundoplication.

Question 17

What are the two objectives of fundoplication surgery?

Answer 17

1. Creating a larger gastro-esophegeal junction which will not pass through the apeture in the diaphragm. 2. Wrapping the fundus makes the sphincter stronger and will reduce reflux.

Question 18

What is an Inguinal hernia

Answer 18

An inguinal hernia occurs when abdominal cavity contents protrudes through the inguinal ring.

Question 19

What forms the hernial sac in an ingunial hernia?

Answer 19

The peritoneum.

Question 20

What is typically contained in the hernial sac of an inguinal hernia?

Answer 20

The intestive and omentum.

Question 21

How is a Inguinal hernia treated?

Answer 21

Surgical correction.

Question 22

Here is a graphic representation of a Inguinal Hernia.

Answer 22

Question 23

Here is a graphic representation of a Sliding Hernia and a Para-esophageal/Rolling Hernia.

Answer 23