Herniation Flashcards

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1
Q

what is herniation?

A

-organ (part) protruding through a supportive/retaining structure: -may protrude through wall (direct) or existing hole (indirect)

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2
Q

where does herniation usually occur

A

in the abdominal cavity

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3
Q

Patho of herniation

A
  • weakened retaining structure (eg. Muscles), weakened d/t acquired(trauma) or congenital
  • increase in intra-abdominal pressure (eg. obesity or pregnancy) cause herniation
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4
Q

what are the two types of hiatal hernias

A
  • axial or sliding hiatal hernia (95%)

- paraesophageal or nonaxial hiatal hernia

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5
Q

Hiatus is an

A

aperture (opening) in the diaphragm for esophagus from thoracic

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6
Q

what is a hiatal hernia

A

stomach pushes through existing hole in the diaphragm
Hiatus: aperture (opening) in diaphragm for esophagus from thoracic to abdominal) Hiatus needs to weaken (enlarges and pressure increases)
-hiatus enlarges
-part of stomach enters thoracic cavity

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7
Q

what are the characteristics of an axial or sliding Hiatal Hernia

A
  • gastroesophageal junction & upper stomach enters thoracic cavity
  • acid is pushed into esophagus, not geared to protect from stomach acid, causes damage
  • “bell Protrusion”
  • aprox 50% asymptomatic
  • other manifestations; chest pain, heart burn, reflux
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8
Q

what type of protrusion is significant characteristic of an axial/sliding Hitatal Hernia

A

-bell protrusion

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9
Q

approx 50 % of axial/sliding hiatal hernias are asymptomatic what are the other symptoms?

A
  • chest pain: stomach being pushed up into thoracic cavity
  • heart burn: acid damaging, pH of 2
  • reflux: gastric content pushed up
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10
Q

what are the characteristics of an paraesophageal or nonaxial hiatal hernia

A
  • non-upper part of stomach enters thoracic cavity
  • gastroesophageal junction remains below diaphragm
    mnfts: chest pain, dyspnea, fullness
  • no reflux: because acid is not being pushed into esophagus
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11
Q

what are some of the significant mnfts of paraesophageal/nonaxial hiatal hernia?

A
  • chest pain
  • dyspnea (protrusion of hernia occupying space so let lung cannot inflate fully)
  • fullness (stretch receptors to feel full, also decrease in volume of stomach because being pushed up, stretch receptors stimulated quickly smaller volume to fill
  • NO reflux: because acid is not being pushed into esophagus
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12
Q

Treatment for Hernias

A

-lifestyle modifications (address symptoms of hernia, ex small meals, don’t bend @ hip, do not compress abdomen, not lift heavy weights, head of bed raised)

  • Drugs (for reflux): -antiacids
    - PPIs (proton pump inhibitors)
    - H2 receptor antagonist (blocks synthesis of acid)

-Sx (approx 15%) Fundoplication (wrap fundus around cardiac part of stomach making bigger)

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13
Q

both proton pump inhibitors and H2 receptor antagonists ______

A

inhibit gastric acid secretion

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14
Q

what is an Inguinal Hernia

A
  • bowel protrudes through the inguinal canal ( inguinal canal allows passage of spermatic cord)
  • peritoneum forms sac (pushes through first): sac contains part of bowel & omentum(membrane that connects all the intestines)
  • requires surgery
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15
Q

what is the omentum

A

membrane that connects all the intestines

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16
Q

an Inguinal Hernia requires _______

A

surgery

17
Q

an indirect inguinal hernia

A

-passes through apture already called the inguinal canal

18
Q

a direct inguinal hernia

A

-passes alongside the inguinal canal