Herniations

Question 1

What is a hernia?

Answer 1

Organ protruding through retaining structure

Question 2

Where do hernia’s usually occur and what is the basic etiology?

Answer 2

Usually in abdm cavity

o Weakened supporting structure (muscles)
• Congenital or acquired
o Inc in intra-abdm Pressure (eg pregnancy, obesity) -> herniation

Question 3

What kind of hernia is associated with the aperture in diaphragm for the esophagus?

Answer 3

Hiatal Hernia

Question 4

What structures are involved in a hiatal hernia?

Answer 4

Part of the stomach enters the thoracic cavity through an enlarged hiatus

Question 5

Two types of Hiatal hernias?

Answer 5

1) Sliding hernia (95%) Gastro esophageal junction GEJ and upper stomach enter the thoracic cavity (37-2)

2) Paraesophageal or rolling hernia (5%)
• Non upper part of stomch enters Thoracic cavity
• GEJ below diaphragm

Question 6

MNFTS of sliding hernia

Answer 6

Sometimse Asymptomatic but Pain, heart burn, gastric reflux are common

Question 7

MNFTS or Rolling hernia

Answer 7

• Chest pain (related to constriction at hiatus), dyspnea, fullness with limited intake (r/t stomach volume reduced)

…No reflux (why?)

Question 8

Tx for mild Hernias

Answer 8

LIFESTYLE MOD
o Issues are gastric reflux, heartburn
o Reduce meals before sleep (r/t inc reflux when supine)
o Dietary: Reduce food that increase acid secretion

Question 9

Three pharmaceutical tx’s for Hiatal hernias?

Answer 9

o Antacids (neutralizes acid)
o H2 receptor antagonists (H2RA)
• discussed more in ulcers, aka receptors blocker
• Blocking histamine (which is the normal binder)
o PPI’s (proton pump inhibitor’s)
• Reduce H+ pumping out of cell (reducing HCL)

Question 10

Is Sx used often for Hiatal Hernias?

Answer 10

About 15% of the time, when drugs are not effective

Question 11

What is fundoplication?

Answer 11

• Take fundus and wraps around JE junction
• Like lacing up boots
• Prevents further upward movement and fortifies sphincter at the junction

Question 12

What is an inguinal hernia?

Answer 12

Abdominal organs protrude via inguinal ring into groin/scrotum

(bilateral space for nerves vessels, etc)

Question 13

What forms the hernial sac? What does it normally contain?

Answer 13

Peritoneum forms the sac

• Sac usually contains intestine and omentum (mesentery)

Question 14

Why should a inguinal hernia be fixed?

Answer 14

High probability of strangulation

Question 15

What does sx correction of inguinal hernia look like?

Answer 15

o Hernia must be reduced

o Inguinal ring tightened

Question 16

Direct vs indirect herniation?

Answer 16

• Direct hernia pushes through weakened structure

* Indirect pushes through existing aperture