Part II. Clinical Flashcards
What is a hiatal hernia?
Protrusion of part of stomach into mediastinum via esophageal hiatus
When and why do hiatal hernias occur most often?
After middle age presumably because diaphragm weakens and/or esophageal hiatus widens
What is a sliding hiatal hernia?
When the esophagus, stomach cardia and parts of the stomach fundus slide through esophageal hiatus
Sliding hiatal hernia is exacerbated by what?
Lying down or bending over
Sliding hiatal hernia is often associated with what other symptom?
Food/acid reflux
Which is more common, sliding hiatal hernia or paraesophageal hiatal hernia?
Sliding hiatal hernia
What is a paraesophageal hiatal hernia?
When pouch of peritoneum (often containing part of fundus) extends through esophageal hiatus
Is acid reflux an issue with paraesophageal hiatal hernia? Why?
No, because cardiac sphincter is not involved
What testicular finding is sometimes associated with indirect inguinal hernia?
Hydrocele - Excess fluid present in a persistent processus vaginalis
What is the examiner looking for when they palpate the spermatic cord and ask the patient to turn their head and cough?
Inguinal hernia which would press against examiner’s finger when patient coughs
What are inguinal hernias?
Protrusion of parietal peritoneum and viscera through inguinal canal
What percentage of abdominal hernias are inguinal?
75%
Which type of hernia is usually reducible by appropriate manipulation?
Inguinal hernia
What is the most common of all inguinal hernias?
Indirect inguinal hernia
Are indirect inguinal hernias more common in men or women?
Men
Where does the indirect inguinal hernia occur?
In Lateral Inguinal Fossa (lateral to Inferior Epigastric AV), enters Deep Inguinal Ring and traverses Inguinal Canal into spermatic cord
Where does the direct inguinal hernia occur?
In Medial Inguinal Fossa (medial to Inferior Epigastric AV), traverses only medial (lower) part of Inguinal Canal and exits Superficial Inguinal Ring adjacent to spermatic cord
NOTE: Parallels spermatic cord but located outside of spermatic fascial coverings
What does the hernial sac of an indirect inguinal hernia contain?
peritoneum plus all three fascial coverings of spermatic cord
What does the hernial sac of a direct inguinal hernia contain?
peritoneum and transversalis fascia
Are femoral hernias more common in men or women?
Women
What are femoral hernias
Protrusions inferior to the inguinal ligament that pass through femoral ring and canal and extend into upper medial thigh
