Herniations

Question 1

What is a hernia?

Answer 1

organ protruding through retaining structure

Question 2

Where does herniation normally occur?

Answer 2

abdominal cavity

Question 3

What is the pathology of herniation? (2 key elements)

Answer 3

• weakened supporting structure (ex. muscles), this is most often acquired but may sometimes be congenital
• increased intra-abdominal pressure (most often from pregnancy or obesity)

Question 4

What is the hiatus?

Answer 4

the opening/aperture where the esophagus passes through the diaphragm

Question 5

What is a hiatal hernia?

Answer 5

• if the hiatus/diaphragm is weakened and pressure is increased, part of the stomach enters the thoracic cavity if hiatus enlarges

Question 6

What are the two types of hiatal hernias?

Answer 6

1) sliding hiatal hernia (95%)

2) paraesophageal/rolling hernia

Question 7

What happens in a sliding hiatal hernia?

Answer 7

• gastro-esophageal junction and upper stomach enter the thoracic cavity
• some people are asymptomatic
• people with symptoms experience chest pain, heartburn and reflux

Question 8

What happens in a paraesophageal/rolling hernia?

Answer 8

• non-upper part of stomach enters the thoracic cavity
• GEJ below the diaphragm
• chest pain, dypsnea (hernia displaced towards the lungs), fullness before/soon after meals (stomach is smaller)

Question 9

How are hiatal hernias treated?

Answer 9

1) lifestyle modifications
- don’t bend over
- don’t eat before bed
- raise the head of your bed
- reduce foods that increase acid secretion like caffeine

2) drugs for reflux
- antacids
- H2 receptor antagonists
- proton pump inhibitors

3) surgery in very few cases (15%), including a procedure called fundoplication

Question 10

What is fundoplication and what two purposes does it serve?

Answer 10

Surgery where the fundus of the stomach is wrapped around the GEJ.

1) prevent future herniation because stomach now bigger than the hiatus
2) fortifies cardiac sphincter to decrease reflux

Question 11

What is an inguinal hernia?

Answer 11

abdominal organ(s) protrude through the inguinal ring and the peritoneum forms a hernial sac

Question 12

What does the hernial sac usually contain?

Answer 12

• intestine

- omentum

Question 13

How is an inguinal hernia treated?

Answer 13

surgically - the hernia is reduced and the inguinal ring is tightened

Question 14

Why is an inguinal hernia more common in men?

Answer 14

because the inguinal ring, although taut, is open to permit the passage of blood vessels and the vas deferens to/from the testes

Question 15

Can women have an inguinal hernia?

Answer 15

yes, it is not as common but women do have an inguinal ring which closes soon after birth

Question 16

What is the difference between an direct and indirect inguinal hernia?

Answer 16

direct: through the retaining structure at a weak point
indirect: through an aperture in the structure