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GI disease profiles > Abdominal hernia > Flashcards

Abdominal hernia Flashcards

1
Q

hernia

A

abnormal protraction of a cavity contents through a weakness in the wall of the cavity

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2
Q

aetiology

A

structural weakness
increased pressure

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3
Q

structural weakness

A
  • Commonly in the body wall
  • Normal anatomical weakness e.g. diaphragm, umbilicus, inguinal/femoral canal
  • Abnormal weakness - congenital diaphragmatic hernia, inherited collagen disorders, surgical scars
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4
Q

increased pressure

A
  • Repeated bouts of increased intra-abdominal pressure on that part of the body wall
    • Smoking
    • Chronic cough
    • Obesity
    • Pregnancy
    • Strenuous activity
    • previous surgery
  • Straining during bowel movements or urination
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5
Q

reducible

A

hernia can easily be pushed back into the abdomen

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6
Q

incarcerated/irreducible hernia

A

when a hernia cannot be manipulated back to the abdomen

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7
Q

strangulated hernia

A
  • vascular supply to the contents contained within the hernia is compromised, resulting in ischaemic and gangrenous tissue
    • Symptoms depend on organ involved
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8
Q

internal hernia

A

cannot be seen or palpated

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9
Q

external hernia

A

can be seen or palpated

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10
Q

clinical presentation

A
  • Symptoms/signs present in 66% of cases
  • Pain and discomfort, especially on straining
  • Bulge that disappears on lying down
  • Bowel obstruction may be first presentation
  • Heartburn or dysphagia
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11
Q

investigations

A
  • Detailed history - SOCRATES
  • Thorough examination
  • Investigations/imaging
    • USS
    • CT
    • Endoscopy
    • Laparoscopy
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12
Q

epigastric hernia

A

Fascial defect in the linea alba between the xiphoid process and the umbilicus

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13
Q

clinical presentation of epigastric hernia

A
  • Main presentation is a midline lump
  • Asymptomatic (75%) or can present with pain
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14
Q

paraumbilical hernia

A
  • Found just above or just below umbilicus
  • Risk factors include stretching of the abdominal wall by obesity, multiple pregnancies and ascites
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15
Q

clinical presentation of paraumbilical hernia

A
  • Frequently symptomatic presenting with pain
  • High incidence of incarceration and strangulation
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16
Q

adult umbilical hernia

A

Usually results from persistent elevation of intraabdominal pressure

17
Q

clinical presentation of adult umbilical hernia

A
  • Frequently symptomatic presenting with pain
  • High incidence of incarceration and strangulation
18
Q

inguinal hernia

A
  • more frequent in males
  • right sided more common than left
19
Q

clinical presentation of inguinal hernia

A
  • Groin swelling which usually disappears when lying down
  • Usually located above and medial to the pubic tubercle
  • Palpable cough impulse on examination
20
Q

investigation of inguinal hernia

A

Dynamic USS can be useful if there is doubt over diagnosis

21
Q

femoral hernia

A
  • Hernia passes through the femoral ring into the femoral canal
  • More common in females
  • occur just below the inguinal ligament
  • femoral hernia has to be repaired as there is a high risk of strangulation
22
Q

incisional hernia

A
  • Iatrogenic
  • Hernia occurs when the defect is the result of an incompletely healed surgical would
  • Commonest complication of a laparotomy
23
Q

risk factors of incisional hernia

A

morbid obesity, wound complications, inherited collagen abnormalities, smoking, wound infection, hematoma

24
Q

parastomal hernia

A
  • Common
  • Develops with increased abdominal pressure around any stoma; ileostomy, colostomy, ileal conduit
  • difficult to treat
25
Q

Spigelian hernia

A

Occur at the lateral edge of the rectus sheath, below and lateral to the umbilicus

26
Q

lumbar hernia

A

Occur on the posterolateral abdominal wall

27
Q

hiatus hernia

A
  • Occurs at the point at which the oesophagus meets the stomach
  • Can be sliding or non-sliding
  • Non-sliding are dangerous as they can cause rotation and obstruction of the stomach
  • Can present with dysphagia and GORD-like symptoms
28
Q

divarication of recti

A
  • Not a true hernia
  • Occurs due to a rupture in the rectus abdomnis
29
Q

obturatory hernia

A
  • Uncommon
  • Usual first presentation is obstruction
  • CT is diagnostic tool for choice
  • surgical repair is necessary
30
Q

management of hernia

A
  • hernia belt or surgery
  • if asymptomatic best to leave alone
  • only perform surgery if there is high risk of strangulation
31
Q

complications of irreducible

A

hernia cannot be manipulated back into abdominal cavity

32
Q

complication of obstruction hernia

A
  • the loop of the bowel can become non functioning with no compromise to its blood supply
    • Gives you more time to plan as opposed to strangulated hernia
33
Q

complications of strangulation hernia

A
  • blood supply to the bowel is compromise leading to gangrene, perforation and peritonitis
    • NEEDS emergency surgical treatment

GI disease profiles (2 decks)

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