Flashcards in Herniations Deck (16)
What is a hernia?
Organ protruding through retaining structure
Where do hernia's usually occur and what is the basic etiology?
Usually in abdm cavity
o Weakened supporting structure (muscles)
• Congenital or acquired
o Inc in intra-abdm Pressure (eg pregnancy, obesity) -> herniation
What kind of hernia is associated with the aperture in diaphragm for the esophagus?
What structures are involved in a hiatal hernia?
Part of the stomach enters the thoracic cavity through an enlarged hiatus
Two types of Hiatal hernias?
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
MNFTS of sliding hernia
Sometimse Asymptomatic but Pain, heart burn, gastric reflux are common
MNFTS or Rolling hernia
• Chest pain (related to constriction at hiatus), dyspnea, fullness with limited intake (r/t stomach volume reduced)
...No reflux (why?)
Tx for mild Hernias
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
Three pharmaceutical tx's for Hiatal hernias?
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)
Is Sx used often for Hiatal Hernias?
About 15% of the time, when drugs are not effective
What is fundoplication?
• Take fundus and wraps around JE junction
• Like lacing up boots
• Prevents further upward movement and fortifies sphincter at the junction
What is an inguinal hernia?
Abdominal organs protrude via inguinal ring into groin/scrotum
(bilateral space for nerves vessels, etc)
What forms the hernial sac? What does it normally contain?
Peritoneum forms the sac
• Sac usually contains intestine and omentum (mesentery)
Why should a inguinal hernia be fixed?
High probability of strangulation
What does sx correction of inguinal hernia look like?
o Hernia must be reduced
o Inguinal ring tightened