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Flashcards in Herniations Deck (16)
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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?

Hiatal Hernia


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


Direct vs indirect herniation?

• Direct hernia pushes through weakened structure
• Indirect pushes through existing aperture