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1

hernia

organ protrusion thru retaining str wall

2

where is there inc prevelance of hernias

abdm cavity

3

2 requirments needed for herniation to occur (patho)

weakening of supporting or retaining str
inc intra abdm pressure

4

what etiologies relate to weakening of supporting strs in herniations

acquired (injury, aging)
congenital (baby born w m. weakness)

5

what etiologies relate to inc abdm pressure

acquired (pregnancy, obesity)

6

hiatus

aperture opening in diaphragm for esophagus

7

what is a hiatal hernia

hiatus enlarges dt age(?) and inc P admn -> part of stomach enters TC

8

2 types of hiatal hernia

sliding
rolling

9

percent incidence in sliding hernia

95%

10

percent incidence in rolling hernia

5%

11

what happens in a sliding hiatal hernia

upper stomach and GEJ slide up into TC. stomach is pinched at entry point into TC

12

what percent of pts w sliding hiatal hernias are symptomatic

50%

13

what symptoms are present in pts w sliding hiatal hernias

chest pain, heart burn, reflux

14

what happens in a rolling/paraesophageal hiatal hernia

non upper part of stomach moves above diaphragm while GEJ remains in normal spot

15

mnfts of rolling hiatal hernia

chest pain
dyspnea
feeling full sooner after meals

16

why is there chest pain in a rolling hiatal hernia

rt anatomical repositioning of stomachq

17

why is there dyspnea in a rolling hiatal hernia

stomach takes up part of TC -> dec lung capacity for 02

18

why does the pt feel full sooner if they have a rolling hiatal hernia

dec stomach capacity AND smaller herniated pocket still fx's normally, this mini stomach has stretch receptors so when small pocket fills -> n. sends signal of feeling full

19

tx for hiatal hernias

lifestyle mods
drugs for gastric reflux
sx

20

what lifestyle mods occur when txing hiatal hernias

avoid bending over after eating, avoid heavy meals, sleeping after meals, inc HOB to address reflux -> dec heartburn and pain

21

what drugs are used to treat gastric reflux in hiatal hernias

antacids
H2RA
PPI

22

what sx is used to treat hiatal hernias

fundoplication, reduce hernia while wrapping fundus of stomach around junction to prevent it from moving up while tightening cardiac sphincter

23

inguinal hernia

abdm organs protrude via inguinal ring forming hernial sac

24

what aperture do inguinal hernias exit from

inguinal ring

25

what is the inguinal ring

taught opening allowing passage of spermatic cord to exterior body

26

what is in a hernial sac

peritonium with organ and omentum inside

27

2 types of hernia

direct
indirect

28

direct hernia

herniation via no aperture (hiatal)

29

indirect hernia

herniation via present aperture (inguinal)

30

peptic ulcer disease

ulcerative disorder of upper GI tract (20% stomach, 80% duodenum).