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Medicine Phase 2a GI > Abdominal hernia > Flashcards

Abdominal hernia Flashcards

1
Q

types of abdominal hernia

A 
Inguinal
Femoral
Incisional
Epigastric
Umbilical
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2
Q

What is a hernia

A

The protrusion of a viscus or part of a viscus through a weakening in its containing cavity.

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3
Q

Types of inguinal hernia

A

Direct

Indirect

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4
Q

Clinical presentation of inguinal H

A

Swelling in the groin that may appear with lifting, accompanied by pain.
Increase in swelling on cough.
Can reduce on reclination, larger requires manual reduction.

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5
Q

Differences in clinical presentation between direct and indirect inguinal h

A

indirect more prone to cause pain in the scrotum and ‘dragging’ sensation

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6
Q

Describe direct inguinal hernia

A

Caused by weakness in the abdominal wall
Located MEDIAL to inferior epigastric vessels
Protrudes directly through a weakness in the POSTERIOR WALL of the inguinal canal.

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7
Q

Describe indirect inguinal hernia

A

Caused by a congenital weakness of the internal inguinal ring
(Protrusion through the internal inguinal ring along with the inguinal canal through the abdominal wall.)
Located LATERAL to inferior epigastric vessels
More common than direct

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8
Q

Pathophysiology of inguinal hernia

A

High abdominal pressure causes the internal organs to push through a weakened section of the abdominal wall

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9
Q

Aetiology of inguinal hernia

A

Con be congenital

Heavy lifting is a risk factor and can weaken the wall

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10
Q

Epidemiology of direct inguinal hernia

A

More common in elderly and men

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11
Q

Epidemiology of indirect inguinal hernia

A

Accounts for 80% of inguinal hernias

More common in men

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12
Q

Diagnosis of inguinal hernia

A

Clinical diagnosis
Ultrasound (radiology)
Seek to identify if inguinal or femoral

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13
Q

Treatment of inguinal hernia

A 
Infancy = Repair soon after diagnosis
Adults = surgical repair in large hernias
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14
Q

Complications of any hernia

A

Incarcerate or strangulate

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15
Q

Clinical presentation of femoral hernia

A

Lump/mass in groin.
Tends to be irreducible.

Lateral and inferior to the pubic tubercle.
Increase in swelling on cough.
May be reducible on reclination or manually.

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16
Q

Pathophysiology of femoral hernia

A

High abdominal pressure causes the internal organs to push through a weakened section of the abdominal wall

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17
Q

Aetiology of femoral hernia

A

Idiopathic
OR due to a weakness in the femoral canal:
-located inferior and lateral to the pubic tubercle
-more common in females
-high risk of strangulation

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18
Q

Epidemiology of femoral hernia

A

More common in middle-aged and elderly women

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19
Q

Diagnosis of femoral hernia

A

Ultrasound

Seek to identify if inguinal or femoral

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20
Q

Treatment of femoral hernia

A

Surgical hernia repair (treatment of choice)

21
Q

Pathophysiology of incisional hernia

A

Location depends on location of incision
Internal organs push through improperly healed section of abdominal wall
Risk of any abdominal operation

22
Q

Aetiology of incisional hernia

A

Weakness caused by a surgical repair that has not fully healed

23
Q

Epidemiology of incisional hernia

A

15% of abdominal operations result in this

24
Q

Diagnosis of incisional hernia

A

observation

25
Q

Treatment of incisional hernia

A

Urgent repair with reinforcing mesh

26
Q

What % of large hernias show recurrence of incisional hernia

A

50%

27
Q

Clinical presentation of epigastric hernia

A

Midline, above the umbilicus in the linea alba. Can be made to bulge by asking the patient to strain.
Usually asymptomatic, can present with epigastric pain.
Possible bloating, nausea and vomiting, often after meals

28
Q

Pathophysiology of epigastric hernia

A

Internal organs push through a weakened section of abdominal muscle

29
Q

Risk factor of epigastric hernia

A

Obesity

30
Q

Epidemiology of epigastric hernia

A

Most common in men between 20-50

31
Q

Diagnosis of epigastric hernia

A

Obese patients might need ultrasound or CT scanning

32
Q

Treatment of epigastric hernia

A

Surgical correction

33
Q

Clinical presentation of umbilical hernia

A

At the site of the umbilicus.
Can be asymptomatic.
Pain can occur if the abdominal wall contracts, worsened on straining.

34
Q

Pathophysiology of umbilical hernia

A

Congenitally can occur as a result of a developmental error. Organs develop outside of the abdominal cavity and enter through an opening in the umbilicus.

35
Q

Aetiology of umbilical hernia

A

Infancy - congenital
Adult - 90% are acquired through multiple and difficult pregnancies
Also ascites and obesity

36
Q

Epidemiology of umbilical hernia

A

10-30% of all hernias

More common in males and due to weakness of the umbilicus

37
Q

Diagnosis of umbilical hernia

A

Ultrasound can confirm

38
Q

Treatment of umbilical hernia

A

<1cm: usually closes spontaneously by 5 years
>1.5cm: usually requires repair with preservation of the umbilicus
(usually is self-resolving)

39
Q

What is the viscera

A

the internal organs in the main cavities of the body, especially those in the abdomen, e.g. the intestines

40
Q

Signs and symptoms of inguinal hernia

A

Mass in the groin
Hernia accentuated by certain situations such as coughing or on standing
Reducible
Pain = hernia likely to be strangulated i.e. blood supply is comprimised

41
Q

Complications of inguinal hernia

A

Strangulation

Incarceration

42
Q

Types of hiatus hernia

A

Sliding

Rolling

43
Q

Causes of hiatus hernia

A

Weakness in the diaphragm that allows the stomach and intestines to move into the chest cavity.
Risk factors that make this more likely such as obesity and constipation

44
Q

Signs and symptoms of hiatus hernia

A 
GORD signs and symptoms:
Heartburn
Acid taste in mouth
Water brash (excess salivation)
Dysphagia
Nocturnal asthma/chronic cough
Laryngitis
45
Q

Investigations of hiatus hernia

A

Endoscopy

Barium study

46
Q

Treatment of hiatus hernia

A

GORD:
Conservative - education, weight loss, raising head of bed at night and avoid precipitating factors such as smoking and large meals

Medical - Antacids (aluminium hydroxide); H2 receptor antagonists (ranitidine); proton pump inhibitors (omeprazole)

Surgical - Nissen’s fundoplication

47
Q

Complications of hiatus hernia

A

Strangulation
Gastric volvulus
GORD complications: Barretts oesophagus etc

48
Q

Complications of femoral hernia

A

Strangulation

Fistula formation

Medicine Phase 2a GI (35 decks)

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