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Gastro > Hernias > Flashcards

Hernias Flashcards

1
Q

What is a hiatus hernia?

A

Herniation of elements of abdo cavity through esophageal hiatus of diaphragm

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2
Q

How can you classify hiatus hernias?

A

Sliding (type 1)

Paraesophageal (type 2, 3 + 4)

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3
Q

What is a sliding hernia?

A

Displacement of the gastroesophageal junction above diaphragm
Stomach remains in longitudinal alignment + fundus remains below GE junction

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4
Q

What are paraesophageal hermias?

A

Upward dislocation of gastric fundus

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5
Q 
How common are sliding (type 1)
vs paraesophageal (type 2, 3 + 4)?
A

Sliding = 95%

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6
Q

Causes of sliding hernias

A

Trauma, congenital malformation, iatrogenics

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7
Q

Causes of paraesophageal hernias

A

Complication of surgical dissection of the hiatus

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8
Q

Pathology of sliding hernia

A

Progressive disruption of the GE junction that allows gastric cardia to herniate ypwards

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9
Q

Pathology of paraesophageal hernia

A

Abnormal laxity of gastrosplenic + gastrocolic ligaments allowing greater curvature of the stomach to roll into thorax

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10
Q

S+S of sliding hernias

A

Asymptomatic if small

Symptoms of GORD if larger

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11
Q

S+S of paraesophageal hernia

A

Asymptomatic

Vague, intermittent symptoms of epigastric or substernal pain or postprandial fullness, nausea + retching

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12
Q

Investigations for hiatus hernias

A

CXR, CT, MRI - shows retrocardiac air-fluid level within hernia
Barium swallow is most sensitive test for paraesophageal hernia, sliding can be diagnosed on barium swallow or endoscopy
Usually found incidentally

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13
Q

Management of hiatus hernias

A

Symptomatic sliding = management of GERD

Surgery only for symptomatic paraesophageal hernias + for management of complications

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14
Q

What are the complications of hiatus hernias?

A

Gastric volvulus, bleeding, obstruction, strangulation, perforation, resporatory compromise

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15
Q

What are the types of groin hernia + how are they classified?

A

Inguinal (direct or indirect)
Direct - protrudes medial to epigastric vessels through Hesselbach’s triangle
Indirect - protrudes lateral to epigastric vessels
Femoral - protrude through femoral canal

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16
Q

RF for groin hernias

A 
White males
Hx of hernias
Older age
Smoking 
AAA
Chronic stretching of abdo wall due to increased pressure - chronic cough, constipation, strenuous exercise
17
Q

Presentation of groin hernias

A

Painless bulge in groin
Sense of heaviness when straining/ lifting
Can present of bowel strangulation

18
Q

Diagnosis of groin hernia

A

Diagnosed on physical exam with pt standing

US 1st line

19
Q

Management of groin hernias

A

Surgery or watchful waiting

20
Q

Complications of groin hernias

A

Strangulation

21
Q

What is an incisional hernia?

A

Abdo contents protrude through incision from surgery

22
Q

RF for incisional hernia

A

Surgical site infection
Obesity
Smoking
Malnutrition

23
Q

What is a ventral hernia?

A

Occur in anterior abdo wall:

Epigastric, umbilical, spigelian, parastomal, incisional

24
Q

Management of ventral hernias

A

Mesh (ideal) or sutures

25
Q

What is the pathology of umbilical hernias?

A

Due to opening of umbilical ring which should spontaneously close

26
Q

What is the natural history of closure of the umbilical ring?

A

Fascial opening exists to allow passage of umbilical vessels
Complete closure occurs with fusion of peritoneal + fascial layers, occuring by 5

27
Q

What other conditions are associated with umbilical hernias?

A 
Ehlers Danlos 
Beckwith-Wiedemann 
Downs 
Hypothyroidism 
Trisomy 18
28
Q

Management of umbilical hernias

A

Watchful waiting

Surgery if incarcerated or strangulated

29
Q

Pathology of epigastric hernia

A

Defects in abdo midline between umbilicus + xiphoid process

Due to weakness of linea alba, forceful diaphragmatic contractions + perforation of linea alba

30
Q

RF for epigastric hernia

A

Physical training or coughing, obesity, smoking, chronic steroid use, diabetes, old age, males

31
Q

S+S of epigastric hernias

A

Asymptomatic

Lump between umbilicus + xihpoid

32
Q

What is a true vs false hernia?

A

True - involve peritoneal sac

False - without peritoneal sac

33
Q

Management of epigastric hernia

A

Surgery for symptomatic pts

Gastro (11 decks)

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