Herniation

Question 1

what is herniation?

Answer 1

-organ (part) protruding through a supportive/retaining structure: -may protrude through wall (direct) or existing hole (indirect)

Question 2

where does herniation usually occur

Answer 2

in the abdominal cavity

Question 3

Patho of herniation

Answer 3

• weakened retaining structure (eg. Muscles), weakened d/t acquired(trauma) or congenital
• increase in intra-abdominal pressure (eg. obesity or pregnancy) cause herniation

Question 4

what are the two types of hiatal hernias

Answer 4

• axial or sliding hiatal hernia (95%)

- paraesophageal or nonaxial hiatal hernia

Question 5

Hiatus is an

Answer 5

aperture (opening) in the diaphragm for esophagus from thoracic

Question 6

what is a hiatal hernia

Answer 6

stomach pushes through existing hole in the diaphragm
Hiatus: aperture (opening) in diaphragm for esophagus from thoracic to abdominal) Hiatus needs to weaken (enlarges and pressure increases)
-hiatus enlarges
-part of stomach enters thoracic cavity

Question 7

what are the characteristics of an axial or sliding Hiatal Hernia

Answer 7

• gastroesophageal junction & upper stomach enters thoracic cavity
• acid is pushed into esophagus, not geared to protect from stomach acid, causes damage
• “bell Protrusion”
• aprox 50% asymptomatic
• other manifestations; chest pain, heart burn, reflux

Question 8

what type of protrusion is significant characteristic of an axial/sliding Hitatal Hernia

Answer 8

-bell protrusion

Question 9

approx 50 % of axial/sliding hiatal hernias are asymptomatic what are the other symptoms?

Answer 9

• chest pain: stomach being pushed up into thoracic cavity
• heart burn: acid damaging, pH of 2
• reflux: gastric content pushed up

Question 10

what are the characteristics of an paraesophageal or nonaxial hiatal hernia

Answer 10

• non-upper part of stomach enters thoracic cavity
• gastroesophageal junction remains below diaphragm
  mnfts: chest pain, dyspnea, fullness
• no reflux: because acid is not being pushed into esophagus

Question 11

what are some of the significant mnfts of paraesophageal/nonaxial hiatal hernia?

Answer 11

• chest pain
• dyspnea (protrusion of hernia occupying space so let lung cannot inflate fully)
• fullness (stretch receptors to feel full, also decrease in volume of stomach because being pushed up, stretch receptors stimulated quickly smaller volume to fill
• NO reflux: because acid is not being pushed into esophagus

Question 12

Treatment for Hernias

Answer 12

-lifestyle modifications (address symptoms of hernia, ex small meals, don’t bend @ hip, do not compress abdomen, not lift heavy weights, head of bed raised)

• Drugs (for reflux): -antiacids
  - PPIs (proton pump inhibitors)
  - H2 receptor antagonist (blocks synthesis of acid)

-Sx (approx 15%) Fundoplication (wrap fundus around cardiac part of stomach making bigger)

Question 13

both proton pump inhibitors and H2 receptor antagonists ______

Answer 13

inhibit gastric acid secretion

Question 14

what is an Inguinal Hernia

Answer 14

• bowel protrudes through the inguinal canal ( inguinal canal allows passage of spermatic cord)
• peritoneum forms sac (pushes through first): sac contains part of bowel & omentum(membrane that connects all the intestines)
• requires surgery

Question 15

what is the omentum

Answer 15

membrane that connects all the intestines

Question 16

an Inguinal Hernia requires _______

Answer 16

surgery

Question 17

an indirect inguinal hernia

Answer 17

-passes through apture already called the inguinal canal

Question 18

a direct inguinal hernia

Answer 18

-passes alongside the inguinal canal