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hernias
hernias
46
Medical
Graduate
06/01/2009

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Term
meckels diverticulum
Definition
embryonic reminant of the vitelline duct, located in antimesenteric border. contains ectopic gastric, pancreatic, duodenal or colonic tissue rule of 2 - 2% of pop, present age 2, 2 feet from ilocaecal valce, 2 inches long. usually asymptomatic. complications - peptic ulceration, intussuception, volvulus, inflammation
Term
Celiac dissease etiology and epidemiology
Definition
1:100/200 common in europeans, strong family history. Aetiology - Autoimmune disease that results in loss of tolerance to gliaden peptide - T-cell mediated v giaden and transglutimase
Term
celiac disease - pathology
Definition
major affect proximal small bowell - crypt hyperplasia, villous atrophy, loss of brush border, vucuolisation, loss of gobletcell, infiltrate in the lamina proprial
Term
clinical features of celiac
Definition
weight loss, diarrhoea (bulky,frothy, smelly), FTT, anaemia, mouth ulcers, infertility,dermitits herpetiforms, osteoporosis. Diagnosis - documentation of malabsorption, biopsy showing loss of villi, restoration on gluten free diet, also presence of anti-gliaden antibiodies, anti- TTG antibodies. Treatment - gluten free diet and replacement antibodies. Complications - Cancer (enteropathic associated T cell lymphom, adenocarcinoma, oesphageal SCC,
Term
tropical sprue
Definition
malabsorbtion disease presumably of infectious origin in people visiting tropics. features - diarroea, malabsorption, anorexia, weight loss, folate and B12 defeciency. Dx by exclusion, antibiotic treatment
Term
Whipples
Definition
rare disease caused by tropheryma whipperlii gram positive actinmycetes in macrophage, shag pile villi - Dx visualisation. features - steatorrhea, feve, wt loss, also arthralgia, cardiac, neurological, and hyperpigmentation
Term
eosinophilic enteritis
Definition
commonly caused by dog hook worm infection that mounts severe allergic responce. abdominal pain, obstruction, diarrheoa, bleeding - tx antihelmetics
Term
affects of intestinal
Definition
upto50% without problems - ileum (bile salt, B12, diarrhoea, electrolyte, steatorrhea) Jejunum (ileum can take over, gastric hypersecretion), Short bowel syndrome (crohns disease) - end in stoma (fluid/electrolyte depleting) colon (reduced fluid and elecrolyte loss, low fat diet)
Term
Hernias
Definition
protrusion of hernia sac and content through a defectit in wall of peritoneal cavity. location - femoral, inguinal, umbilical, surgical, retroperitoneal. complications - incarceration, obstruction, strangulation
Term
Adhesions
Definition
fibrous bridge formaion commonly from surgery, lead to internal herniation and obstruction
Term
Volvulus
Definition
twisting of loop of bowel and mesentary. leads to obstruction, infarction. commonly - sigmoid, caecum, small bowel, stomach
Term
causes of obstruction
Definition
hernia, adhesion, intussusception, volvulus, tumor, strictures, stones, foreighn body, pseudoobstruction
Term
Intussusception
Definition
segment of intestine is telescoped into the immediate distal segment. cause - children, hypertropic lymphoid tissue, mass or tumour. complication obstructin and infarction. Tx barium meal, resection
Term
Ischemic bowel
Definition
elderly, RF for emboli/atherosclerosis present with pain, centra/constant, increased WCC, fever. Cause - arterial occlusion (emboli, atherosclerosis) End artery occlusion (small focal ischemia), Venous occlusion (compression, thrombosis - heamorrhagic necrosis) No-occlusive (CHF, shock, dehydraction, vasoconstrictors-broad,spotty ischaemia) - massive oedema (thumbprints on mucosa, commonly affects watershed area)
Term
benign tumors of small intestine
Definition
Adenomas, hemangiomas (obstruct), connective tissue (stroma tumors - more aggressive c.f stomach)
Term
malignant tumors of small intestine
Definition
metastasis (most common) Adenomas (penetrate to serosal surface) Carcinoids - 50% of tumors, most common appendix, ielum, rectum, stomach, colon least common. multicentric, carcinoid syndrome. metasticis - lymph node, liver. Appendix usually benign. Morphology - rounded, well circumscribed, intact mucosa, yellow in colour. Lympoma (95%B-cell) plaques, diffue mural thickening, polyps, ulcerations - present obstruction, haemorrhage, perforation
Term
Acute appendicites pathology
Definition
20-30yrs, obstruction of lumen via faecolith leading to bacterial proliferation. Macro - swollen, purulent, faecal matter. Histo - infiltrate of neutraphils, gangrenous. Presentation - anorexia, nausea, vomiting, diarrhoea, Abd pain central ->mcburney point. systemic signs of inflammation. Complications - perforation and peritonitits, abscess formation
Term
other pathologies of appendix
Definition
infection (enterobius vermicularis, eosinophilic rxns), tumour (adenocariconoma, carcinoid, adenoma). Mucoceloesle (obstruction and fills with mucus, may rupture and spread to peritoneaum)
Term
Defence mechanisms of the GIT
Definition
peristalsis, saliva, low pH, free flow of fluid, shedding of epithelia, secretary IgA, mucus, normal flora, macrophages, digestive enzymes, reticuloendothelial system
Term
pathophysiology of peritonisits
Definition
Lack of containment(organisms, inflammatory break down prods,leak of cytokines, increase ADH and aldosterone) Triggers inflammatory cascade (neutraphil, platelet, macrophage, release of cytokines, perpertuating cascade) Effects of mediatiors (fever, tachycardia, peripheral vasodilation, capillary permiability, massive exudate of inflammatory fluid) Generalisation (non containment of inflammatory mediator ->SIRS)
Term
Effects of peritonitis
Definition
Circulatory (hypovolemia, renal impairment, increased permeability, decreased peripheral resistance). Ventilatory (impaired gas exchange - VQ mismatchy or shunt, impaired diffusion, hypoventilation) GIT (impaired cell metabolism- open of tight junction, passige of organism, products into circulation. Absosption failure - decreased absorption of water and elecrtrolytes, worseinging of vol depletion, increased secretion. bacterial overgrowth in stasis)
Term
Causes of peritonitis
Definition
Bacteria (direct-trauma, local extension, blood borne) Bile/acid (chemical burn-secondary infection) Urine, Blood (breakdown activates inflammatory cascade)
Term
types of peritonitis
Definition
primary (rare-prepubertal girls strep infection from genital tract, liver disease) Secondary - Localised (sepsis at certain area, body is capable of containing,local pain, guaring) Generalised (continuation of localised, peritoneal adheasion and omentum contain, pain generalised, marked guarding and rigidity, inflammatory changes - temp tachy, inc BMR
Term
organs causes of peritonitis
Definition
appendix (most common), gall bladder (chemical, secondary bacterial), Colon (diverticulitis, colitis, trauma, ischemia) small bowel (trauma, ischemia, emboli, herniation) Stomach (ulcers, tumors) duodenum, Gynae (PID, post terminatio) Bladder and UTI (bladder rupture, trauma)
Term
hernia epidemiology and terminology
Definition
10-20/1000 births (premature), 3% of adults, M>F inguinal, F>M femoral. Indirect inguinal most comm. Reducible (contents return spontaneously of manually) Irreducible (contents cannot be returned) Obstructed (bowel is obstructed) Strangulated (compromised blood supple)
Term
Pathophysiology of hernias
Definition
embryological inherint weakness in abdominal wall (exit of extraperitoneal structures, devoid of multilayer support) surgical incision. hernial sac - peritoneum and contents within. RF - prematurity, family history, undescended testes, increased intraabdominal pressure (ascites, peritoneal dialysis, copd, pregnancy)
Term
Anatomy of the inguinal canal
Definition
deep ring (transversalis fascia) M (transverse abdominus, internal oblique) A (aponeurosis of internal(lateral) external oblique) L (inguinal ligament) T (transverse fascia, conjoint tendon (medialy)
Term
Inguinal hernia
Definition
75% of hernias, 25x more commen in men. Indirect - congenital (persistant process vaginalis), follows path of descending testes,lateral to epigastic vessels, frequently incarcerate. Direct - passage thru transversalis fascia via inguinal triangle, acquired defect, rarely extend to scrotum, rarely incarcerate
Term
Femoral hernia
Definition
protrustion thru the femoral canal (femoral sheath) medial to femoral vein and lateral to the lacunar ligament. bulge below inguinal crease, roughly midline, more common in females, frequently stangulate
Term
umbilical hernia
Definition
incomplete development of the muscular umbilical ring allows herniation of abd contents. congenital - disapear by age of 2. adult hernia - frequently incarcerate
Term
other hernias
Definition
epigastric (linea alba) Incisional (post surgical) Spigelian (semilunaris, arcurate line) Pelvic (sciatic, perineal, obturator) Lumbar
Term
Hernia - features
Definition
symptomatic lump. Incarceration - hernia does not reduce on lying, sudden onset of pain, irritability in children, bowel obstruction) Strangulation (toxic, perforation, peritonitis, shock)
Term
Examination of a hernia
Definition
inspection (full exposure, standing, lumps, scars, cough, examine in relation to pubic tubucle) Palpation (hand over tubucle ask to cough, check two testis, inversion of scrotum in inquinal canal cough - tapping relfex) Incarceration - tender, dont transluminate, bowel sounds, visable peristalsis
Term
DDx of pelvic lump
Definition
inguinal hernia (above ing ligament), femoral hernia, lymph node (tender, multiple), Hydrocoele (transilluminate, nont tender) testicular torsion, tumor, undescended testis, epididmymitis, goin cellulitis, femoral thrombophlebitits, feroral artery aneurysm.
Term
reduction of a hernia
Definition
resent duration place in trendelemburg position, administer analgesic, relaxants, warm compress, gentle compression. ->surgical resection of those that cannot be reduced. painless or reducible (elective, no heavy lifting, laxatives,return if pain) strangulation - broad spectrum antibiotics, fluid resusitaion
Term
Visceral pain
Definition
stretching, ischemia, inflammtion. steady ache or colicky. follows segmental distribution (foregut, midgut, hind gut) felt in midline. patients wryth in agony
Term
somatic/parietal pain
Definition
irritaions of fibers in parietal peritoneam, localised to specific ares, tenderness, guarding, rigidity and rebound tenderness. patient lie still to avoid pain
Term
acute abdomen history
Definition
pain - nildocalfiaat, time frame (sudden- perforation, rupture. gradual - inflammatory) Associate symptoms - GI (nausea, vomiting, diarrhoea, constipation, flatus) Genitourinary (dysuria, frequency, urgency, hematuria) Gynaecological histor, Vascular. PMH - medications, surgery, hospitalisation,chronic disease.
Term
Examination of the acute abdomen
Definition
General - facial expression, diaphoresis, pallor, agitation, mobile/still. Vitals - pulse and bp standing (>30 bpm or >15/10) Abdomen - inspection (distension, peristalisis, scars, masses) Palpation (guarding, tenderness, rigidity, organomegaly, bladder, hernias) Auscultation (bowel sound, succession splash) pelvic exam, rectal exam
Term
investigation of acute abdomen
Definition
FBC (WCC), amylase, electrolyes (status) pregnancy test, CXR, ABD X-ray, Ultrasound, CT
Term
acute appendicites presentation
Definition
fever, central abdominal pain->localised to RIF, nausea, anorexia, vomiting occasional diarrhoea. tenderness at mcburneys point, Rosvings sign, Inv - Raised WCC, ultrasound, CT. DDx msenteric lymphdenitis, acute salpingitits, meckels diverticulum, functional, ileitis
Term
presentation of peritonisits
Definition
sudden onset (perforation,rupture) or gradual (inflammation) guarding, rigidity, rebound tenderness. Investigations - amylase, CXR, ultrasound, CT. Tx resusitation,
Term
Bowel obstruction - causes
Definition
adhesion, hernias, strictures, neoplasm, volvulus, intussesception, radiotion, foreighn body, diverticulu, congential
Term
Pathophysiology of bowel obstruction
Definition
dilation of bowel above the block, increased secretion of fluid in distended bowel, bacterial contamination, venous stangulation, ischemia and necrosis -> perforation, peritonitis
Term
bowel obstruction - presentation
Definition
symptoms - colicky abd pain, nausea vomiting (early small bowel) constipation, no passage of flatus. Signs abdominal distension, peristalsis, tenderness, rigidity, Auscultation - hyperactive bowel sound. Strangulation - tachycardia, abdominal tenderness, fever, leucocytosis, acidosis
Term
Intestinal psuedo obstructionq
Definition
no mechanical cuase. causes - post trauma, surgery, sepsis, pneumonia, metabolic, drugs. presentation - as per obstruction. management - withdrawel of drugs, treat offending cause, iv neostigmane
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