Hernias

 

A rupture in smooth muscle tissue through which a part of the body protrudes abnormally through a tear or opening in an adjacent part, especially of the abdomen.

Patho

  • Weakening of containing membranes or muscles.

 

Etiology

  1. Usually congenital:
  • tendency of herniae runs in families

 

  1. Risk increases with age:

degeneration of the annulus fibrosus of the intervertebral disc)

 

  1. Chronically increase intra-abdominal pressure:
  • pregnancy

abdominal hernias are very frequent.

Types of Herniation

Hiatal hernia

  • hernia resulting from the protrusion of part of the stomach through the diaphragm opening and enters thoracic cavity
  • hiatus: junction where esophagus and stomach meet through the diaphram
  • typically a small, tight junction, yet aging, or other factors allows it to enlarge

 

2 Types of Hiatial hernia

  1. Sliding Hiatal hernia

 

  • A sliding hernia occurs as the gastroesophageal junction and part of the stomach protrude intot the thoracic cavity
  • 95% of cases

 

Sliding hiatal hernia manifestation

  • heartburn (gastric acids damaging esophageal lining)
  • reflex
  • substernal pain
  • 50% asymptomatic

 

  1. Paraesophageal Rolling Hiatal Hernia

 

  • gastroesophageal junction remains attached at the level of the diaphragm, but part of the stomach bulges into the thoracic cavity.

 

Paraesophageal hiatal hernia manifestation

  • no reflux
  • chest pain
  • sensation of fullness post meal
  • dyspnea

 

Hiatal Hernia Tx

  • Raised head of bed to prevent reflux
  • Medications to ↓ acid reflux
  • Fundoplication: surgical procedure (15% of cases) where the upper part of the stomach is wrapped around the lower oesophagus and sutured in place to repair herniation.

 

 

Inguinal Hernias

Protrusions of part of the intestine through the muscles of the groin. The peritoneum forms hernal sac

containing intestine and omentum.

  • The inguinal canal is a passage in the anterior abdominal wall which in men conveys the spermatic cord and in women the round ligament.
  • Direct inguinal hernia: herniation occurring next to the opening of the inguinal canal in the groin area. Occurs in both sexes.
  • Indirect inguinal hernia: results from the failure of embryonic closure of the internal inguinal ring after the testicle has passed through it.

Tx

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