MedLecturesMadeEasy Bowel hernias

🎯 Загружено автоматически через бота: 🛑 Оригинал: 📺 MedLecturesMadeEasy — @MedLecturesMadeEasy 📃 Оригинальное описание: This is a short video on bowel hernias. This video was created with Google Slides and all images and figures were created or adapted from Wikimedia Commons. ADDITIONAL TAGS: Bowel hernias Intro: reducible incarcerated strangulated Inguinal hernias Femoral hernias Incisional hernias Diaphragmatic hernias Umbilical hernias and Abd wall defects By BruceBlaus - Own work, CC BY-SA 4.0, Reducible: hernia that can be pushed out (by strain, cough, exercise, etc) but can be pushed back in. Worsened with Valsalva/standing, better while supine. Treatment: elective surgery if femoral; elective surgery or watchful waiting if inguinal. Diagnose with history and physical → CT/MRI if needed Incarcerated: not reducible back into abdomen/pelvis; irreducible; cannot be pushed back in. Signs of small bowel obstruction: progressive abdominal pain, nausea/vomiting, high-pitched bowel sounds on examination, and distended loops of bowel with air-fluid levels on x-ray. Treatment: urgent surgery Strangulated Also irreducible; blood supply is cut off → ischemia, necrosis Sx: tenderness, fever, erythema peritoneal signs : abd pain worse with motion, n/v, fever, swollen/distended/tight/rigid abdomen, rebound tenderness Treatment: emergent surgery (within 4-6 hrs), broad spectrum abx By National Institutes of Health - , Public Domain, a) rectus abdominis (conjoint tendon) b) inferior epigastric vessels c) inguinal ligament By Anpol42 - Own work, CC BY-SA 3.0, Direct inguinal hernia directly through the abdominal wall muscle (weak point in transversalis fascia), within Hesselbach triangle through the external inguinal ring (but not rest of inguinal canal) → covered by external spermatic fascia. Usually don’t protrude into scrotum medial to inferior epigastric vessels acquired as adult; usually older men Indirect inguinal hernia through both internal and external inguinal rings → covered by 3 layers of spermatic fascia lateral to inferior epigastric vessels congenital (infants, premies) or adult onset most common in M and W By - , CC BY-SA 4.0, Pass under inguinal ligament Through the femoral ring Medial to the femoral vein, and lateral to the lacunar ligament Usually seen in older women. W M Signs/symptoms: progressive abdominal pain, nausea/vomiting, high-pitched bowel sounds on examination, and distended loops of bowel with air-fluid levels on x-ray Elective surgery even if reducible (unlike inguinal hernias where you can do watchful waiting) Don’t confuse with pulsatile mass below below inguinal ligament → femoral artery aneurysm (associated with AAA) Incisional hernia (aka ventral hernia) Usually iatrogenic: Incorrectly healed surgical wound. Bowel bulges or protrudes at or near surgical incision Caused by failure of fascia to close Risk factors: high intra abd pressure (cough [COPD], urinary obstruction, constipation, pregnancy, etc) Treatment often requires re-incision and repair; /- mesh High recurrence rates Abdominal bowel enters the thorax through the esophageal hiatus Left right since liver shields the right side of diaphragm Pic C: Sliding hiatal Gastroesophageal junction goes into thorax Hourglass shape Reduce surgically (Nissen fundoplication); medically manage GERD Pic D: Paraesophageal Fundus of stomach goes into thorax Retrocardiac air-fluid level within the thoracic cavity GE junction is fine Diaphragmatic hernia By Mysid - Self-made in Inkscape, based on File:Hiatus ., CC0, Umbilical hernia and abdominal wall defects Umbilical hernias can be congenital: more common in African descent; associated with Down syndrome aquired: pathophys: obese, coughing, multiparous → high abd pressure reducible, incarcerated, strangulated Abdominal wall defects Omphalocele Herniation of abd contents into umbilicus, covered by peritoneum Gastroschisis Herniation of uncovered abd contents out of abdomen, through abd folds (usually to right of umbilicus) By Internet Archive Book Images - book page: #page/n60/mode/1up, No restrictions, By Adewale O. Oyinloye1*, Auwal M. Abubakar1, Samuel Wabada2 and Lateef O. Oyebanji1 - , CC BY 4.0,