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What is Diastasis recti?
Not a true hernia, represents a weakened abdominal fascia, usually happens post pregnancy or with obesity
What type of �hernia� causes tenting when you have the patient lie on their back and put their head up?
What is the pathogenesis of diastasis recti?
The abdominal muscles bow outward because of abdominal girth
What is the treatment for diastasis recti?
Reduce obesity and PT for abdominal muscle strengthening
Where is pilonidal disease usually found?
Intergluteal cyst, abscess or sinus tract of the upper part of the natal cleft
Is pilonidal disease more common in men or women?
What is the peak incidence of pilonidal disease?
35 to 45 rare over 45yo
what is the major complication of pilonidal disease?
Can form absess and follow sinus tract to form bigger abcess
Your patient is having trouble sitting recently, they have minor discomfort around the anus. The patient said they looked at it with a mirror and were surprised to see that it was swollen and red, they also ruefully tell you that they are �hairy back there� as they drop their pants for the rectal exam before looking at the rectum what do you think is the diagnosis?
What are some signs and symptoms of Acute abscess in a patient with pilonidal disease?
- Sudden onset of severe pain and swelling
- acutely inflamed mass noted overlying the sacrum or coccyx
- fever is unusual unless cellulitis is present
- may occur following trauma
Describe a Chronic pilonidal cyst
persistent drainage from the sinus connected to the cyst 1 or more sinus openings with drainage of mucoid or purulent fluid
What are the treatment options for patients with Pilonidal cysts?
- Sitz baths/donuts
- surgical treatments- I and D if acute
- Surgical excision cysts and tracts = definitive treatment with primary or secondary closure
- Antibiotic to cover skin flora if exacerbated- no indication for long term use
- can recur Prevention is shaving hair of gluteal area
A common western diet with low fiber puts a person at risk of what disease?
Where do diverticula form?
Where blood vessels penetrate the colon
What part of the colon are diverticula most common in?
silent disease where patient has diveraticula but they don't cause a problem they are silent
when those diverticuli get infected or perforate or abscess or become inflammed
sac like protrusion of the colonic wall
What are some concerns/complications of diverticular disease?
- fistula formation- openings to bladder or vagina
What will you find on history and physical of a patient with diveraticular disease
- often asymptomatic
- crampy LLQ pain
- alternating diarrhea constipation
- with or without fever
- can develop lower gi bleed
What diagnostic tests would you run on a patient who you suspect has diverticulitis
- none if asymptomatic
- occult blood and stool leukocytes
- abdominal plain film free air for perforation
- CT of abdomen- if they don't respond to treatments
- Other- barium enema but only if not acute b/c you risk perfing their colon same with colonoscopy
What are 4 complications of Diverticulitis?
- Perforation- secondary to incresed intraluminal pressure insipissated food particles or inflammation necrosis and infection
- Peritonitis- purulent or fecal
- abscess or fistula- can cause communication
- stricture- from scarring predisposition to obstruction
What is the Treatment/Prevention for Diverticulitis
- Prevention: high fiber diet, exercise, adequate liquids
- Treatment: bowel rest, antibiotics if diverticulitis, surgical repair of any damage
- Other strategies: treat constipation, increase exercise, increase fiber
Genetic disorder that has an increased gastric polyp incidence and thus an increased risk of colon cancer require frequen colonoscopies 1-2 scopes per year starting at age 10
Familial polyposis syndrome
Clinical symptoms of colonic polyps
- generally asymptomatic
- constipation, flatulence, rectal bleeding
What diagnostic tests do you do for a patient with colonic polyps?
Colonoscopy, Occult blood test, biopsy of the polyp
This type of colonic polyp has a higher risk of cancer and tend to be on the right side and very large
hyperplastic and inflammatory
These types of colonic polyp are on the left side and generally have a lower risk of cancer
adenoma and adenomatous polyps
What are some risk factors for colon cancer?
- Pts over 50 y.o.
- Diet rich in red and processed meats
- inflammatory bowel disease
- inherited disorders (FAP, hereditary non-polyposis colon cancer)
- Heavy EtOH
List the six type of hernia
epigastric, incisional, umbilical, direct inguinal, indirect inguinal, femoral
Name the 3 ventral hernias
epigastric, umbilical, incisional
Where does the weakness occur in a ventral hernia?
In the anterior abdominal wall
Where does an epigastric hernia occur?
Area between the breastbone to the umbilicus
Are epigastric hernias mostly congenital or aquired?
What is the most common type of incisional hernia?
Which are better upper incisions or lower incisions
which are better verticle incisions or transverse incisions?
3 post surgical factors that contribute to hernia risk
tension, technique, infection
True or false once a hernia is fixed it will never rupture again
False recurrence rate after surgical repair is 25-50%
Weak muscle next to the opening of inguinal canal, occurs in men over 40 years aging or injury, or weakness in Hesselbach's triangle
Direct inguinal hernia
�weakness in Hesselbach's triangle�
Direct inguinal hernia
Most common type of hernia in men
Indirect inguinal hernia
When a loop of intestine and/or fat goes through or into the inguinal canal
Indirect inguinal hernia
Most common inguinal hernia in women
Weakness in the femoral canal area of the groin
What type of inguinal hernia is most likely to become incarcerated or strangulated?
What are some risk factors for a femoral hernia
- Female especially older
- prior childbirth
- muscle weakness
- prior inguinal repair
What are some symptoms of inguinal herniation
- heaviness or dull sense of discomfort
- worsens with strainign lifting end of day or with prolonged standing
- manual/physically active professions are aware before more sedentary workers
- incarceration and strangulation
- pain in area of hernia
What is a sports hernia ?
Unilateral pain in the groin without demonatrated hernia
Who is more likely to get a sports hernia men or women?
Sports hernia are more common in sports that involve what motion?
Leaning forward and bending (hockey, soccer, rugby, football)
What are some causes of sports hernias?'
- repetitive strain in the inguinal area
- tear external oblique with illioinguinal nerve injury
- osteitis pubis
- myotendinous strain- adductor rectus
You have a hockey player who presents to you with groin pain especially increased with coughing and sneezing what do you diagnose?
What kind of imaging do you get for a sports hernia?
- Osteitis pubis is possible so bone scan
- MRI/US- occult hernias
What is treatment for a sports hernia?
Rest, NSAIDs, Ice packs, surgical consult if it fails conservative exploratory and repair
occurs when the antemesenteric wall of the intestine protrudes through a defect in the abdominal wall. If such a herniation becomes necrotic and is subsequently reduced during hernia repair, perforation and peritonitis may result. A Richter's hernia can result in strangulation and necrosis in the absence of intestinal obstruction. It is a relatively rare but dangerous type of hernia.
- �Lateral Ventral hernia�
- developse through the spigelian fascia
- occurs between the muscles found in the abdominal wall
- Linea semilunaris on each side of the rectus abdominus
- osften little outward evicence of swelling so may go undetected longer
- occur in men and women equally