PCM Hernias Flashcard.txt

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BostonPhysicianAssist
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116785
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PCM Hernias Flashcard.txt
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2011-11-14 18:34:36
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Hernia
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Hernia Lecture
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  1. What is Diastasis recti?
    Not a true hernia, represents a weakened abdominal fascia, usually happens post pregnancy or with obesity
  2. What type of �hernia� causes tenting when you have the patient lie on their back and put their head up?
    Diastasis Recti
  3. What is the pathogenesis of diastasis recti?
    The abdominal muscles bow outward because of abdominal girth
  4. What is the treatment for diastasis recti?
    Reduce obesity and PT for abdominal muscle strengthening
  5. Where is pilonidal disease usually found?
    Intergluteal cyst, abscess or sinus tract of the upper part of the natal cleft
  6. Is pilonidal disease more common in men or women?
    Men
  7. What is the peak incidence of pilonidal disease?
    35 to 45 rare over 45yo
  8. what is the major complication of pilonidal disease?
    Can form absess and follow sinus tract to form bigger abcess
  9. 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?
    Pilonidal disease
  10. 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
  11. 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
  12. 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
  13. A common western diet with low fiber puts a person at risk of what disease?
    Diveriticular disease
  14. Where do diverticula form?
    Where blood vessels penetrate the colon
  15. What part of the colon are diverticula most common in?
    Sigmoid colon
  16. Divriticulosis
    silent disease where patient has diveraticula but they don't cause a problem they are silent
  17. Diverticulitis-
    when those diverticuli get infected or perforate or abscess or become inflammed
  18. Diverticulum-
    sac like protrusion of the colonic wall
  19. What are some concerns/complications of diverticular disease?
    • Diverticulitis
    • abscess
    • PERITONITIS
    • fistula formation- openings to bladder or vagina
    • bleeding
  20. 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
  21. 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
  22. 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
  23. 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
  24. 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
  25. Clinical symptoms of colonic polyps
    • generally asymptomatic
    • constipation, flatulence, rectal bleeding
  26. What diagnostic tests do you do for a patient with colonic polyps?
    Colonoscopy, Occult blood test, biopsy of the polyp
  27. 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
  28. These types of colonic polyp are on the left side and generally have a lower risk of cancer
    adenoma and adenomatous polyps
  29. 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)
    • Obesity
    • Smoker
    • Heavy EtOH
    • Diabetes
  30. List the six type of hernia
    epigastric, incisional, umbilical, direct inguinal, indirect inguinal, femoral
  31. Name the 3 ventral hernias
    epigastric, umbilical, incisional
  32. Where does the weakness occur in a ventral hernia?
    In the anterior abdominal wall
  33. Where does an epigastric hernia occur?
    Area between the breastbone to the umbilicus
  34. Are epigastric hernias mostly congenital or aquired?
    Congenital
  35. What is the most common type of incisional hernia?
    Midline incisions
  36. Which are better upper incisions or lower incisions
    upper incisions
  37. which are better verticle incisions or transverse incisions?
    Verticle
  38. 3 post surgical factors that contribute to hernia risk
    tension, technique, infection
  39. True or false once a hernia is fixed it will never rupture again
    False recurrence rate after surgical repair is 25-50%
  40. 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
  41. �weakness in Hesselbach's triangle�
    Direct inguinal hernia
  42. Most common type of hernia in men
    Indirect inguinal hernia
  43. When a loop of intestine and/or fat goes through or into the inguinal canal
    Indirect inguinal hernia
  44. Most common inguinal hernia in women
    Femoral
  45. Weakness in the femoral canal area of the groin
    Inguinal hernia
  46. What type of inguinal hernia is most likely to become incarcerated or strangulated?
    Femoral hernia
  47. What are some risk factors for a femoral hernia
    • Female especially older
    • prior childbirth
    • muscle weakness
    • prior inguinal repair
  48. What are some symptoms of inguinal herniation
    • asymptomatic
    • 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
  49. What is a sports hernia ?
    Unilateral pain in the groin without demonatrated hernia
  50. Who is more likely to get a sports hernia men or women?
    Men
  51. Sports hernia are more common in sports that involve what motion?
    Leaning forward and bending (hockey, soccer, rugby, football)
  52. 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
  53. You have a hockey player who presents to you with groin pain especially increased with coughing and sneezing what do you diagnose?
    Sports hernia
  54. What kind of imaging do you get for a sports hernia?
    • Osteitis pubis is possible so bone scan
    • MRI/US- occult hernias
  55. What is treatment for a sports hernia?
    Rest, NSAIDs, Ice packs, surgical consult if it fails conservative exploratory and repair
  56. Richters Hernia
    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.
  57. Spigelian 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

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