final - Hernias o o Caused by weakness/defects in anterior...

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Hernias o Caused by weakness/defects in anterior abdominal wall o Portions of small bowel protrude o Types: inguinal, umbilical, femoral, incisional o Present as bulges o Worsened by increased intraabdominal pressure (heavy lifting, coughing, sneezing) o Disappear when lying down Diagnosis o Clinical: history, physical exam o Irreducible hernia: bowel entrapped/obstructed o Blood supply compromised o Strangulated hernia: death of entrapped loop of bowel o Surgical emergency o Synthetic mesh required to cover defect Inguinal Hernias Indirect: result of patent processus vaginalis o Originate lateral to inferior epigastric vessels Direct: caused by weakness in transverses abdominis muscle o Associated w/ chronic, repetitive increase in intraabdominal pressure (athletes, chronic cough, constipation) o Originate medial to IEV Incisional Hernias o Occur after surgical incision of fascia o Bowel protrudes through all/part of prior incision o Surgical repair Umbilical Hernias o Congenital (present at birth) o Result of abdominal wall defect at umbilicus o Children: often resolve spontaneously o Surgical repair by age 4 if persistent o Adults: acquired during pregnancy Fetal Gastroschisis and Omphalocele Normal development of embryo o Midgut herniates outward through umbilical ring, continues to grow o 11 th  week of gestation: returns into abnormal cavity o undergoes normal rotation/fixation o closure of umbilical ring
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This note was uploaded on 02/02/2009 for the course BISP bisp 194 taught by Professor J during the Fall '07 term at UCSD.

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final - Hernias o o Caused by weakness/defects in anterior...

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