Hernias and Intestinal Obstructions
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| What is the most common type of hernia? | Inguinal Hernia
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| Where does the inguinal hernia occur? | at the point of weakness in the abdominal wall where the spermatic cord in men and the round ligament in women emerge.
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| Where does the femoral hernia occur? | Occurs when there is a protrusion through the femoral ring into the femoral canal.
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| When does the umbilical hernia occure? | when the rectus muscle is weak or the umbilical opening fails to close after birth.
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| Where does a Ventral/Incisional hernia occure? | weakness of the abdominal wall at the site of a previous incision.
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| What hernia is most common in men? | Inguinal hernia
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| What hernia is more common in women? | Femoral hernia
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| What hernia is more common in children? | Umbilical hernia
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| What hernia is related to poor nutrition or infection? | Ventral/Incisional
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| Define reduceable hernia: | the protruding structure can be replaced to its original position in the abdominal cavity via manipulation, by having the patient lie down supine while careful manual pressure and manipulation is supplied over the site of protrusion.
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| Define irreducible hernia: | the hernia cannot be manually manipulated and replaced into the abdominal cavity.
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| Define hernial incarceration: | edema of the hernia and constriction of the muscular opening around it makes it impossible for the hernia to be reduced.
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| Define strangulated hernia: | a hernia is strangulated when the blood supply and intestinal flow are occluded. Immediate surgical intervention is required.
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| What do most hernias occure from? | congenital or acquired weakness of the abdominal wall... or from a postoperative defect, coupled with increased intra-abdominal pressure from coughing or straining
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| True or False: More hernias occur with transverse incisions than with longitudinal incisions. | False. More hernias occur with longitudinal incisions than with transverse incisions.
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| Severe pain with a hernia is caused by what? | strangulation of the hernia
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| Strangulation of a hernia will cause what? | *Severe pain *Bowel obstruction *Vomiting *Distension *Abdominal cramping
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| What is the most common sign of a hernia? | the most common sign is to visualize the protruding mass or bulge
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| Hernias can be left unrepaired until when? | Until complications occur.
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| How can a hernia be manually reduced? | By using a truss or firm pad placed over the hernia site and held in place with a belt.
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| Define hiatal hernia? | A hiatal hernia occurs when a portion of the stomach prolapses through the diaphragmatic esophageal hiatus
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| How are the majority of hiatal hernias found? | The majority of hiatal hernias are asymptomatic and are discovered incidentally
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| What are other names for hiatal hernia? | Also called an esophageal or diaphragmatic hernia
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| What life threatening complication can present acutely with a hiatal hernia? | gastric volvulus or strangulation
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| What percent of the population do Hiatal hernias affect? | 40%
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| What are the predisposing factors of hiatal hernias? | *Obesity. *Pregnancy. *Trauma. *Ascites.
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| Define sliding hiatal hernia: | occurs when the gastroesophageal junction, along with a portion of the stomach, migrates into the mediastinum through the esophageal hiatus.
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| Define paraesophageal hernia: | The widened hiatus permits the fundus of the stomach to protrude into the chest, anterior and lateral to the body of the esophagus; however, the gastroesophageal junction remains below the diaphragm, causing the stomache to rotate in a clockwise direction
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| What is the most common type of hiatal hernia? | Sliding hiatal hernia
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| What is another name for paraesophageal hernia? | Rolling-type hiatal hernia
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| The main symptoms of a hiatal hernia are associated with what? | with reflux and its complications.
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| True or False. The size of a hiatal hernia does not increase the severity of symptoms. | True. No clear correlation exists between the size of a hiatal hernia and the severity of the symptoms
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| Incarceration of a hiatal hernia is rare and is observed only with what hernia? | Paraesophogeal hernia
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| What two surgeries are used to correct a hiatal hernia? | *Posterior Gastropexy *Transabdominal or Transthoracic Fundoplication
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| What is the most common problem of the diaphragm that affects the alimentary tract? | Hiatal hernias
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| If scrotal edema is present, what can be done to decrease it? | by elevating the scrotum on a rolled pad, applying an ice pack and providing a supportive device (jockstrap or briefs).
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| How should deep breathing and coughing exercises be done in a PT with a hernia? | Deep breathing is to be encouraged, but coughing discouraged.
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| What can the PT splint the hernia area with? | Pillow or pad
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| For how long should the PT avoid lifting heavy objects or straining with bowel movement after hernia surgery? | 5 - 6 weeks
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| How much should the nurse ambulate a hernia PT? | Limit the patient's activity to decrease further strain on the abdomen
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| How much secretion and reabsorption of electrolyte-rich fluid is interrupted in a PT with a bowel obstruction? | 7 - 8 liters
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| What builds up proximal to a bowel obstruction? | Large amounts of fluid, bacteria and swallowed air
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| Where do most bowel obstructions occur? | In the ileum
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| 90% of all mechanical bowel obstructions are due to what? | adhesions or incarcerated hernias
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| What is the most common cause of a non-mechanical bowel obstruction? | A paralytic ileus
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| What are the causes of a paralytic ileus? | *Abdominal surgery *Inflammatory reactions *Electrolyte abnormalities *Thoracic or lumbar trauma
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| What is heard upon auscultation of partial or early phase intestinal obstruction? | loud, frequent, high-pitched sounds during partial or early phases of mechanical obstruction
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| When are bowel sounds quiet when auscultating an intestinal obstruction? | Bowel sounds will be weak or absent with smooth muscle atony
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| Early intestinal obstruction will cause what? | An increase in peristaltic activity proximal to the obstruction. This will manifest itself as spasms or cramping abdominal pain.
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| True or False: Bowel obstructions eliminate bowel movements alltogether. | Fall. The PT may still void despite the bowel obstruction.
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| Why are Non-opioid analgesics are given in place of opioids to treat the pain? | Non-opioids do not decrease the intestinal motility seen with the administration of opioids.
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| Which intestinal obstructions require prompt medical attention? | Complete obstruction as seen in intussusception
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| Placing the postop PT in which position allows for greater diaphragm expansion? | Fowlers.
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| What is the purpose of an NG tube following intestinal surgery? | An NG tube is used to decompress the abdomen and relieve distension
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| Follow up teaching for the post-surgical intestinal obstruction PT includes what? | dietary management, prevention of constipation and recognition of early signs of recurrence.
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| Two common medications used in the treatment of constipation and diarrhea in a PT with bowel obstruction are what? | Mitrolan and Metamucil
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