Lesson 3

Neuro, Hernia and Pancreatic

disorders
 What is a hernia?
• A hernia is abnormal
protrusion parts of
organ or tissue.
• The most common
hernia occurs in
abdomen (intestines)
 Reasons for hernias
• Combination of increased abdominal pressure
and weakening of abdominal wall muscle
• Mix these two together and you get give-way
weakness!
 Types of hernias
1) Umbilical hernia is
common in new born
children who has weak
muscle around the
umbilicus
Also seen in older women
who have had multiple
pregnancies
 Types of hernias
2) Inguinal hernia is a
bulge through the inguinal
canal from small intestine
• most common type of
hernia
 Types of hernias
3) Femoral hernia is a
herniation of the
intestines into the femoral
hiatus and femoral canal

Femoral and inguinal area

usually occurs in people
who have a heavy lifting
job
 Types of hernias
4) Incisional hernia is
herniation of abdomen
thru the old scar of a
previous surgery because
in this area the muscles
are weak
 Types of hernias
5) Hiatal (epigastric)
Hernia
• where the upper part of
the stomach protrudes
into the chest cavity
through the esophageal
hiatus due to a tear or
weakness in the
diaphragm
Types Summarized
 Symptoms of hernia
• In first stage, the
patient feels burning in
the area which
increases by introducing
abdominal pressure
(coughing, sneezing,
lifting heavy objects)
• Next stage the bulging
in the area can be seen
with the naked eye.
 Resolution
1) Spontaneous
Reduction (some
hernias are reduced
by themselves)
2) Manual reduction (use
of the hands)
3) Surgery (more
common)
 Complications
1) Incarceration (when
the herniated organ does
not move back by itself
and gets stuck)
 Complications
2) Strangulation: when
the stuck herniated tissue
undergoes ischemia (due
to compression effect of
vessels)
There is the danger of
necrosis, infection and
septicemia.
The Pancreas
 The Pancreas
• The pancreas has a head, neck, body and tail
• Not unique to any abdominal quadrant
• The pancreas is unique in that it can act as a
digestive organ or as a gland
 Sphincter of Oddi
The sphincter of Oddi is a muscular valve that
controls the flow of bile through ducts from the
gallbladder and pancreas into the first part of
the small intestine
 The Pancreas: As a gland
• This organ acts like a
gland releasing
hormones
• 2 most important ones:

1) Insulin (decreases
blood sugar)
2) Glucagon (increases
blood sugar)
The Pancreas: As a digestive organ
• It also releases
pancreatic juice which is
rich in enzymes that
help break down food
for digestion
The Pancreas: As a digestive organ
• Normally these enzymes are not active inside
the pancreas and only after they enter the
intestine do they become active

• They would be damaging to the pancreas if

they were active!
 2 pancreatic diseases
• The 2 most common
diseases of the
pancreas as a digestive
organ are:

1) Pancreatitis
2) Pancreatic Cancer
 Pancreatitis
• Inflammation of the
pancreas
• Most common causes
are alcohol abuse
(chronic) and gallstones
(acute)
 Why gallstones?
• Gallstones can block the bile duct stopping
pancreatic enzymes from traveling to the
small intestine and forcing them back into the
pancreas.

• The enzymes then begin to irritate the cells of

the pancreas, causing the inflammation
associated with pancreatitis
 Why alcohol?
• Reason is not clear!

• The central hypothesis is that alcohol irritates

the sphincter of Oddi and then spreads
throughout the pancreas body
 Symptoms of acute pancreatitis
• Abdominal pain which is
very severe, radiates to
the back, and any
movements cause the
pain
• Nausea
• Vomiting
• Low grade fever
 Symptoms of acute pancreatitis
• Onset is usually
abrupt and
dramatic and may
follow a heavy
meal or an
alcoholic binge
 Symptoms of acute pancreatitis
• Most common initial
symptom is severe
abdominal pain that
radiates to the back
• the pain is
aggravated when the
person is lying supine
and is less severe
when the person is
sitting and leaning
forward
 Symptoms of chronic pancreatitis
• Over time, the enzymes produced by the
pancreas for digestion get less and less

• This leads to malabsorption of food in the gut

and can lead to blood sugar problems
(diabetes)and/or nutritional deficiencies
 Pancreatic Cancer
• Considered to be one of
the most deadly
malignancies
– Risk increases after age
50, most cases
occurring between the
ages of 60-80 years
– smoking appears to be
a major risk factor
 Pancreatic Cancer
• Appears to be an
association of
pancreatic cancer with
an increasing total
calorie intake and a
high intake of fat,
meat, salt, dehydrated
foods, fried foods,
refined sugars, soy
beans, and
nitrosamines
Neuropathology
 Spina Bifida

– congenital neural tube

defects characterized by
failure of posterior
spinous processes to
close

This causes protrusion of

meninges, and spinal cord
resulting in neurologic
impairment
 Spina Bifida

– Most cases are show a

skin depression, dark
tufts of hair or a reddish
stain at the site of the
defect
– This is because neural
tissue and skin tissue
both derive from
ectoderm as an origin
 Cerebral Palsy
• motor disorders caused
by cerebral damage
during fetal life, birth or
early childhood

– The condition is not

progressive but the
disease is irreversible
 Cerebral Palsy
• lack of coordination and
exaggerated reflexes
• Muscles are loose and
floppy or hard and stiff,
leading to muscle
contractures
• Intellect spared
 Seizures/Epilepsy
• Seizures are sudden
changes in the brain's
electrical activity.
• These changes can
cause dramatic,
noticeable symptoms or
it may not cause any
symptoms at all
 2 types of seizures
1) partial seizures: where the abnormal brain
activity is one single area of the brain and the
person does not lose consciousness
 2 types of seizures
2) generalized seizures: involve a larger area of
the brain and patients lose consciousness
 Epilepsy manifestations
Partial seizures are
associated with repeated
non-purposeful
movements such as
turning the head from side
to side

• Aka “petit mal” or “little

sick”
 Epilepsy manifestations

Generalized seizures
are associated with
intermittent
contraction and
relaxation of muscles

Aka “grand mal”

 Status epilepticus

• Occurs when seizures

are recurrent without a
full return to
consciousness from the
preceding seizure or any
seizure lasting more
than 30 minutes
 Epilepsy: Myths & Truths
• Myth: during a seizure, you can swallow your
tongue and die

• It is impossible to swallow your tongue!! At

worst, a seizure may cause you to bite it..
That’s about it
 Epilepsy Myths & Truths
• Myth: You should force something into the
mouth of someone having a seizure

• Never put anything into a person’s mouth if

they are having a seizure! This could actually
injure them or cause them to choke
 Epilepsy: Myths & Truths
• Myth: when someone has a seizure call 911!

• No!! The answer is… do nothing. Let them ride

it out. They will be fine after.
 Epilepsy Myths & Truths
• Myths: Epilepsy is more common in kids

• Epilepsy has been noted very, very young or in

the elderly, but really can occur at any age and
does not predelect any age group
 Epilepsy Myths & Truths
• Myth: Women with epilepsy shouldn’t get
pregnant

• Epilepsy does not affect a woman’s ability to

conceive and has a minimal effect on a child’s
development.
• However, if women are taking anti-epileptic
drugs, the risk of birth defects ranges from 2 to
10 percent
 Epilepsy Myths & Truths
• Myth: Epilepsy can be passed on to your kids

• Very little correlation. This is because a single

gene problem rarely causes epilepsy; it usually
involves a combination of gene defects in
multiple areas
 Epilepsy Myths & Truths
• Myth: if you have a seizure, you are epileptic

• A person is diagnosed with epilepsy when he or

she has two or more unprovoked (“out of the
blue”) seizures that occur more than 24 hours
apart.
• When something provokes a seizure, such as
binge drinking, sleep deprivation, or a new
medication, these are NOT related to epilepsy
 Trigeminal neuralgia

pain due to compression of

the trigeminal nerve (CN
V) 

There is severe pain in the

regions supplied by
trigeminal nerve and the
pain is extremely severe,
unilateral and transient.
 Migraine

– severe and recurrent

headaches with visual
disturbances and nausea

– They are often provoked

by a trigger factor which
includes hunger,
chocolate, red wine etc.
 Migraine
The headache is throbbing
and the pain is located on
one side, but may spread to
the entire head

• Pain is usually increased

by physical activity and
patient may experience
visual symptoms like
flashes of light before
onset of headache (aura)
 Stroke (cerebrovascular accident)
• a sudden disruption in
cerebral blood flow by
occlusion or rupture of blood
vessel

1) hemorrhagic- when the

cerebral artery ruptures
flooding the brain with blood
(fatal)

2) ischemic-due to occlusion of
an artery (may/may not be fatal)
 Symptoms of stroke
• Trouble with speaking
• Paralysis or numbness of
face, arm or leg
• Trouble with vision in 1 or
both eyes
• Sudden, severe headache
• Loss of balance
• Difficulty swallowing
• Memory loss or thinking
difficulties
 Causes of stroke
• High blood pressure
• Atherosclerosis
• Heart disease
• Smoking
• Alcohol
• Medications
• Diabetes
• Obesity
 Multiple Sclerosis

– progressive
autoimmune
demyelination of
the neurons of the
brain, spinal cord
and cranial nerves
(especially the optic
nerve)
 Parkinson’s Disease

– progressive degenerative
neurologic disorder due
to damage to neurons in
the basal ganglia

– Symptoms include
muscle rigidity, tremors
and slowness of
voluntary movements
and decreased emotion
 Alzheimer’s Disease
• progressive
degenerative disease of
brain
• Manifestations:
memory loss, changes
in personality
 Meningitis

– Infection/inflammation of
the meninges (protective
covering of central
nervous system)
– generalized headache,
neck stiffness, red skin
rash, and projectile
vomiting
– muscular weakness,
mental confusion, and
even coma.
 Spinal/Brain injuries: Important words

• Paresis: weakness, but still movement

• Plegia: no movement at all!

• Hemi: half – one leg and one arm same side or

one leg alone or one arm alone
• Para: both arms or both legs
• Quad: all 4 limbs
 If it is half… which side????
• It depends!!!!

• If the lesion is the brain (motor cortex) then

contralateral

• If the lesion is in the spinal cord, then

ipsilateral
 Spinal Cord Injury

– If the injury is in cervical

spine, quadriplegia
(paralysis of trunk and all
four extremities) results
 Spinal Cord Injury
- damage to thoracic
or lumbar region of
spinal cord results in
paraplegia (paralysis
of lower trunks and
legs).
 Spinal Cord Injury
Hemiplegia: (paralysis
of one half of the
body) comes from
damage to one half
of the cord
 Spinal Cord Injury
Hemiparesis: means
weakness on one side of
the body but not
complete paralysis
 Self Test questions
• What position aggravates acute pancreatitis?
• What are the two most common causes of acute
pancreatitis?
• What is the most common type of hernia?
• What would the effect be of a spinal cord injury in the
thoracic region?
• What type of stroke is always fatal?
• What is the visual disturbance preceding a migraine called?
• What is the typical referral pain pattern for pancreatitis?
• Name 2 risk factors for pancreatic cancer?
 Self Test Questions
• What is the difference between hemiparesis
and hemiplegia?
• What structure herniates in a hiatal hernia?
• What type of seizures cause loss of
consciousness?
• What is meant by “status epilepticus”?
• What would an injury to the cervical spinal
cord produce?