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Epigastric hernia

1. Protrusion of extraperitoneal fat / peritoneal contents through a small defect in the linea alba
2. Usually halfway between xiphoid process and umbilicus
3. Usual presentation
   • Commonly confused with upper GI pathology
   • Epigastric pain which may increase after meals
   • May be acutely painful after physical exercise
   • Nause and early satiety
   • Reflux and non-ulcer dyspepsia

Approach

• Expose abdomen

1. Inspect
   • Lump may appear when asking patient to lift head off bed
   • Ask patient to cough to see if this becomes more prominent
2. Palpate
   • Can be difficult to find the hernia
   • Try to identify the borders of the defect and the size of the neck
3. Percuss
4. Auscultate

Completion

1. Complete the abdominal examination

Treatment options

1. Non-surgical
2. Surgical (site should be marked with patient lying supine)
   • Excise sac
   • Repair defect