Hernia

Hernia

1. HERNIA

• It is the protrusion of an organ or part of an organ through the wall of the cavity that
normally contains it.
• It is classified by location.

Types of Hernia
• Inguinal hernia
• Umbilical hernia
• Incisional or ventral hernia
• Hiatal hernia

Inguinal hernia
Pathophysiology
• Often are congenital, caused by improper closure of the tract that develops as the testes
descend into the scrotum during fetal development.
• Or acquired defects that result from weakness of the posterior inguinal wall.

Indirect inguinal hernia
• Are caused by improper closure of the tract that develops as the testes descend into
scrotum before birth.
• A sac of abdominal contents protrudes through the internal inguinal ring into the inguinal
canal.
• It often descends into the scrotum.
• often not evident until adulthood, when increased intra-abdominal pressure and dilation
of inguinal ring allow contents to enter the channel.

Direct inguinal hernias
• Are acquired defects that result from weakness of the posterior inguinal wall.
• Usually affect older adults

Clinical Manifestations
• May produce no manifestations
• May cause a lump, swelling, or bulge in the groin, particularly with lifting or straining.
• May cause sharp pain or a dull ache that radiates into the scrotum.
• A palpable mass may be present in the groin, although it may be felt only with increased
intra-abdominal pressure (as occurs during coughing).

Umbilical hernia
Pathophysiology
• Pregnancy and obesity contribute to the development of umbilical hernias in adults
• May be congenital and evident during infancy, or acquired as the tissue closing the
umbilical ring weakens, allowing protrusion of abdominal contents.
• More common in women.

Clinical manifestations
• May cause sharp pain on coughing or straining or a dull, aching sensation.

2. Incisional or ventral hernia
Pathophysiology
• Occurs at a previous surgical incision or following abdominal muscle tears
• Contributing factors include poor wound closure, postoperative infection, age or debility,
obesity, and excess incisional stress caused by vigorous coughing.

Clinical manifestation
• Characterized by a bulge at the incisional site, often noted when the client pulls to a sitting
position from lying position.

Hiatal hernias
Pathophysiology
• Sliding hiatal hernia, the gastroesophageal junction and the fundus of the stomach slide
upward through the esophageal hiatus.

Contributing factors include:
• weakened gastroesophageal-diaphragmatic anchors
• shortening of the esophagus
• increased intra-abdominal pressure.

Pathophysiology
• In a paraesophageal hiatal hernia, the junction between the esophagus and stomach
remains in its normal position below the diaphragm while a part of the stomach herniates
through the esophageal hiatus.
• Further classified as type II, III, or IV. Depending on the extent of herniation, with type
IV having the greatest herniation.

Clinical Manifestations
• Sliding hernia:
→ 50% of patients with sliding hernia are asymptomatic.
→ Heartburn
→ Regurgitation
→ Dysphagia
• Paraesophageal hernia:
→ Sense of fullness after eating or chest pain, or there may be no symptoms.
→ Reflux usually doesn’t occur, because the gastroesophageal sphincter is intact.

Complications
• If the content of hernia cannot be returned to the abdominal cavity, it is said to be
incarcerated.
• Incarceration increases the risk of complications, including obstruction and strangulation.
• Obstruction occurs when the lumen of the bowel contained within the hernia becomes
occluded.
• A strangulated hernia develops when blood supply to bowel and other tissues in the hernia
sac is compromised, leading to a necrosis.
• The affected bowel can infarct, leading to perforation with contamination of the potential
cavity.

3. Diagnostic tests
• Diagnosis is made by physical examination
→ The client is examined in a supine or standing position
→ A bulge may be seen or felt when the client coughs or bears down.
• Diagnosis of hiatal hernia can be confirmed by:
→ X-ray
→ Barium swallow
→ Fluoroscopy

Medical and surgical management
• Surgical repair, or herniorrhaphy, is the usual treatment for hernia
→ Abdominal wall defect is closed by suturing or with wire or mesh over the defect.
• If incarceration has occurred or strangulation is suspected, the abdomen is explored at the
time of surgery and any infarcted bowel restricted.
• Hiatal hernia:
→ Frequent, small feedings that can pass easily through the esophagus.
→ The patient is advised not to recline for 1 hour after eating, to prevent reflux or movement
of the hernia
→ The patient is advised to elevate the head of bed on 4-8 inches blocks to prevent the hernia
from sliding upward.
→ Surgery is indicated in about 15% of patients.
• May require emergency surgery to correct torsion (twisting) of the stomach or other body
organ that leads to restriction of blood flow to that area.

Nursing Process

Assessment Nursing
Diagnosis
Goal Interventions Outcome
Bulging at
hernia site
Risk of
ineffective
tissue perfusion
r/t hernia and
the possibility
of obstruction
and
strangulation
Complications
will be avoided
next 24 hours
Watch for and
immediately
report signs of
incarceration
and
strangulation
There is no
signs of
complications
within 24 hours
Patient is
complaining of
pain 5 on score
Acute pain r/t
swelling and
pressure
The patient will
express feelings
of comfort
• Watch for and
immediately
report signs of
incarceration
and
strangulation.
• Administer
I.V. fluids and
analgesics for
pain as ordered.
• Place the
patient in
Trendelenburg’s
position to
Pain was
relieved from 5
to 2 on score

4. reduce pressure
on the hernia
site.
Patient said that
he often have
oral
regurgitation
after meals
Risk of
aspiration r/t
reflux of gastric
content.
Client will be
able to state the
steps in
preventing
aspiration after
2 hours of
nursing
interventions
• Instruct to take
small frequent
meals
• Encourage not
to take meals 2
hours before
bed time.
Patient has no
episodes of oral
regurgitation
after 2 hours of
interventions.
Patient has
repeated doubts
regarding
surgery
Fear and
anxiety r/t
hospitalisation
Patient to be
free from
anxiety with 2
hours of
interventions
• Explain the
procedure to the
patient in
simple terms
• Introduce the
patient to
similar patients
who had
undergone the
surgery.
Patient is
relieved of fear
and anxiety as
he state it.

Summary
• It is the protrusion of an organ or part of an organ through the wall of the cavity that normally
contains it.
• Inguinal hernia, Umbilical hernia, Incisional or ventral hernia, and Hiatal hernia
• Main manifestation is bulging or pain.
• Incarceration leads to obstruction or strangulation
• Diagnosed mainly with physical exam
• Surgical repair is the treatment
• Nurses play a significant role in care of patients with hernia.