Hernia

Hernia

1. HERNIAHERNIA
PRESENTED BY: PRESENTED BY:
PROF.VIJAYREDDY VANDALIPROF.VIJAYREDDY VANDALI
DEPT OF MEDICAL-SURGICAL NURSINGDEPT OF MEDICAL-SURGICAL NURSING
INDIA.INDIA.

2. DEFINITIONDEFINITION

A hernia is an abnormal weakness or hole A hernia is an abnormal weakness or hole
in an anatomical structure which allows in an anatomical structure which allows
something inside to protrude through.something inside to protrude through.

A Hernia is protrusion of an organ or the A Hernia is protrusion of an organ or the
muscular wall of an organ through the muscular wall of an organ through the
cavity that normally contents it. It is an cavity that normally contents it. It is an
abnormal protrusion of the intestine or abnormal protrusion of the intestine or
other abdominal organ through a other abdominal organ through a
weakness or defect in the musculature weakness or defect in the musculature
into another cavity. into another cavity.

3. CLASSIFICATIONCLASSIFICATION

INGUINAL HERNIAINGUINAL HERNIA

HIATUS HERNIAHIATUS HERNIA

FEMORAL HERNIIAFEMORAL HERNIIA

UMBILICAL HERNIAUMBILICAL HERNIA

INCISIONAL HERNIAINCISIONAL HERNIA

EPIGASTIC HERNIAEPIGASTIC HERNIA

OBTURATOR HERNIAOBTURATOR HERNIA

VENTRAL HERNIAVENTRAL HERNIA

HERNIATION OF INTERVERTEBRAL HERNIATION OF INTERVERTEBRAL
DISCDISC

4. INGUINAL HERNIAINGUINAL HERNIA

An inguinal hernia occurs in the An inguinal hernia occurs in the
groin (the area between the abdomen groin (the area between the abdomen
& thigh). It is called inguinal because & thigh). It is called inguinal because
the intestines push through a weak the intestines push through a weak
spot in the inguinal cavity, which is a spot in the inguinal cavity, which is a
triangle shaped opening between triangle shaped opening between
layers of abdominal muscle near the layers of abdominal muscle near the
groin.groin.

5. TYPES OF INGUINAL TYPES OF INGUINAL
HERNIAHERNIA

Indirect Inguinal HerniaIndirect Inguinal Hernia

Direct Inguinal Hernia Direct Inguinal Hernia

6. Indirect Inguinal HerniaIndirect Inguinal Hernia

Fallow pathway that testicles made Fallow pathway that testicles made
during prebirth development. This during prebirth development. This
pathway normally closes before birth pathway normally closes before birth
but remains a possible place for a but remains a possible place for a
hernia. Some time the hernia sac hernia. Some time the hernia sac
may protrude into the scrotum. may protrude into the scrotum.

7. Direct Inguinal Hernia Direct Inguinal Hernia

This occurs slightly to the This occurs slightly to the
inside of the sight for the inside of the sight for the
indirect hernia, in a place indirect hernia, in a place
where the abdominal wall is where the abdominal wall is
naturally slightly inner. It rarely naturally slightly inner. It rarely
protrude into the scrotum.protrude into the scrotum.

8. HIATUS HERNIAHIATUS HERNIA

10. Types of HerniasTypes of Hernias

Inguinal hernia: Makes up 75% of all abdominal Inguinal hernia: Makes up 75% of all abdominal
wall hernias and occurring up to 25 times more wall hernias and occurring up to 25 times more
often in men than women.often in men than women.

Two types of inguinal hernias: indirect inguinal Two types of inguinal hernias: indirect inguinal
hernia and direct inguinal hernia.hernia and direct inguinal hernia.

Indirect inguinal herniaIndirect inguinal hernia

follows pathway that testicles made during prebirth follows pathway that testicles made during prebirth
development. development.

This pathway normally closes before birth but remains This pathway normally closes before birth but remains
a possible place for a hernia.a possible place for a hernia.

11. Cont.Cont.

Sometimes the hernial sac may protrude into the scrotum. Sometimes the hernial sac may protrude into the scrotum.

This type of hernia may occur at any age but becomes This type of hernia may occur at any age but becomes
more common as people age.more common as people age.

Direct inguinal hernia Direct inguinal hernia

This occurs slightly to the inside of the sight fo the indirect This occurs slightly to the inside of the sight fo the indirect
hernia, in a place where the abdominal wall is naturally hernia, in a place where the abdominal wall is naturally
slightly thinner.slightly thinner.

It rarely will protrude into the scrotum.It rarely will protrude into the scrotum.

The direct hernia almost always occurs in the middle-aged The direct hernia almost always occurs in the middle-aged
and elderly because their abdominal walls weaken as they and elderly because their abdominal walls weaken as they
age. age.

12. Types Cont.Types Cont.

Hiatus herniaHiatus hernia

A hiatus hernia occurs when the upper part of A hiatus hernia occurs when the upper part of
the stomach, which is joined to the the stomach, which is joined to the
oesophagus (gullet), moves up into the chest oesophagus (gullet), moves up into the chest
through the hole (called a hiatus) in the through the hole (called a hiatus) in the
diaphragm. diaphragm.

It is common and occurs in about 10 per cent It is common and occurs in about 10 per cent
of people. of people.

14. Hiatus herniaHiatus hernia

Symptoms include:Symptoms include:

HeartburnHeartburn

Sudden regurgitationSudden regurgitation

BelchingBelching

Pain on swallowing hot fluidsPain on swallowing hot fluids

Feeling of food sticking in the oesophagusFeeling of food sticking in the oesophagus

15. Hiatus herniaHiatus hernia

It is most common in overweight middle-It is most common in overweight middle-
aged women and elderly people. aged women and elderly people.

It can occur during pregnancy. It can occur during pregnancy.

The diagnosis is confirmed by barium The diagnosis is confirmed by barium
meal X-rays or by passing a tube with a meal X-rays or by passing a tube with a
camera on the end into the stomach camera on the end into the stomach
(gastroscopy). (gastroscopy).

16. Treatment for Hiatus HerniaTreatment for Hiatus Hernia

Losing weight nearly always cures it. Losing weight nearly always cures it.

Eating small meals each day instead of 2 or 3 Eating small meals each day instead of 2 or 3
large ones helps. large ones helps.

Avoid smoking. Avoid smoking.

Take antacid. Take antacid.

Avoid spicy food. Avoid spicy food.

Avoid hot drinks. Avoid hot drinks.

Avoid gassy drinks. Avoid gassy drinks.

17. Types Cont.Types Cont.

Femoral herniaFemoral hernia

The femoral canal is the way that the femoral artery, The femoral canal is the way that the femoral artery,
vein, and nerve leave the abdominal cavity to enter vein, and nerve leave the abdominal cavity to enter
the thigh. the thigh.

Although normally a tight space, sometimes it Although normally a tight space, sometimes it
becomes large enough to allow abdominal contents becomes large enough to allow abdominal contents
(usually intestine) into the canal. (usually intestine) into the canal.

This hernia causes a bulge below the inguinal crease This hernia causes a bulge below the inguinal crease
in roughly the middle of the thigh. in roughly the middle of the thigh.

Rare and usually occurring in women, these hernias Rare and usually occurring in women, these hernias
are particularly at risk of becoming irreducible and are particularly at risk of becoming irreducible and
strangulated. strangulated.

19. Types Cont.Types Cont.

Umbilical herniaUmbilical hernia

These common hernias (10-30%) are often noted at These common hernias (10-30%) are often noted at
birth as a protrusion at the bellybutton (the birth as a protrusion at the bellybutton (the
umbilicus). umbilicus).

This is caused when an opening in the abdominal This is caused when an opening in the abdominal
wall, which normally closes before birth, doesn’t wall, which normally closes before birth, doesn’t
close completely. close completely.

Even if the area is closed at birth, these hernias can Even if the area is closed at birth, these hernias can
appear later in life because this spot remains a appear later in life because this spot remains a
weaker place in the abdominal wall. weaker place in the abdominal wall.

They most often appear later in elderly people and They most often appear later in elderly people and
middle-aged women who have had children. middle-aged women who have had children.

21. Types Cont.Types Cont.

Incisional herniaIncisional hernia

Abdominal surgery causes a flaw in the abdominal Abdominal surgery causes a flaw in the abdominal
wall that must heal on its own. wall that must heal on its own.

This flaw can create an area of weakness where a This flaw can create an area of weakness where a
hernia may develop. hernia may develop.

This occurs after 2-10% of all abdominal surgeries, This occurs after 2-10% of all abdominal surgeries,
although some people are more at risk. although some people are more at risk.

After surgical repair, these hernias have a high rate of After surgical repair, these hernias have a high rate of
returning (20-45%). returning (20-45%).

22. Types Cont.Types Cont.

Spigelian herniaSpigelian hernia

This rare hernia occurs along the edge of the This rare hernia occurs along the edge of the
rectus abdominus muscle, which is several rectus abdominus muscle, which is several
inches to the side of the middle of the inches to the side of the middle of the
abdomen. abdomen.

23. Types Cont.Types Cont.

Obturator herniaObturator hernia

This extremely rare abdominal hernia This extremely rare abdominal hernia
happens mostly in women. happens mostly in women.

This hernia protrudes from the pelvic cavity This hernia protrudes from the pelvic cavity
through an opening in your pelvic bone through an opening in your pelvic bone
(obturator foramen). (obturator foramen).

This will not show any bulge but can act like a This will not show any bulge but can act like a
bowel obstruction and cause nausea and bowel obstruction and cause nausea and
vomiting. vomiting.

24. Types Cont.Types Cont.

Epigastric herniaEpigastric hernia

Occurring between the navel and the lower Occurring between the navel and the lower
part of the rib cage in the midline of the part of the rib cage in the midline of the
abdomen, these hernias are composed abdomen, these hernias are composed
usually of fatty tissue and rarely contain usually of fatty tissue and rarely contain
intestine. intestine.

Formed in an area of relative weakness of the Formed in an area of relative weakness of the
abdominal wall, these hernias are often abdominal wall, these hernias are often
painless and unable to be pushed back into painless and unable to be pushed back into
the abdomen when first discovered.the abdomen when first discovered.

27. Causes of herniasCauses of hernias

Any condition that increases the pressure of the Any condition that increases the pressure of the
abdominal cavity may contribute to the formation abdominal cavity may contribute to the formation
or worsening of a hernia.or worsening of a hernia.

ObesityObesity

Heavy liftingHeavy lifting

CoughingCoughing

Straining during a bowel movement or urinationStraining during a bowel movement or urination

Chronic ling diseaseChronic ling disease

Fluid in the abdominal cavityFluid in the abdominal cavity

HereditaryHereditary

28. Signs and SymptomsSigns and Symptoms

The signs and symptoms of a hernia can range The signs and symptoms of a hernia can range
from noticing a painless lump to the painful, from noticing a painless lump to the painful,
tender, swollen protrusion of tissue that you are tender, swollen protrusion of tissue that you are
unable to push back into the abdomen—possibly unable to push back into the abdomen—possibly
a strangulated hernia. a strangulated hernia.

Asymptomatic reducible herniaAsymptomatic reducible hernia

New lump n the groin or other abdominal wall areaNew lump n the groin or other abdominal wall area

May ache but is not tender when touched.May ache but is not tender when touched.

Sometimes pain precedes the discovery of the lump.Sometimes pain precedes the discovery of the lump.

29. Cont.Cont.

Lump increases in size when standing or when Lump increases in size when standing or when
abdominal pressure is increased (such as abdominal pressure is increased (such as
coughing) coughing)

May be reduced (pushed back into the abdomen) May be reduced (pushed back into the abdomen)
unless very large unless very large

Irreducible herniaIrreducible hernia

Usually painful enlargement of a previous hernia Usually painful enlargement of a previous hernia
that cannot be returned into the abdominal cavity that cannot be returned into the abdominal cavity
on its own or when you push it on its own or when you push it

Some may be long term without pain Some may be long term without pain

30. Cont.Cont.

Can lead to strangulation Can lead to strangulation

Signs and symptoms of bowel obstruction may Signs and symptoms of bowel obstruction may
occur, such as nausea and vomiting occur, such as nausea and vomiting

Strangulated herniaStrangulated hernia

Irreducible hernia where the entrapped intestine Irreducible hernia where the entrapped intestine
has its blood supply cut off has its blood supply cut off

Pain always present followed quickly by Pain always present followed quickly by
tenderness and sometimes symptoms of bowel tenderness and sometimes symptoms of bowel
obstruction (nausea and vomiting) obstruction (nausea and vomiting)

You may appear ill with or without fever You may appear ill with or without fever

31. Cont.Cont.

Surgical emergency Surgical emergency

All strangulated hernias are irreducible (but all All strangulated hernias are irreducible (but all
irreducible hernias are not strangulated)irreducible hernias are not strangulated)

32. When to call the doctor!When to call the doctor!

All newly discovered hernias or symptoms that suggest All newly discovered hernias or symptoms that suggest
you might have a hernia should prompt a visit to the you might have a hernia should prompt a visit to the
doctor. doctor.

Hernias, even those that ache, if they are not tender and Hernias, even those that ache, if they are not tender and
easy to reduce (push back into the abdomen), are not easy to reduce (push back into the abdomen), are not
surgical emergencies, but all have the potential to surgical emergencies, but all have the potential to
become serious. become serious.

Referral to a surgeon should generally be made so that Referral to a surgeon should generally be made so that
you can have surgery by choice (called elective surgery) you can have surgery by choice (called elective surgery)
and avoid the risk of emergency surgery should your and avoid the risk of emergency surgery should your
hernia become irreducible or strangulated. hernia become irreducible or strangulated.

33. DiagnosisDiagnosis

If you have an obvious hernia, the doctor If you have an obvious hernia, the doctor
will not require any other tests will not require any other tests

If you have symptoms of a hernia the If you have symptoms of a hernia the
doctor may feel the area while increasing doctor may feel the area while increasing
abdominal pressure (having you stand or abdominal pressure (having you stand or
cough). cough).

This action may make the hernia able to This action may make the hernia able to
be felt. be felt.

34. TreatmentTreatment

Treatment of a hernia depends on whether it is Treatment of a hernia depends on whether it is
reducible or irreducible and possibly reducible or irreducible and possibly
strangulated.strangulated.

ReducibleReducible

Can be treated with surgery but does not have to be. Can be treated with surgery but does not have to be.

IrreducibleIrreducible

All acutely irreducible hernias need emergency treatment All acutely irreducible hernias need emergency treatment
because of the risk of strangulation.because of the risk of strangulation.

An attempt to push the hernia back can be made An attempt to push the hernia back can be made

35. Treatment Cont.Treatment Cont.

StrangulationStrangulation

OperationOperation

PreventionPrevention

You can do little to prevent areas of the You can do little to prevent areas of the
abdominal wall from being or becoming weak, abdominal wall from being or becoming weak,
which can potentially become a site for a which can potentially become a site for a
hernia.hernia.

36. ReferencesReferences
http://www.emedicine.com/aaem/topic248.htmhttp://www.emedicine.com/aaem/topic248.htm

Osburn, Kimberly Pagewise 2002Osburn, Kimberly Pagewise 2002

Medline Plus American Medical Medline Plus American Medical
AssosiationAssosiation