HERNIA in children/intestinal hernia in children.pptx

HERNIA in children/intestinal hernia in children.pptx

1. HERNIA IN CHILDREN PRESENTED BY: M.C.KNIRANDA ASSISTANT PROFESSOR SSNSR, SU.

2. DEFINITION A hernia is the abnormal exit of tissue or an organ , such as the bowel, through the wall of the cavity in which it normally resides. Hernia is a protrusion of intestine through a weakness in the abdominal muscles.

3. TYPES OF HERNIA IN CHILDREN A hernia that occurs in the belly button area is called an  umbilical hernia . A hernia that occurs between the belly button and the breast bone is called an  epigastric hernia . A hernia that occurs in the groin area is called an  inguinal hernia . A hernia that occurs in the diaphragm area is called a  diaphragmatic hernia .

4. CAUSES A hernia can develop in the first few months after the baby is born because of a weakness in the muscles of the abdomen.

5. RISK FACTORS Prematurity A parent or sibling who had a hernia as an infant Cystic fibrosis ( inherited disorder that causes severe damage to the lungs, digestive system and other organs in the body .) Developmental dysplasia ( presence of abnormal cells within a tissue or organ) of the hip Undescended testes ( occurs when one or both testicles fail to move into the scrotum before birth) Abnormalities of the genitourinary system

6. UMBILICAL HERNIA An umbilical hernia occurs when part of intestine bulges through the opening in abdominal muscles near the bellybutton (navel ). Umbilical hernias are common and typically harmless.

7. CAUSES During gestation, the umbilical cord passes through a small opening in the baby's abdominal muscles. The opening normally closes just after birth . If the muscles doesn't join together completely in the midline of the abdominal wall, an umbilical hernia may appear at birth or later in life.

8. RISK FACTORS Umbilical hernias are most common in infants — especially premature babies and those with low birth weights. In the United States, black infants appear to have a slightly increased risk of umbilical hernias. The condition affects boys and girls equally .

9. CLINICAL FEATURES Soft swelling or bulge near the navel. The bulge may be visible only when they cry, cough or strain. Umbilical hernias in children are usually painless. Severe symptoms – Begins to vomit Has tenderness, swelling or discoloration at the site of the hernia

10. DIAGNOSIS An umbilical hernia is diagnosed during a physical exam . Sometimes imaging studies — such as an abdominal ultrasound or a CT scan — are used to screen for complications.

11. TREATMENT More than 90% of these hernias will naturally close on their own , typically by the time the child reaches the age of 2 years. In cases where the patient becomes symptomatic or if the umbilical hernia has not healed by the age of 5 years , a surgical repair  can be considered a treatment option.

12. SURGICAL MANAGEMENT The only treatment for an umbilical hernia is  hernia repair surgery . During the procedure, a surgeon makes incisions (cuts) that allow them to access the hernia and push the tissue back into place . Then , they strengthen the abdominal wall muscle to hold the tissue in place. Sometimes , they use a material called surgical mesh to strengthen the tissue barrier.

13. INGUINAL HERNIA An inguinal hernia in an infant is a hernia that occurs in the groin . Inguinal means groin. An inguinal hernia occurs when part of intestine pushes through an opening in their abdominal wall through the inguinal canal. The inguinal canal extends from baby’s abdomen to their genitals.

14. INCIDENCE Inguinal hernias occur in 1% to 5% of healthy , full-term baby boys. Up to 30% of premature babies are born with an inguinal hernia.

15. CAUSES All babies are born with a tunnel-like passage called the inguinal canal . The inguinal canal extends from baby’s belly (abdomen) to their genitals. During   fetal development , a baby boy’s testicles form inside his abdomen . Then his testicles move through the inguinal canal into his scrotum. Normally, the inguinal canal closes before birth. But sometimes, it doesn’t close all the way. This leaves an opening from belly into the inguinal canal. When this happens, the intestines can slide through the opening, causing a hernia. Inguinal hernias are rare in female babies , but they can occur.

16. CLINICAL FEATURES The main symptom of an inguinal hernia is a bulge under the  skin  in their groin or scrotum. Pain and discomfort that improves with rest. Heaviness or pressure in their groin. Swollen scrotum . Burning at the site of the bulge. Crankiness ( grumpy,irritable ) and D ifficulty feeding in infants.

17. SEVERE SYMPTOMS Severe pain or tenderness. Redness and bruising around the site of the bulge. No appetite. Fever. Nausea and vomiting. Bloody stool

18. DIAGNOSIS An inguinal hernia is diagnosed during a physical exam . Sometimes imaging studies — such as an abdominal ultrasound or a CT scan — are used to screen for complications.

19. TREATMENT Unlike some umbilical hernias, inguinal hernias will not resolve on their own . Surgery is required to correct the defect and prevent any harm to the hernia contents.

20. The surgery to repair an inguinal hernia is usually a day surgery , the child will go home the same day as the procedure. Premature babies who are less than 60 weeks post-conception age may require an overnight stay. The procedure will be done under general anesthesia .

21. The surgical approach for repair of an inguinal hernia depends on the clinical situation: Open repair : A tiny incision is made in the groin and the hernia is closed using sutures . The overlying skin is sealed with DERMABOND, a sterile, liquid adhesive that will hold the edges of child’s wound together and act as a waterproof dressing.

22. Open repair with laparoscopic evaluation of the other side : The procedure is done in the same manner as the open repair; however, prior to closing the hernia, a small camera (laparoscope) is used to check for the presence of a hernia on the opposite side of the groin or scrotum. If a second hernia is present, another tiny incision is made on the opposite side of the groin and the other hernia is repaired. Using a laparoscope to evaluate the opposite side for a hernia is done in certain situations depending upon the patient’s age, since hernias on both sides are more common in babies and small children. The overlying skin is sealed with DERMABOND.

23. Open repair with laparoscopic evaluation

24. NURSING MANAGEMENT Encourage parents to hold infants when crying and during feeding Instruct the child to avoid pushing, lifting, or engaging in vigorous activity. Prevents strain on the incision and possible hernia recurrence. Instruct in doing sponge baths till the incision heals. Maintains integrity of the incision.