Umbilical hernia

Umbilical hernia

1. U mbilical H ernia

2. HERNIA: Protrusion of a part or structure through the tissues normally containing it. U mbilical H ernia

3. Umbilical hernia : Part of the intestine or fatty tissue bulges through the muscle near umbilicus. U mbilical H ernia

4. U mbilical H ernia Topics of Presentation : Introduction & definition. Anatomy. Causes & risk factors. History. Physical Examination. Investigations. Management. Complications.

5. U mbilical H ernia Anterior Abdominal wall: Anatomy

6. U mbilical H ernia Umbilical Ring:

7. U mbilical H ernia Causes & risk factors Infant : Incomplete closure of umbilical opening. premature babies  and those with low birth weights . Black infants. Adults : Obesity. Multiple pregnancies. Fluid in the abdominal cavity ( ascites). Previous abdominal surgery. Chronic peritoneal dialysis.

8. U mbilical H ernia History - Sewlling Hx . - Predisposing factors questions. - Complication quistions . - Past surgical hx .

9. U mbilical H ernia Swelling Hx . : Where is it ? When did you notice it ? Did you notice it by your self ? - How did you notice it ?

10. U mbilical H ernia Swelling Hx . : Does it disappears ? Is there any change in it’s size, shape and color ? Did you had a previous similar case? Do you have any other lumps?

11. U mbilical H ernia Predisposing factors : - Did you have a chronic cough ? - Do you have a chronic constipation? - Do you lift heavy objects ? - Multiparous or not ?

12. U mbilical H ernia Complication symptoms : - Did you have abdominal pain ? - Do you have abdominal distension ? - Do you have vomiting ?

13. U mbilical H ernia Systemic review : - Respiratory system. - Gastrointestinal symptoms. - Urinary system.

14. U mbilical H ernia - Previous surgeries . - Past medical Hx . - Social Hx .

15. U mbilical H ernia Physical Examination Identify The hernia. Look for a mass in the area of the fascial defect. Define the borders of the fascial defect. The size of the fascial defect and whether it is circular provide management clues. Generally asymptomatic , it may cause mild discomfort in some children. Central , mid abdominal bulge. Hypertrophic, hyperpigmented

16. U mbilical H ernia - Easily reduced hernial sac with well-defined border of fascia central defect of variable diameter. - The overlying skin may appear stretched and proboscoid (redundant and protuberant). - If presents with tenderness, incarceration with or without strangulation should be suspected. - Symptoms of bowel obstruction include vomiting, abdominal pain, and constipation.

17. U mbilical H ernia - Strangulated hernias are differentiated from incarcerated hernias by the following: 1. Pain out of proportion to examination findings. 2. Fever or toxic appearance. 3. Pain that persists after reduction of hernia.

18. U mbilical H ernia Investigations An umbilical hernia is diagnosed during a physical exam. Sometimes imaging studies — such as an abdominal ultrasound or CT scan — are used to screen for complications Complications from umbilical hernias rarely occur in children. However, additional complications can occur in both children and adults if the umbilical cord is incarcerated.

19. U mbilical H ernia Investigations CBC X–Ray US Lactate level.

20. U mbilical H ernia Management (Infant) Observation and reassurance as these defects typically close by age 4 or 5 years. *Except for symptomatic patient and hernia > 2cm. Any defects that persist beyond 5 years should undergo surgical repair.

21. U mbilical H ernia Management (Adult) When to do surgery? Special consideration: Obese, chronic cough, constipation….etc.

22. U mbilical H ernia Umbilical herniorrhaphy

23. U mbilical H ernia hernioplasty

24. U mbilical H ernia Additional lipectomy ( panniculectomy )

25. U mbilical H ernia In Case of Strangulation

26. U mbilical H ernia complications - Incarceration. - Strangulation. - Perforation.

27. U mbilical H ernia Postoperative complications - Postoperative pain. - Recurrence. - Hernia at the port site.

28. U mbilical H ernia - Hematoma. - Seroma. - Wound infection.

29. U mbilical H ernia Sources Uptodate . American College of Surgeons . Medscape.

30. U mbilical H ernia Done by .. Abdullah Alnewirah . Abdulaziz Bagasi . Eyad Alterazi . Adel Alshehri . Moayad Fallatah . Suhib Baaremah . Baraa Alim . Ahmed Taher .