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Hernia

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Information about Hernia
Health & Medicine

Published on November 24, 2008

Author: txnurse

Source: slideshare.net

Description

Class Presentation on Hernia
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by Maria G. Nelson

Occurs when contents of a body cavity bulge out of the area where they are normally contained. Term to denote bulges in other areas, but usually describes hernias of the lower torso (abdominal wall hernias) May be asymptomatic If blood supply of hernia sac contents is cut off – a medical and surgical emergency!

Occurs when contents of a body cavity bulge out of the area where they are normally contained.

Term to denote bulges in other areas, but usually describes hernias of the lower torso (abdominal wall hernias)

May be asymptomatic

If blood supply of hernia sac contents is cut off – a medical and surgical emergency!

Inguinal (groin) Femoral Umbilical Incisional Epigastric

Inguinal (groin)

Femoral

Umbilical

Incisional

Epigastric

Inguinal Hernia (groin) 75% of all abdominal wall hernias Occurs 25% more often in men than women 2 types which occur both in the groin area where the skin crease at the top of the thigh joins the torso (inguinal crease) Indirect inguinal – hernia sac may protrude into the scrotum; may occur at any age Direct inguinal hernia – middle-aged to elderly as their abdominal walls weaken with age

Inguinal Hernia (groin)

75% of all abdominal wall hernias

Occurs 25% more often in men than women

2 types which occur both in the groin area where the skin crease at the top of the thigh joins the torso (inguinal crease)

Indirect inguinal – hernia sac may protrude into the scrotum; may occur at any age

Direct inguinal hernia – middle-aged to elderly as their abdominal walls weaken with age

 

 

Femoral Hernia Femoral canal is the path through which the femoral artery, vein and nerve leave the abdominal cavity to enter the thigh Causes a bulge just below the inguinal crease in roughly the mid-thigh area Usually occurs in women At risk of becoming irreducible (not able to be pushed back into place) and strangulated

Femoral Hernia

Femoral canal is the path through which the femoral artery, vein and nerve leave the abdominal cavity to enter the thigh

Causes a bulge just below the inguinal crease in roughly the mid-thigh area

Usually occurs in women

At risk of becoming irreducible (not able to be pushed back into place) and strangulated

 

Umbilical Hernia Common hernias (10-30%) often noted at birth as a protrusion at the bellybutton (umbilicus) Caused by an opening in the abdominal wall, which normally closes before birth, does not close completely Less than ½ inch – closes gradually by age 2 Large hernias – surgery at age 2-4 years Even if closed, may reappear later in life (weak spot in the abdominal wall) Can occur in women who are having/have had children

Umbilical Hernia

Common hernias (10-30%) often noted at birth as a protrusion at the bellybutton (umbilicus)

Caused by an opening in the abdominal wall, which normally closes before birth, does not close completely

Less than ½ inch – closes gradually by age 2

Large hernias – surgery at age 2-4 years

Even if closed, may reappear later in life (weak spot in the abdominal wall)

Can occur in women who are having/have had children

 

Incisional Hernia Abdominal surgery causes flaw in the abdominal wall – create an area of weakness where hernia may develop Occurs after 2-10% of all abdominal surgeries, although some people may be more at risk May return even after surgical repair

Incisional Hernia

Abdominal surgery causes flaw in the abdominal wall – create an area of weakness where hernia may develop

Occurs after 2-10% of all abdominal surgeries, although some people may be more at risk

May return even after surgical repair

Epigastric Hernia Occurs between the navel and the lower part of the rib cage in the midline of the abdomen Usually composed of fatty tissue and rarely contain intestine Formed in the area of relative weakness of the abdominal wall Often painless and unable to be pushed back into the abdomen when first discovered

Epigastric Hernia

Occurs between the navel and the lower part of the rib cage in the midline of the abdomen

Usually composed of fatty tissue and rarely contain intestine

Formed in the area of relative weakness of the abdominal wall

Often painless and unable to be pushed back into the abdomen when first discovered

 

 

Any condition that increases pressure on the abdominal cavity Obesity Heavy lifting Coughing Straining during a bowel movement or urination Chronic lung disease Fluid in the abdominal cavity Family history

Any condition that increases pressure on the abdominal cavity

Obesity

Heavy lifting

Coughing

Straining during a bowel movement or urination

Chronic lung disease

Fluid in the abdominal cavity

Family history

Reducible hernia New lump in the groin or other abdominal wall area May ache but not tender when touched Sometimes pain precedes the discovery of the lump. Lump increases in size when standing or when abdominal pressure is increased (ex. coughing). May be reduced (pushed back into the abdomen) unless very large

Reducible hernia

New lump in the groin or other abdominal wall area

May ache but not tender when touched

Sometimes pain precedes the discovery of the lump.

Lump increases in size when standing or when abdominal pressure is increased (ex. coughing).

May be reduced (pushed back into the abdomen) unless very large

Irreducible hernia Occasionally painful enlargement of a previously reducible hernia that cannot be returned to the abdominal cavity on its own or when you push it. Some may be long term without pain. Also known as incarcerated hernia Can lead to strangulation Signs and symptoms of bowel obstruction may occur, such as nausea and vomiting.

Irreducible hernia

Occasionally painful enlargement of a previously reducible hernia that cannot be returned to the abdominal cavity on its own or when you push it.

Some may be long term without pain.

Also known as incarcerated hernia

Can lead to strangulation

Signs and symptoms of bowel obstruction may occur, such as nausea and vomiting.

Strangulated hernia Irreducible hernia in which the entrapped intestine has its blood supply cut off Pain is always present, followed quickly by tenderness and sometimes symptoms of bowel obstruction (nausea and vomiting). The affected person may appear ill with or without fever. Not all strangulated hernias are irreducible (but all irreducible hernias are strangulated).

Strangulated hernia

Irreducible hernia in which the entrapped intestine has its blood supply cut off

Pain is always present, followed quickly by tenderness and sometimes symptoms of bowel obstruction (nausea and vomiting).

The affected person may appear ill with or without fever.

Not all strangulated hernias are irreducible (but all irreducible hernias are strangulated).

Diagnosis Simply by touch – cough, make it stick out Barium Swallow and EGD Treatment Truss or abdominal support over the herniated area Herniorrhaphy – surgical repair using a laparoscopic extraperitonial approach (LEP) after abdominal insufflation with carbon dioxide; 2-3 stab wounds instead of an incision; less pain & short recovery Hernioplasty – if hernia has gone untreated for many years; reconstructive repair

Diagnosis

Simply by touch – cough, make it stick out

Barium Swallow and EGD

Treatment

Truss or abdominal support over the herniated area

Herniorrhaphy – surgical repair using a laparoscopic extraperitonial approach (LEP) after abdominal insufflation with carbon dioxide; 2-3 stab wounds instead of an incision; less pain & short recovery

Hernioplasty – if hernia has gone untreated for many years; reconstructive repair

Client allowed out of bed on day of operation Usually done on outpatient basis Can have food and fluids Void postoperatively – urinary retention is a common problem Client to move around but avoid straining and lifting for several weeks or months Return to routine activities occurs quickly Return to work – depends on age, weight, type of work, nature and extent of hernia Referral to vocational rehabilitation services

Client allowed out of bed on day of operation

Usually done on outpatient basis

Can have food and fluids

Void postoperatively – urinary retention is a common problem

Client to move around but avoid straining and lifting for several weeks or months

Return to routine activities occurs quickly

Return to work – depends on age, weight, type of work, nature and extent of hernia

Referral to vocational rehabilitation services

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