7/27/2019 hernia-1227564017925552-8 (1)

1/20

by Maria G. Nelson

7/27/2019 hernia-1227564017925552-8 (1)

2/20

Occurs when contents of a body cavity bulgeout of the area where they are normallycontained.

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

May be asymptomatic

If blood supply of hernia sac contents is cutoff a medical and surgical emergency!

7/27/2019 hernia-1227564017925552-8 (1)

3/20

Inguinal (groin)

Femoral

Umbilical

Incisional

Epigastric

7/27/2019 hernia-1227564017925552-8 (1)

4/20

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 thetorso (inguinal crease)

Indirect inguinal hernia sac may protrude into thescrotum; may occur at any age

Direct inguinal hernia

middle-aged to elderly as theirabdominal walls weaken with age

7/27/2019 hernia-1227564017925552-8 (1)

5/20

7/27/2019 hernia-1227564017925552-8 (1)

6/20

7/27/2019 hernia-1227564017925552-8 (1)

7/20

Femoral Hernia Femoral canal is the path through which the

femoral artery, vein and nerve leave the abdominalcavity to enter the thigh

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

Usually occurs in women

At risk of becoming irreducible (not able to be

pushed back into place) and strangulated

7/27/2019 hernia-1227564017925552-8 (1)

8/20

7/27/2019 hernia-1227564017925552-8 (1)

9/20

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 closecompletely

Less than inch closes gradually by age 2

Large hernias surgery at age 2-4 years

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

Can occur in women who are having/have had children

7/27/2019 hernia-1227564017925552-8 (1)

10/20

7/27/2019 hernia-1227564017925552-8 (1)

11/20

Incisional Hernia Abdominal surgery causes flaw in the abdominal

wall create an area of weakness where hernia maydevelop

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

May return even after surgical repair

7/27/2019 hernia-1227564017925552-8 (1)

12/20

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

7/27/2019 hernia-1227564017925552-8 (1)

13/20

7/27/2019 hernia-1227564017925552-8 (1)

14/20

7/27/2019 hernia-1227564017925552-8 (1)

15/20

Any condition that increases pressure on theabdominal cavity Obesity

Heavy lifting

Coughing Straining during a bowel movement or urination

Chronic lung disease

Fluid in the abdominal cavity

Family history

7/27/2019 hernia-1227564017925552-8 (1)

16/20

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

7/27/2019 hernia-1227564017925552-8 (1)

17/20

Irreducible hernia Occasionally painful enlargement of a previously

reducible hernia that cannot be returned to theabdominal 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.

7/27/2019 hernia-1227564017925552-8 (1)

18/20

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 bowelobstruction (nausea and vomiting).

The affected person may appear ill with or withoutfever.

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

7/27/2019 hernia-1227564017925552-8 (1)

19/20

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 abdominalinsufflation with carbon dioxide; 2-3 stab woundsinstead of an incision; less pain & short recovery

Hernioplasty

if hernia has gone untreated formany years; reconstructive repair

7/27/2019 hernia-1227564017925552-8 (1)

20/20

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