HERNIA
OBJECTIVES
n By the end of this lecture students should know:
n What is meant by hernia
n The mechanism of developing a hernia
n Signs and symptoms produced by a hernia
n The types of hernia
n Complications produced as a result of hernia
n Treatment of hernia
n Preventive measures against development of hernia
DEFINITION
n A hernia is a protrusion of any viscus from its proper cavity
n The protruded parts are generally contained in a sac-like structure, formed by the membrane with which the cavity is naturally lined
MECHANISM
n The wall of the abdomen, the gastro-oesophageal valves, and other areas of the body, comprising muscle and tendon, performs several functions, one of which is to provide strong support to the internal organs which are exerting significant outward pressure.
n The opening of a gap in the tissue can occur of its own accord at a point of natural weakness, or by over-stretching a part of the tissue.
n Overexertion can cause a hernia eg, lifting heavy loads or chronic cough
TYPES OF HERNIA
n Groin hernia (inguinal, femoral, scrotal)
n Umbilical
n Incisional
n Hiatal
n Congenital diaphragmatic
n Ventral / Epigastric Hernia
n Spigelian Hernia
n Recurrent Hernia
n Stoma Hernia
INGUINAL HERNIA:
n A portion of intestine or internal fat protrudes through a weakness in the inguinal canal
n Appears at the groin crease
n May be DIRECT or INDIRECT
n More common in males
FEMORAL HERNIA:
n Hernia through the femoral canal in the femoral triangle
n Appears between the thigh and groin region
n More common in females
UMBILICAL HERNIA:
n Hernia in the abdominal wall from or around the umbilicus (paraumbilical)
INCISIONAL HERNIA:
n From defects created due to previous surgeries
HIATAL HERNIA:
n Stomach passes from the gastro oesophageal sphincter into the oesophagus
EPIGASTRIC:
n From a defect between the umbilicus and xiphisternum in the midline
SPIGELIAN:
n This rare hernia occurs along the edge of the rectus abdominus muscle, which is several inches to the side of the middle of the abdomen.
OBTURATOR HERNIA:
n This hernia protrudes from the pelvic cavity through an opening in the pelvic bone (obturator foramen)
n Causes no bulge
n Difficult to diagnose
RECURRENT HERNIA:
n Occurs at the site of previous hernia repair
CONGENITAL DIAPHRAGMATIC HERNIA:
n A diaphragmatic hernia is a birth defect in which there is an abnormal opening in the diaphragm
STOMA HERNIA:
n Occur at the site of surgical stoma
RISK FACTORS
n Family history
n Overweight or Obesity
n Undescended testes (groin hernias)
n Gastro-oesophageal reflux disease (GERD)
n Any condition that increases the abdominal pressure:
e.g.,
– chronic coughing,
– chronic constipation
– enlarged prostate causing straining with urination,
– carrying or pushing heavy loads
SYMPTOMS
n Lump
n Painful swelling
n Nausea/ vomiting
n Sepsis
SIGNS
n Lump
– Reducible/ irreducible: can or cannot be pushed back to its original position
– Direct/ indirect (inguinal hernia): comes through the abdominal wall (direct) or through the inguinal canal (indirect)
– Tender
n Fever
n Signs of Intestinal obstruction
n Sepsis
COMPLICATIONS
n Incarceration:
– Hernia contents get “stuck” in the hernia sac causing irreducibility
n Obstruction:
– Intestinal obstruction as a result of incarceration
n Strangulation:
– Blood circulation to the hernial contents is compromised
– Necrosis/ gangrene formation
– Sepsis
DIAGNOSIS
n Clinical, based on physical examination
n U/S
n C.T. scan
n Fetal U/S for congenital defect
TREATMENT
n CONSERVATIVE:
n DEFINITIVE:
Surgical repair
PREVENTION
n Few preventive measures
n Avoid heavy weight lifting and straining
n Avoid food that precipitate reflux from stomach into oesophagus (hiatal hernia)
LEARNING RESOURCES:
n http://www.emedicinehealth.com
n http://emedicine.medscape.com
n http://www.nlm.nih.gov/
n North Penn Hernia Institute
n http://hernia.tripod.com
n http://www.searchmedica.co.uk
n http://myweb.lsbu.ac.uk
n http://www.surgical-tutor.org.uk
n www.mejfm.com/volume-5_issue-8 (Middle East Journal of Family Medicine)