For 2nd year B.Sc. Nursing students

1. HERNIA
Presented By:
Mr. Nandish. S
Asso. Professor
Mandya Institute of Nursing Sciences

2. Definition :
 It is a protrusion of a viscus (internal organ) through an abnormal
opening or weakened area in the wall of the cavity in which it is
normally contained.
 Hernia occurs when an organ pushes through an opening in the
muscle or tissue that holds it in place.
 It is an abnormal exit of tissue or an organ through the wall of cavity
in which it normally resides.
 It can occur at any part of the body, commonly abdomen or groin.

3. Types / Classification :
1) Reducible : if the hernia can be placed back into the abdominal
cavity.
2) Irreducible / incarcerated : if the hernia cannot be placed back into
the abdominal cavity.

4. a) Inguinal Hernia :
• It is the most common type of hernia & mainly seen in men.
• It is a protrusion of abdominal contents through inguinal canal
• It occurs at the point of weakness in the abdominal wall where the
spermatic cord in men & round ligament in women emerge.
• When the protrusion escapes through inguinal ring, it is termed as
Indirect Hernia.
• When the protrusion escapes through posterior inguinal wall, it is
termed as Direct Hernia.
• Pantaloon Hernia / saddlebag hernia is a combination of both
direct & indirect hernia.

6. b) Femoral Hernia :
• It occurs when there is protrusion of abdominal contents through
femoral ring into the femoral canal.
• It occurs below the inguinal ligament.
• It becomes strangulated (high incidence) & occurs more often in
women.
• They appear more rounded.
• A Cooper’s Hernia is a type of femoral hernia with Two sacs, one
in the femoral canal and second through a defect in the superficial
fascia.

7. c) Umbilical Hernia :
• It occurs when part of the intestine / intra abdominal contents
protrudes through the weak umbilical opening in the abdomen.
• It occurs when the rectus muscle is weak or the umbilical opening
fails to close after the birth.
• It is acquired in adults.
• It is more frequent in obese and pregnant women.

9. Incisional Hernia:
 It occurs due to weakness of abdominal wall at the site of previous
incision with incompletely healed surgical wound.
 They occur in about 13 % of patients after surgery.
 It is found in patients who are obese, who had multiple surgeries in
the same area, who had inadequate wound healing because of poor
nutrition or infection.

11. Etiology:
• Heavy weight lifting
• Straining while using toilet
• Any activity that raises pressure inside the belly
• Long term constipation
• Chronic coughing or sneezing
• Obesity
• Ascites
• Poor nutrition
• Smoking
• Overexertion

12. • Aging
• Premature or low birth weight
• Cystic fibrosis
• Family history

13. Pathophysiology :
Due to etiological factors / risk factors
Increase in the abdominal pressure
Weakness of muscles / peritoneal layer
Protrusion of organ
Clinical features

14. Clinical Manifestations :
o Hernia Commonly occurs over involved area when the person stands
or strains.
o Pain at the site
o Tenderness
o A visible palpable lump
o Nausea & vomiting
o Fever
o Discomfort
o Bowel Obstruction

15. Diagnostic studies :
- History collection & Physical examination
- CBC
- Urine analysis
- Blood Urea Nitrogen, Serum electrolytes
- X-Ray
- Ultrasound
- CT scan
- MDCT (Multi Detector Computed Tomography)

16. Complications :
If untreated :
o Strangulation
o Hydrocele
o Hemorrhage
o Obstruction of the lumen (Bowel)
o Irreducibility / incarcenation
After the surgical repair :
o Rejection of Mesh (post operative)
o Auto immune problems
o Inguinodynia (pain or discomfort lasting greater than 3 months after
surgery)

17. Management:
Truss :
o It is a kind of appliance, used in hernia patients.
o It is an external device to maintain reduction of hernia without
repairing underlying defect.
o It provides support for the herniated area, using pad & belt
arrangement to hold it in correct position.
o Use it before moving from bed.

18. - Binders or Corsets
- Topical Therapy
- Compression dressings
- Manual hernia reduction.

19. Surgical :
Hernioplasty – The reinforcement of weakened area with wire, fascia
or Mesh. Staples are used to keep mesh in place. It is
also called as “Tension free repair” because muscles
are not pulled together under tension.
Herniorrhaphy – uncomplicated hernias are repaired by pushing back
or reducing hernias & then mending the weakness in
muscle tissue.

21. - Laproscopic Surgery : uses a laproscope, a long thin tube with
lighted camera on the end. The wound heals relatively fast
- Robotic Surgery : surgeon controls the tools from computer using
robotic arms.

22. Prevention :
- Use proper lifting techniques
- Reduce the weight
- Avoid constipation by consuming plenty of water, fibre rich diet,
going to toilet as soon as you urge and doing exercises regularly.

23. Nursing Management :
 Fear & anxiety related to undergoing surgery.
 Pain acute abdomen related to surgical wound.
 Risk for infection related to surgical incision & poor healing.
 Risk for aspiration related to reflux of gastric contents.