1. HERNIA
Nowadays this terminology “Hernia” is very much common in occurrence in our society.
What is Hernia?
In simple words it can be defined as the abnormal protrusion of a viscous pr part of a viscous
along with or without abdominal contents (mesentery or omenta) through defect in anterior
abdominal wall.
What are the causes of Hernia?
There are many causes of hernia. The most common etiologies of hernia include:
1) Either a defect in anterior abdominal wall which may be congenital in origin.
2) Other etiology includes weakening of muscles in the anterior abdominal wall. This weakening
of muscles can be caused by multiple pregnancies, constipation, persistent cough which can
lead to increase in intra abdominal pressure, smoking etc.
3) Other causes includes obesity, ascites, previous scars etc.
What are the types of Hernia?
Hernias can be classified by2 types:
Anatomical Types: It includes hernias which occur in different areas of the body.
Examples include: Inguinal Hernia, Femoral Hernia, Umbilical Hernia, Epigastric Hernia,
Para umbilical Hernia, Incisional Hernia, Hiatal Hernia and Littre’s Hernia etc.
Other classification: It includes hernia which can be reduce or non reducible.
Reducible hernia: It is a type of hernia which when press on abdomen can go back into
the abdominal cavity. Therefore it is called reducible hernia.
Irreducible Hernia: It is a type of hernia which when press on abdomen cannot go back
into abdominal cavity. Therefore it is called irreducible hernia. Obstructive Hernia and
strangulated Hernia can be considered its subtypes.
Another type includes obstructive hernia in which a loop of intestine become trapped
and is narrowed. It can also be considered as a subtype of irreducible hernia.

2. Last type of hernia includes strangulated hernia. It occurs when part of intestine
becomes entrapped and the blood supply is cut off (ischemia). It will ultimately leads to
development of gangrene and necrosis of that area. It requires immediate surgery.
How we can distinguish between obstructive herniaand strangulated hernia?
Obstructive hernia and strangulated hernia can be differentiated on the basis of
examination.
If on palpating hernia with the palm there is no complain of pain (non tender) from the
patient than such a hernia is called obstructive hernia. In simple words obstructive
hernias are non tender while if there is a complain of pain on palpating hernia such a
hernia will be strangulated hernia. In simple words strangulated hernias are tender.
Inguinal Hernias can be classified into 2 sub types:
Indirect inguinal Hernia:
1) It arise from deep inguinal ring
2) It travels throughout inguinal canal so it has oblique course
3) A prominent lump is present in scrotum
4) As it travels through whole inguinal canal therefore it acquires all 3 fascias of
spermatic cord that is internal spermatic fascia, cremasteric fascia and external
spermatic fascia
5) It is most common type of inguinal hernia in men.
6) It is congenital in origin
Direct Inguinal Hernia:
1) It arises outside the deep inguinal ring that is in hesselbach's triangle. It arises
through defect in posterior wall of inguinal canal.
2) It has a straight course that is it does not travel throughout inguinal canal.

3. 3) A prominent bulge is present near hypo gastric region.
4) It does not acquire all 3 coverings of spermatic cord.
5) It is least common type of inguinal hernia in men.
6) It can be acquired in origin.
Signs and Symptoms: The most common signs and symptoms with which patient
can be present in the hospital includes swelling on abdomen (lump) and pain.
Diagnosis of Hernia:
Any type of Hernia can be diagnosed by taking proper history and by performing
several tests. 2 most common types of physical tests include cough impulse and
carnet’s sign.
Cough Impulse: This test can be performed by asking patient to cough. While the
patient coughs the doctor should check out the bulging of hernia. If on coughing the
hernia contents bulge out than cough impulse will be positive. If there is no bulging
of hernial contents than cough impulse will be negative.
Carnet’s Sign: This is done by asking the patient to put his both hands behind the
head and ask him/her to raise from supine to sitting position without any support. If
hernial contents bulge out on changing posture than Carnet’s sign will be positive
and vice versa. If patient is critically ill than perform this test by raising up the legs.
Occurrence of hernia is most common in males than females. Indirect inguinal
hernias are most common in males while femoral hernias are most common in
females.
Treatment:
There are 2 techniques of inguinal hernia repair:

4. 1) Open or conventional hernia repair
2) Laparoscopic hernia repair
The gold standard treatment for inguinal hernia is herniotomy and hernioplasty
which is comparatively called as Mesh Repair.
Written by:
Asra Iqbal