EPIGASTRIC HERNIA

1. CASE ON EPIGASTRIC HERNIA
PRESENTED BY:-
B. Sunil Nayak

2. PROBLEMS LIST
• Patient Demographics
Age: 74yrs
Sex : Male
Unit: Surgical
No. of days hospitalised:- 9 days
• C/O Upper abdomen midline swelling with pain since 20 days
• MEDICAL HISTORY: Nothing significant
• MEDICATION HISTORY: Nothing significant
• SOCIAL HISTORY: occasionally toddy consumption, agriculture
• FAMILY HISTORY: Nothing significant

3. GENERAL PHYSICAL EXAMINATION
• BP- 110/70 mm Hg
• PR- 72 bpm
LABORATORY INVESTIGATIONS:-
HAEMATOLOGY
• RBC- 4.9 mill.cells/cumm
• Hb-14.8 (M- 13-17 g/dl, F- 12-15 g/dl)
• PLATELETS- 1.76 (1.5-4 lakhs cells/mm3)
• WBC- 10000 cells/mm3( 4000-11000 cells/mm3)

4. • N- 70 % (40-80 %)
• L- 21 % (20-40 %)
• M- 7 % (2-10 %)
• E- 2 % (1-6 %)
• B- 0 % (0-1 %)
BIOCHEMISTRY
• Blood urea:- 27mg/dl (15-45 mg/dl)
• Serum creatinine:-1.4 mg/dl (0.7-1.5 mg/dl)
• Serum electrolytes:-
Na-143 mmol/lit(135-145 mmol/lit)
K- 4.3 mmol/lit (3.5-5 mmol/lit)

5. • 2D Echo and colour Doppler :- No abnormalities detected
• ECG :- Normal
• CUE :- Normal
• USG Abdomen
Impression :- Herniation of momentum noted through defect of
7mm at periumbilical region s/o hernia

6. SUBJECTIVE EVIDENCE
Upper abdomen midline swelling with pain since 20 days
OBJECTIVE EVIDENCE
• USG Abdomen
Impression :- Herniation of momentum noted through defect of
7mm at periumbilical region s/o hernia

7. ASSESSMENT
• From subjective and objective evidence, the patient was finally
diagnosed with EPIGASTRIC HERNIA.
ETIOLOGY:-
In this case, hernia is due to excessive lifting of weights which in turn
increases the pressure .
ASSESSMENT IF THERAPY IS INDICATED:-
Yes, therapy is to be given to treat this condition (EPIGASTRIC
HERNIA ), otherwise it can cause complications rarely like
obstruction.

8. DAY WISE ASSESSMENT
Day 2:-
BP – 110/70 mm of Hg
PR – 80 bpm
Day 3:-
BP- 110/70 mm of Hg
PR- 72bpm
Day 4:-
Surgery was done
BP- 110/70 mm of Hg
PR- 70 bpm
Day 5:-
C/o fever from night
BP- 110/70 mm of Hg
PR- 90bpm

9. Day-6:-
C/o constipation
BP :- 100/60 mmHg
PR :- 80 bpm
Day-7 :-
C/o Constipation
BP:- 120/80 mm Hg
PR :- 70 BPM
Day-8 :-
No fresh complaints
BP :- 130/80 mm Hg
PR :- 72 bpm

10. s.no Current drugs dose route freq 1 2 3 4 5 6 7 8
1. Tab.Tramadol+
Acetaminophen
37.5+32
5
PO 8th
hrly
+ + + + + + + +
2. Inj.Pantoprazole 40mg IV OD + + + + + + + +
3. Inj.Cefixime 1g IV BD - - - - + + + +
4. Inj.Metronidazo
le
100mg IV OD - - - - + + + +
5. Syp.liq.paraffin
+milk of
magnesia
15ml
(3.75+1
1.25)
PO OD - - - - - + + +
6. Tab.Trypsin+Br
omelain+Rutosi
de
48+90+
100mg
PO OD - - - - - - + +
7. IVF NS 2 pint IV 100
ml/h
r
- - - - + + - -
ASSESMENT OF CURRENT TREATMENT

11. DISCHARGE MEDICATION
• Tab.Tramadol+Acetaminophen
37.5+325mg-po-bid
• Tab.Pantoprazole
40mg-po-od
• Syp.liq.paraffin+milk of magnesia
15ml-po-od
• Tab.Trypsin+Bromelain+Rutoside
1tab-po-od
• Tab. Amoxcillin
625mg-po-bid

12. Tab.Amoxicillin
• Category :- Antibiotic
• MOA :- Prevents the bacterial cell wall synthesis
• Indication :- Stop bacterial infections
• Sideeffects :- Nausea, rash, bleeding, insomnia
Tab.Pantoprazole
• Category :- Proton pump inhibitor
• MOA:- Inhibitor of H+/K+ ATPase pump
• Indication :- Reduction in gastric acid secretion
• Sideefects :-Pruitus, rash, gut ifections

13. Tab.Phlogam ( trypsin,bromelain, rutoside)
• Category :- Proteolytic enzymes
• Indications :- To reduce swelling and inflammation
• Sideeffects :- Tachycardia, nausea, shortness of breath
Syp.Cremaffin
• Category :- Laxative
• MOA:- Retains water in the intestine
• Indication :- Constipation
• Sideeffects :- Interferes the absorption of iron and folic acid, local
irritation

14. DRUG INTERACTIONS
DRUG- DRUG INTERACTIONS:-
• No drug interactions were found.

15. OPTIMAL THERAPY
There is no optimal therapy for hernia. But the treatment includes 2 types
of measures.
1.Conservative treatment
Support with Padded belt, if not effecting the daily activities.
2. Curative treatment
Laproscopic surgery

16. PLAN
GOALS:-
Patient specific:-
To relieve from the abdominal pain
To reduce the swelling
Disease specific:-
To prevent further complications like obstruction and infections.

17. MONITORING PARAMETERS:-
THERAPEUTIC :-
Acid reflux is majorly seen in this patients. So carefully
monitor the symptoms associated with acid reflux like
epigastric pain, vomitings etc.

18. PATIENT EDUCATION
ABOUT DISEASE:-
A hernia occurs when the inside layers of the abdominal
muscle have weakened, resulting in a bulge or tear. An epigastric
hernia is a type of hernia which may develop in the epigastrium (upper,
central part of the abdomen). Symptoms include pain in abdomen,
swelling, indigestion. Complications include obstruction in the
intestine .

19. ABOUT MEDICATION:-
Tab.Amoxicillin is an antibiotic, which is given to prevent the
infection. It is taken after the food, twice daily.
Tab.Acetaminophen+Tramadol acts as analgesic to reduce the pain and
it is taken twice daily after the food.
Tab.Pantoprazole is given to decrease the gastric secretions and it is
taken before breakfast once daily.
Syp.Cremmaffin is a laxative which is taken in the night about 15ml

20. ABOUT LIFESTYLE MODIFICATION:-
•The best lifestyle change for epigastric hernia is exercise. One
can get engaged in general or light exercised to strengthen
abdominal muscles after complete recovery from epigastric
hernia surgery.
• Avoid wearing tight clothes as it can exert pressure on the
abdomen.
•Avoid lifting of heavy objects as it may increase the abdominal
pressure.

21. • Sleeping, lying down or bending after eating should be completely
avoided.
• Taking fiber (bread, almonds etc) will help to make better bowel
movements and prevent constipation.

22. FUTURE PLANS
• Patient should come for a follow up after 5days so that physician
can remove the sutures.

23. THANK YOU