1. HerniaHernia
Elizabeth Travis and Michael SnyderElizabeth Travis and Michael Snyder
AH 322AH 322
10-1-0310-1-03

2. What is a hernia?What is a hernia?
 A hernia is an abnormal weakness or holeA hernia is an abnormal weakness or hole
in an anatomical structure which allowsin an anatomical structure which allows
something inside to protrude through.something inside to protrude through.
 It is commonly used to describe aIt is commonly used to describe a
weakness in the abdominal wall.weakness in the abdominal wall.

3.  Hernias by themselves usually areHernias by themselves usually are
harmless, but nearly all have a potentialharmless, but nearly all have a potential
risk of having their blood supply cut offrisk of having their blood supply cut off
(becoming strangulated).(becoming strangulated).
 If the blood supply is cut off at the herniaIf the blood supply is cut off at the hernia
opening in the abdominal wall, it becomesopening in the abdominal wall, it becomes
a medical and surgical emergency.a medical and surgical emergency.

5. Types of HerniasTypes of Hernias
 Inguinal hernia: Makes up 75% of all abdominalInguinal hernia: Makes up 75% of all abdominal
wall hernias and occurring up to 25 times morewall hernias and occurring up to 25 times more
often in men than women.often in men than women.
 Two types of inguinal hernias: indirect inguinalTwo types of inguinal hernias: indirect inguinal
hernia and direct inguinal hernia.hernia and direct inguinal hernia.
 Indirect inguinal herniaIndirect inguinal hernia
 follows pathway that testicles made during prebirthfollows pathway that testicles made during prebirth
development.development.
 This pathway normally closes before birth but remainsThis pathway normally closes before birth but remains
a possible place for a hernia.a possible place for a hernia.

6. Cont.Cont.
 Sometimes the hernial sac may protrude into the scrotum.Sometimes the hernial sac may protrude into the scrotum.
 This type of hernia may occur at any age but becomesThis type of hernia may occur at any age but becomes
more common as people age.more common as people age.
 Direct inguinal herniaDirect inguinal hernia
 This occurs slightly to the inside of the sight fo the indirectThis occurs slightly to the inside of the sight fo the indirect
hernia, in a place where the abdominal wall is naturallyhernia, in a place where the abdominal wall is naturally
slightly thinner.slightly thinner.
 It rarely will protrude into the scrotum.It rarely will protrude into the scrotum.
 The direct hernia almost always occurs in the middle-agedThe direct hernia almost always occurs in the middle-aged
and elderly because their abdominal walls weaken as theyand elderly because their abdominal walls weaken as they
age.age.

7. Types Cont.Types Cont.
 Hiatus herniaHiatus hernia
 A hiatus hernia occurs when the upper part ofA hiatus hernia occurs when the upper part of
the stomach, which is joined to thethe stomach, which is joined to the
oesophagus (gullet), moves up into the chestoesophagus (gullet), moves up into the chest
through the hole (called a hiatus) in thethrough the hole (called a hiatus) in the
diaphragm.diaphragm.
 It is common and occurs in about 10 per centIt is common and occurs in about 10 per cent
of people.of people.

9. Hiatus herniaHiatus hernia
 Symptoms include:Symptoms include:
 HeartburnHeartburn
 Sudden regurgitationSudden regurgitation
 BelchingBelching
 Pain on swallowing hot fluidsPain on swallowing hot fluids
 Feeling of food sticking in the oesophagusFeeling of food sticking in the oesophagus

10. Hiatus herniaHiatus hernia
 It is most common in overweight middle-It is most common in overweight middle-
aged women and elderly people.aged women and elderly people.
 It can occur during pregnancy.It can occur during pregnancy.
 The diagnosis is confirmed by bariumThe diagnosis is confirmed by barium
meal X-rays or by passing a tube with ameal X-rays or by passing a tube with a
camera on the end into the stomachcamera on the end into the stomach
(gastroscopy).(gastroscopy).

11. Treatment for Hiatus HerniaTreatment for Hiatus Hernia
 Losing weight nearly always cures it.Losing weight nearly always cures it.
 Eating small meals each day instead of 2 or 3Eating small meals each day instead of 2 or 3
large ones helps.large ones helps.
 Avoid smoking.Avoid smoking.
 Take antacid.Take antacid.
 Avoid spicy food.Avoid spicy food.
 Avoid hot drinks.Avoid hot drinks.
 Avoid gassy drinks.Avoid gassy drinks.

12. Types Cont.Types Cont.
 Femoral herniaFemoral hernia
 The femoral canal is the way that the femoral artery,The femoral canal is the way that the femoral artery,
vein, and nerve leave the abdominal cavity to entervein, and nerve leave the abdominal cavity to enter
the thigh.the thigh.
 Although normally a tight space, sometimes itAlthough normally a tight space, sometimes it
becomes large enough to allow abdominal contentsbecomes large enough to allow abdominal contents
(usually intestine) into the canal.(usually intestine) into the canal.
 This hernia causes a bulge below the inguinal creaseThis hernia causes a bulge below the inguinal crease
in roughly the middle of the thigh.in roughly the middle of the thigh.
 Rare and usually occurring in women, these herniasRare and usually occurring in women, these hernias
are particularly at risk of becoming irreducible andare particularly at risk of becoming irreducible and
strangulated.strangulated.

14. Types Cont.Types Cont.
 Umbilical herniaUmbilical hernia
 These common hernias (10-30%) are often noted atThese common hernias (10-30%) are often noted at
birth as a protrusion at the bellybutton (thebirth as a protrusion at the bellybutton (the
umbilicus).umbilicus).
 This is caused when an opening in the abdominalThis is caused when an opening in the abdominal
wall, which normally closes before birth, doesn’twall, which normally closes before birth, doesn’t
close completely.close completely.
 Even if the area is closed at birth, these hernias canEven if the area is closed at birth, these hernias can
appear later in life because this spot remains aappear later in life because this spot remains a
weaker place in the abdominal wall.weaker place in the abdominal wall.
 They most often appear later in elderly people andThey most often appear later in elderly people and
middle-aged women who have had children.middle-aged women who have had children.

16. Types Cont.Types Cont.
 Incisional herniaIncisional hernia
 Abdominal surgery causes a flaw in the abdominalAbdominal surgery causes a flaw in the abdominal
wall that must heal on its own.wall that must heal on its own.
 This flaw can create an area of weakness where aThis flaw can create an area of weakness where a
hernia may develop.hernia may develop.
 This occurs after 2-10% of all abdominal surgeries,This occurs after 2-10% of all abdominal surgeries,
although some people are more at risk.although some people are more at risk.
 After surgical repair, these hernias have a high rate ofAfter surgical repair, these hernias have a high rate of
returning (20-45%).returning (20-45%).

17. Types Cont.Types Cont.
 Spigelian herniaSpigelian hernia
 This rare hernia occurs along the edge of theThis rare hernia occurs along the edge of the
rectus abdominus muscle, which is severalrectus abdominus muscle, which is several
inches to the side of the middle of theinches to the side of the middle of the
abdomen.abdomen.

18. Types Cont.Types Cont.
 Obturator herniaObturator hernia
 This extremely rare abdominal herniaThis extremely rare abdominal hernia
happens mostly in women.happens mostly in women.
 This hernia protrudes from the pelvic cavityThis hernia protrudes from the pelvic cavity
through an opening in your pelvic bonethrough an opening in your pelvic bone
(obturator foramen).(obturator foramen).
 This will not show any bulge but can act like aThis will not show any bulge but can act like a
bowel obstruction and cause nausea andbowel obstruction and cause nausea and
vomiting.vomiting.

19. Types Cont.Types Cont.
 Epigastric herniaEpigastric hernia
 Occurring between the navel and the lowerOccurring between the navel and the lower
part of the rib cage in the midline of thepart of the rib cage in the midline of the
abdomen, these hernias are composedabdomen, these hernias are composed
usually of fatty tissue and rarely containusually of fatty tissue and rarely contain
intestine.intestine.
 Formed in an area of relative weakness of theFormed in an area of relative weakness of the
abdominal wall, these hernias are oftenabdominal wall, these hernias are often
painless and unable to be pushed back intopainless and unable to be pushed back into
the abdomen when first discovered.the abdomen when first discovered.

22. Causes of herniasCauses of hernias
 Any condition that increases the pressure of theAny condition that increases the pressure of the
abdominal cavity may contribute to the formationabdominal cavity may contribute to the formation
or worsening of a hernia.or worsening of a hernia.
 ObesityObesity
 Heavy liftingHeavy lifting
 CoughingCoughing
 Straining during a bowel movement or urinationStraining during a bowel movement or urination
 Chronic ling diseaseChronic ling disease
 Fluid in the abdominal cavityFluid in the abdominal cavity
 HereditaryHereditary

23. Signs and SymptomsSigns and Symptoms
 The signs and symptoms of a hernia can rangeThe signs and symptoms of a hernia can range
from noticing a painless lump to the painful,from noticing a painless lump to the painful,
tender, swollen protrusion of tissue that you aretender, swollen protrusion of tissue that you are
unable to push back into the abdomen—possiblyunable to push back into the abdomen—possibly
a strangulated hernia.a strangulated hernia.
 Asymptomatic reducible herniaAsymptomatic reducible hernia
 New lump n the groin or other abdominal wall areaNew lump n the groin or other abdominal wall area
 May ache but is not tender when touched.May ache but is not tender when touched.
 Sometimes pain precedes the discovery of the lump.Sometimes pain precedes the discovery of the lump.

24. Cont.Cont.
 Lump increases in size when standing or whenLump increases in size when standing or when
abdominal pressure is increased (such asabdominal pressure is increased (such as
coughing)coughing)
 May be reduced (pushed back into the abdomen)May be reduced (pushed back into the abdomen)
unless very largeunless very large
 Irreducible herniaIrreducible hernia
 Usually painful enlargement of a previous herniaUsually painful enlargement of a previous hernia
that cannot be returned into the abdominal cavitythat cannot be returned into the abdominal cavity
on its own or when you push iton its own or when you push it
 Some may be long term without painSome may be long term without pain

25. Cont.Cont.
 Can lead to strangulationCan lead to strangulation
 Signs and symptoms of bowel obstruction maySigns and symptoms of bowel obstruction may
occur, such as nausea and vomitingoccur, such as nausea and vomiting
 Strangulated herniaStrangulated hernia
 Irreducible hernia where the entrapped intestineIrreducible hernia where the entrapped intestine
has its blood supply cut offhas its blood supply cut off
 Pain always present followed quickly byPain always present followed quickly by
tenderness and sometimes symptoms of boweltenderness and sometimes symptoms of bowel
obstruction (nausea and vomiting)obstruction (nausea and vomiting)
 You may appear ill with or without feverYou may appear ill with or without fever

26. Cont.Cont.
 Surgical emergencySurgical emergency
 All strangulated hernias are irreducible (but allAll strangulated hernias are irreducible (but all
irreducible hernias are not strangulated)irreducible hernias are not strangulated)

27. When to call the doctor!When to call the doctor!
 All newly discovered hernias or symptoms that suggestAll newly discovered hernias or symptoms that suggest
you might have a hernia should prompt a visit to theyou might have a hernia should prompt a visit to the
doctor.doctor.
 Hernias, even those that ache, if they are not tender andHernias, even those that ache, if they are not tender and
easy to reduce (push back into the abdomen), are noteasy to reduce (push back into the abdomen), are not
surgical emergencies, but all have the potential tosurgical emergencies, but all have the potential to
become serious.become serious.
 Referral to a surgeon should generally be made so thatReferral to a surgeon should generally be made so that
you can have surgery by choice (called elective surgery)you can have surgery by choice (called elective surgery)
and avoid the risk of emergency surgery should yourand avoid the risk of emergency surgery should your
hernia become irreducible or strangulated.hernia become irreducible or strangulated.

28. DiagnosisDiagnosis
 If you have an obvious hernia, the doctorIf you have an obvious hernia, the doctor
will not require any other testswill not require any other tests
 If you have symptoms of a hernia theIf you have symptoms of a hernia the
doctor may feel the area while increasingdoctor may feel the area while increasing
abdominal pressure (having you stand orabdominal pressure (having you stand or
cough).cough).
 This action may make the hernia able toThis action may make the hernia able to
be felt.be felt.

29. TreatmentTreatment
 Treatment of a hernia depends on whether it isTreatment of a hernia depends on whether it is
reducible or irreducible and possiblyreducible or irreducible and possibly
strangulated.strangulated.
 ReducibleReducible
 Can be treated with surgery but does not have to be.Can be treated with surgery but does not have to be.
 IrreducibleIrreducible
 All acutely irreducible hernias need emergency treatmentAll acutely irreducible hernias need emergency treatment
because of the risk of strangulation.because of the risk of strangulation.
 An attempt to push the hernia back can be madeAn attempt to push the hernia back can be made

30. Treatment Cont.Treatment Cont.
 StrangulationStrangulation
 OperationOperation
 PreventionPrevention
 You can do little to prevent areas of theYou can do little to prevent areas of the
abdominal wall from being or becoming weak,abdominal wall from being or becoming weak,
which can potentially become a site for awhich can potentially become a site for a
hernia.hernia.

31. ReferencesReferences
 http://www.emedicine.com/aaem/topic248.htmhttp://www.emedicine.com/aaem/topic248.htm
 Osburn, Kimberly Pagewise 2002Osburn, Kimberly Pagewise 2002
 Medline Plus American MedicalMedline Plus American Medical
AssosiationAssosiation