Mr. Pradeep Abothu, M.Sc (N), PhD Scholar, Associate Professor Dept. Of Child Health Nursing ASRAM College Of Nursing ◦ A hernia is a condition in which an organ, part of an organ, or tissue protrudes through an abnormal opening in the surrounding muscle or connective tissue. The etiology of hernias in children can be multifactorial, including: • Congenital Factors: Many hernias are present at birth due to incomplete closure of the abdominal wall or other developmental issues. • Increased Abdominal Pressure: Due to factors such as coughing, straining, or heavy lifting. • A family history of hernias may increase the risk. Hernias occurring in newborns are i. ii. Gastroschisis Omphalocele Commonly diagnosed hernias during infancy and childhood are i. ii. Inguinal Hernia Umbilical Hernia. Gastroschisis: Gastroschisis is a congenital abdominal wall defect characterized by an opening, through which the abdominal contents protrude without a protective sac. It is usually located to the right of the umbilical cord. It occurs in approximately 1 in 10,000 live births Pathophysiology: In gastroschisis, the abdominal wall fails to close during fetal development, leading to exposure of the intestines to amniotic fluid. This exposure can cause inflammation and damage to the bowel, resulting in complications such as intestinal atresia or malrotation. Clinical Features: • Protruding abdominal contents at birth. • Size of the defect typically ranges from 1 to 5 cm. • Noprotective membrane covering the organs • Possible associated complications, including: prematurity, low birth weight, • Feeding difficulties, • Electrolyte imbalances. • Visible abdominal deformity at the time of delivery. Omphalocele: Omphalocele is a congenital abdominal wall defect in which abdominal organs, such as the intestines, liver, and spleen, protrude into the base of the umbilical cord, covered by a thin, protective membrane. It has an incidence of about 1 in 5,000 live births. Pathophysiology: An omphalocele occurs due to an error in embryonic development, specifically involving the intestinal tract. During fetal development, the midgut temporarily herniates through the umbilicus, but it should later re-enter the abdomen as the abdominal wall closes. In omphalocele, this process fails, resulting in the midgut remaining outside the abdomen. Clinical Features: ◦ Protrusion of abdominal contents at the base of the umbilicus, often visible at birth ◦ The defect can vary in size, from small to large, i.e. 4- 12 cms. ◦ Presence of a protective sac covering the herniated organs ◦ Large omphalocele can cause dystocia and injury to the liver ◦ Small and undeveloped abdominal and thoracic cavities ◦ Possible associated anomalies, including: cardiac defects, gastrointestinal malformations, chromosomal abnormalities. Diagnostic Evaluation: Prenatal Tests:  Blood Tests: Elevated levels of maternal alpha-fetoprotein (AFP) during pregnancy can in

1. HERNIAS
Mr. Pradeep Abothu, M.Sc (N), PhD Scholar,
Associate Professor
Dept. Of Child Health Nursing
ASRAM College Of Nursing

2. A hernia is a condition in which
an organ, part of an organ, or tissue
protrudes through an abnormal
opening in the surrounding muscle or
connective tissue.
DEFINITION

3. The etiology of hernias in children can be multifactorial, including:
• Congenital Factors: Many hernias are present at birth due to incomplete
closure of the abdominal wall or other developmental issues.
• Increased Abdominal Pressure: Due to factors such as coughing,
straining, or heavy lifting.
• A family history of hernias may increase the risk.
ETIOLOGY

4. Commonly diagnosed hernias during infancy and childhood are
i. Inguinal Hernia
ii. Umbilical Hernia.
TYPES

6.  Inguinal Hernia: Occurs in the groin area when the intestine pushes through a defect in the abdominal muscles.
It is more common in males.
 Umbilical Hernia: Occurs when part of the intestine protrudes through the abdominal wall near the umbilicus. It
is common in infants and usually resolves on its own.
 Femoral Hernia: Occurs when the intestines push through the femoral canal, located just below the inguinal
ligament. It is less common but can be serious.
 Incisional Hernia: Develops through a scar from previous abdominal surgery.
 Hiatal Hernia: Occurs when part of the stomach pushes through the diaphragm into the chest cavity. It is less
common in children.
 Epigastric Hernia: Occurs when the intestine pushes through the abdominal wall between the umbilicus and the
chest.
 Diaphragmatic Hernia: Involves the displacement of abdominal contents into the thoracic cavity through a
defect in the diaphragm. This can be congenital or acquired.

7. INGUINAL HERNIA: Inguinal hernia
occurs in the groin area when the
intestine pushes through a defect in
the abdominal muscles.
• Hernias are relatively common in
children, particularly inguinal hernias,
which occur in 1-5% of infants and are
more prevalent in premature infants.
INGUINAL HERNIA

8. Pathophysiology:
• During fetal development, the testicles form in the abdomen and typically descend into
the scrotum through the inguinal canal before birth.
• After the descent, the inguinal canal should close to prevent abdominal contents from
protruding.
• However, if this canal fails to close properly, a weak spot remains, allowing intra-
abdominal pressure to push tissues through the defect, leading to an inguinal hernia.
• This condition can be congenital (present at birth) or acquired due to factors such as
increased abdominal pressure from activities like coughing or heavy lifting.

9. Clinical Manifestations:
• A noticeable bulge or swelling in the groin or scrotum, especially when
crying, coughing, or straining.
• Mild discomfort or pain in the groin
• The hernia may be reducible or irreducible.
• Incarceration or strangulation can occur,
leading to fever, irritable, severe pain, nausea, vomiting,
and abdominal distention.

10. Diagnostic Evaluation:
• Physical Inspection: The groin area is examined to determine the size,
reducibility, and tenderness of the hernia.
• Ultrasound: Commonly used in children to visualize the hernia and assess
its contents.

11. Management:
◦ In asymptomatic cases, particularly in infants with small, reducible hernias,
watchful waiting may be appropriate, as most of these hernias are
reducible.
◦ Surgery is recommended for symptomatic hernias, those that are
irreducible, or when complications such as incarceration or strangulation
occur.
◦ Surgery involves making a small incision over the weakened area to push
the hernia back into the abdomen, excise the hernia sac, and reinforce the
area with sutures or mesh.
◦ Laparoscopic repair may also be performed.

12. INGUINAL HERNIA: Umbilical hernia
occurs when part of the intestine
protrudes through the abdominal wall
near the umbilicus. It is common in
infants and usually resolves on its own.
Umbilical hernias occur in approximately
10-20% of newborns, often resolving on
their own by age 1 or 2 years.
UMBLICAL HERNIA

13. Pathophysiology:
◦ During fetal development, there is a small opening in the abdomen for the
umbilical cord that connects the baby to the mother.
◦ After birth, this opening should close as the abdominal muscles develop.
◦ However, if the muscles around the umbilical opening do not fully close, it
creates a weakness through which intra-abdominal contents can push,
leading to an umbilical hernia.

14. Clinical Manifestations:
• A visible, soft, protruding bulge near the umbilicus, which may be more
noticeable when the child cries, coughs, or strains.
• The hernia can usually be pushed back into the abdominal cavity.
• Mild discomfort may be felt, particularly when the child is active.
• In rare cases, the hernia can become incarcerated or strangulated, leading
to severe pain, vomiting, and abdominal distention.

15. Management:
• In infants, many umbilical hernias resolve on their own by
age 1 or 2.
• Observation is often the preferred management for
small, asymptomatic hernias. Surgery is recommended if
the hernia is large, symptomatic, or does not resolve by
age 4-5.
• The surgical procedure involves herniorrhaphy, in which
the hernia sac is pushed back into the abdomen, and the
muscle wall is repaired, often reinforced with mesh.

16. NURSING
MANAGEMENT

17. Preoperative Care:
• Monitor for signs of complications such as pain, vomiting, or changes in the
hernia's appearance.
• Provide emotional support to the child and family, and educate them about
the surgical procedure and expected outcomes.
• Ensure that all preoperative tests are completed.
• Confirm that the child is appropriately prepared for anesthesia, including
any necessary preoperative medications.

18. Postoperative Care
• Monitor vital signs and continue administering IV fluids.
• Administer prescribed pain medications to manage postoperative discomfort.
• Use non-pharmacological methods for pain relief, such as positioning the child
in a semi-upright position and using diversional therapy.
• Monitor the surgical site for signs of infection, such as redness, swelling, or
discharge.
• Regularly assess vital signs and observe for any signs of complications, such as
fever, increased pain, or changes in bowel function.
• Gradually reintroduce fluids and a regular diet once bowel movements are
restored.

19. •Encourage gentle movements and activities as tolerated to promote
circulation and prevent complications.
•Teach parents how to care for the wound at home, including keeping the
area clean and dry.
•Advise parents on activity restrictions, such as avoiding heavy lifting or
strenuous play, until the child is fully healed.