2. A hernia is protrusion of an organ or the muscular wall of an organ
through the cavity that normally contains it .
It is an abnormal protrusion of the intestine or other abdominal organ
through a weakness or defect in the musculature in to another cavity .
INTRODUCTION
3. “According to Brunner & suddarh”
The medical condition in which on organ inside the
body for example the stomach pushes through the wall of muscle which surrounds it .
“According to K. P. PARK”
A hernia is an abnormal protrusion of avicus through the wall of a cavity which normally
contains it .
“According to BT basavanthappa”
A hernia is the protrusion of an organ through its contwning wall .
DEFINITION
4. Hernia can occur at any age and either sex .
Indirect inquinal hernias are the most the hypically occur in men .
Direct hernia arefound mor community in older adult .
Incisional or ventral hernia occar most after in dient .
75–80% are inguinal or femoral.
2% are incisional or ventral.
3–10% are umbilical, affecting 10-20% of newborns; most close by themselves by 5 years of age.
1–3% are other types.
INCIDENCES
6. In anatomy, the abdominal wall represents the boundaries of the abdominal cavity. The abdominal wall is
split into the anterolateral and posterior walls.
There is a common set of layers covering and forming all the walls: the deepest being the visceral
peritoneum, which covers many of the abdominal organs (most of the large and small intestines, for
example), and the parietal peritoneum- which covers the visceral peritoneum below it, the extraperitoneal
fat , the transversalis fascia, the internal and external oblique and transversus abdominis aponeurosis, and
a layer of fascia ,which has different names according to what it covers (e.g., transversalis, psoas fascia).
In medical vernacular, the term 'abdominal wall' most commonly refers to the layers composing the anterior
abdominal wall which, in addition to the layers mentioned above, includes the three layers of muscle: the
transversus abdominis (transverse abdominal muscle), the internal (obliquus internus) and the external
oblique (obliquus externus).
Anatomy of the Abdominal wall
7. In human human anatomy the layers of the anterolateral abdominal wall are (from superficial to
deep)
Skin
Subcutaneous tissue
Fascia
Camper's fascia - fatty superficial layer.
Scarpa's fasciau- deep fibrous layer.
Muscle
External oblique abdominal muscle
Internal oblique abdominal muscle
Rectus abdominis
Transverse abdominal muscle
Pyramidalis muscle
Transversalis fascia
Extraperitoneal fat
Peritoneum
Layers of anterolateral abdominal wall
8. There are many different kinds of hernias that are
able to affect different arers of the body each hernia
will be one of there types .
1. Reducible .
2. Irreducible .
3. Stranguluted .
TYPES OF HERNIA
11. When the hernias is reducible it has the ability to be pushed back inside of
the abdominal cavity .
It may apperx as a new lump in the groin or other abdominal area .
It may be reduced( pushed back in to the abdomen ) untess very large .
13. When a hernias is irreducible it eans that you do not have the ability to push the mass back
inside of the abdominal cavity .
Many people perfer to treat the through surgery as soon as possible to avoid it becoming
strangulated hernia .
It may be an occasionally painful enlargement .
Some may be chronic without pain .
Signs and symptoms of bowel obstraction may occur , such as nausea and vomiting .
15. When the hernia is strangulated surgery is only the option this is when the hernia has
become twisted with anintestine and is cutting off its blood supply cut off .
This is an irreducible hernia in which the entrapped intestine has it blood supply cut off .
Sometimes symptoms of bowel obstruction ( nausea and vomiting .
This condition is a surgical emergency .
16. Hernia can be classified according to
their anatomical location :-
Inguinal hernia .
Femoral hernia .
Umbilical hernia .
Incisional hernia .
Hiatal hernia
Other types of hernias include:
Epigastric hernia .
Ventreal hernia .
Obturator hernia .
Herniation of intervertebrrl disc .
CLASSIFICATION OF HERNIA
17. A condition in which soft tissue bulges through a weak point in the abdominal
muscles .
The soft tissue is often part of the intestine its easy to see and feel the bulge , although not all are
visible by the patient especially when obese .
The intestine push through a weak or tear into the lower abdominal wall .
75% of all abdominal wall hernias .
Occurs 25 % more often in men than women .
In men, the inguinal canal is a passageway for the spermatic cord and blood vessels leading to the
testicles. In women, the inguinal canal contains the round ligament that gives support for the womb.
In an inguinal hernia, fatty tissue or a part of the intestine pokes into the groin at the top of the inner
thigh. This is the most common type of hernia, and affects men more often than women.
2 type :-
(1) Indirect inguinal hernia .
(2) Direct inguinal hernia .
INGUINAL HERNIA
18. (1) INDIRECT INGUNAL
HERNIA :-
Muscle weakness at the inguinal
ring causes failure closure of the
deep inguinal ring .
When icreased intra – abdominal
pressure and contents to enter the
channel .
The protrusion passes through the dep
inguinal ring and is located lateral to
the inferior epigastric artery .
19. (2) DIRECT INGUNAL
HERNIA :-
It pass through a weak ponit in the
fascia of abdominal wall and at the
medial to the inferior astric artery .
20.
21. A femoral hernia usually occurs when fatty tissue or part of your bowel pokes through into your grain at the
top of uour inner thigh .
1 .It pushes through a weak spot in the swrounding muscle wall into an area called the femoral canal .
2. A plug of fats in the femorl canal enlarged and pull the peritoneum and often the urinary bladder into sac .
3. More frequently in women because of the wider of the femal pelvis .
4. Common in obese or preganat women .
5. Fatty tissue or part of the intestine protrudes into the groin at the top of the inner thigh. Femoral hernias
are much less common than inguinal hernias and mainly affect older women.
FEMORAL HERNIA
22. Part of small intestine passes through the abdominal
wall near the navel , umbilical hernias are most
comon in children .
An umbilical hernia occurs when intestine , fat or
fluid pushes through a weal=k spot in the belly .
This causes abulge near the belly button , or navel .
Fatty tissue or part of the intestine pushes through
the abdomen near the navel (belly button).
CONGENITAL :- Appear in infancy .
ACQUIRED:- Increased in intaabdominal pressure
common seen in obese or pregnant women .
UMBILICAL HERNIA
23. HIATAL HERNIA
A hiatal hernia develops in a small opening in the diaphragm through which the esophagus passes that allows the
upper part of the stomach to move up into the chest .
Part of the stomach protrudes up diaphragm into the chest .
Part of the stomach pushes up into the chest cavity through an opening in the diaphragm (the horizontal sheet of
muscle that separates the chest from the abdomen).
2 types histal hernia .
(1) SLIDING HIATUS HERNIA :-
the distal oesophagus and cardia slides inti the thorax with an
intact gastro – oesophagel junction and therfore usually asymptomatic .
(2) ROLLING HIATUS HERNIA :-
most of the stomach rolls into the thorax , the stomach may also undergo a twist
.
24. The intestine pushes through the abdominal wall
at the site of previous abdomonal surgery . This
types is most common in elderlg or overweight
pepople who are inactive after abdominal surgery
.
Tissue protrudes through the site of an abdominal
scar from a remote abdominal or pelvic
operation.
Incisonal / ventral hernia (occur at the site pf
previous surgical incision ) results from
inadequate healing of the incision .
Cause be postoperative wound infection
,indequate , nutrition , and obesity .
INCISIONAL HERNIA
25. This types of hernia occurs as a result
of a weaknessin the muscles of the
upper – middle abdominal .
Fatty tissue protrudes through the
abdominal area between the navel and
lower part of the sternum
(breastbone).
EPIGASTRIC HERNIA
26. A ventral hernia is a bulge of tissues
through an opening of weakness with
in your abdominal to move up into the
chest .
he intestine pushes through the
abdomen at the side of the abdominal
muscle, below the navel.
VENTRAL HERNIA
27. • The obturator hernia occurs when
part the intestine passrs through
the gap between the bones of the
front of the pelvis .
• Organs in the abdomen move into
the chest through an opening in
the diaphragm.
OBTURATOR HERNIA
28. HERNIATION OF INTERVERTEBRRL DISC
The nucleus of disc protrudes into
the annulus with subsequent never
compression
30. ETIOLOGY
Any condition that increases the pressure in the intra – abdominal cavity may contribute to the formation
of a hernia including the following .
A) Any condition that is increases pressure on abdominal cavity :-
Combination of muscle weakness and strain .
Marked Obesity .
Heavy lifting .
Presistant coughing or sneezing .
Pregnancy .
Straining during bowel movement or urination .
Diarhea or constipation .
Ascites – fluid in the abdominal cavity .
Chronic obstructive pulmonary disese (COPD) .
Poor nutrition .
Smoking .
B) family history of hernias .
34. Goal of management :- it is to improve symprons and the quality of life in general and to prevent ,
adverse envents the rate of surgical complication .
General maneagement :- (1) open surgery –
it is sugery in which a cut made into the body at location of hernia .
(2) laparscopic surgery –
it indude as some type of repairs in surgery .
(3) rabotic hernia – like laparoscopic surgery uses a laparosocpe and is
performed with small incisions .
MANAGEMENTT
35. Propylatic antibiatics are given .
Maintainence of intrrvenous fluids are administred .
The patient is tough to apply truss daily .
Hernias that are not strangalate can be mechaniclly reduced .
Intrunt the patient to inspect the skin under the truss for any
manifestation of skin break down .
Neonates with intact omphalocel are usually in no distress unless
associated with pulmonary hypoplasia .
The baby should be cerefully examined to be detect any associated
problems .
Maintainense of intravenous fluids are administered .
Prophylatic antibiotics are given .
MEDICAL MANAGEMENT
36. ANTIBIOTIC
(Used if the patient has strangulated hernia )
i. IV cefoxitin ( mefoxin ) 1g 6-8 hourly .
ii. Cap . Ampicilln 250 -500 mg 6 hourly .
H2 RECETOR BLOCKER
( Used if the patient with hiatal hernia)
i. Tab . Famotidine 40 mg dly .
ii. Tab . Ranitdine 150 mg BD .
PHARMACLOGY MANAGEMNT
37. PPT
( Used if the patient with hiatal hernia )
i. Tab . Lansoprazole (prevacid ) 15 -30 mg dly .
ii. Cap . Osomeprazole ( nexium ) 20- 40 mg dly .
iii. Cap . Omeprazole ( prilosec) 20-40 mg dly .
iv. Tab . Pantoprazole (controloc ) 20-40 mg dly .
ANTIANXIMETY AGENTS
( indicated for patient who may experience significant anxiety before a surgery )
1. Tab . Dormicum 7.5-15 mg PRN.
NONSTEROIDAL ANTI –INFLAMMATORY DRUGS (NSAIDs)
( for patients with mild to moderate pain )
I. Tab. Ibuprofen (Advil) 100 mg 6 hourly .
II. Tab . Ketoprofen 50-75 mg 6 hourly .
38. NON – PHARMACOLOGICAL MANAGEMENT :-
1) Avoid food that cause acid reflux or heartburn such as
spicy food .
2) Don’t lie down or bend over after a meal .
3) Exercise .
4) Stop smoking .
5) Avoid gassy drinks .
6) Avoid life heavy object .
40. Non – surgical management :-
Truss( Inginal hernia) :- A pad made with firm material that will held in place over the hernia with belt to
help the abdominal contents from protruding into the hernia sac .
41. NURSING MANAGEMENT
1) Reduce the anxiety of patient .
2) To provide clean environment .
3) To improve the knowledge of the disease .
4) To provide the psychological support of the patient .
43. MEDICAL TREATMENT :-
• hernia that are not strangulated can be mechanically reduced .
•Truss ( firm pad ) held by a belt to keep the hernia in place or reduced .
•The hernia patient is taught to apply the truss daily .
•Instruct the patient to inspect the skin under the truss for any manifestation of skin breakdown .
•If patient has preexisting medical conditions that make surgery unafe , doctor may not repair hernia but
will watch it closely .
•Some hernia have very large openings in the abdominal wall , and closing the opening is compliated may
be treated without surgery ,using abdominal binders .
•Some doctors feel that the hernia with large openings have a low risk of strangulation .
•An attempt to ( push back ) the hernia will generally be made , often after giving medicine for pain and
muscle relaxation .
TREATMENT
44. SURGICAL TREATMENT :-
1) A hernia repair is performed using a small incision directly over the weakened area . The intestine is then
returned to the perineal cavity , yhe hernial sac excised and the muscle closed tightly over the area .
2) Hernia in the ingunial region are usually repaired under spinal or local anesthesia .
3) Some repair is difficult becsuse there is insufficient muscle to keep the intestines in place . So steel mesh
grafts are used to reinforce the rea of herniation .
4) Clients with difficult repairs are usually hospitalized for 1 to 2 days to prophylactic antibiotics .
5) If the intestinal contents of the hernia had the blood supply cut off , the development of dead ( gangrenous
) bowel is possible in as little as six hours .
45.
46. NURSING DIAGNOSES
PRE –OPERATIVE FOR HERNIA REPAIR:-
1) Fear and anxiety related to undegoing surgery .
POST - OPERATIVE FOR HERNIA REPAIR:-
2) Acute pain related to surgical intervention .
3) Risk of infection related to surgical site .
HIATAL HERNIA :-
Risk for aspiration related to reflux of gastric content .
47. HEALTH EDUCATION
Intake output:-
Drink safe water.
Drink water 50ml/dl.
Use chlorine in drinking water.
Hygiene:-
maintain person hygiene.
Wash the hand before intake water and food.
Excersize:-
Active and pasive excersize.
To protecte the injury.
To maintain health.
Rest and sleep:-
Giving the active in patient to feel better in rest, sleep.
Rest for 8-10 hour.
