This document provides information on hernias, including what they are, types of hernias, signs and symptoms, risk factors, and treatment options. The main types of hernias discussed are inguinal, hiatal, femoral, umbilical, and incisional hernias. Hernias occur when an organ or fatty tissue protrudes through a weakness in the abdominal wall. While usually harmless, hernias can become strangulated and cut off blood flow, which is a surgical emergency. Surgery is the primary treatment for hernias to prevent complications, with options like mesh plugs and laparoscopic repair.

1. HERNIA
&
its treatment
BY
SROTA DAWN.
M.PHARM(PHARMACOLOGY)
1

2. What is a hernia
Hernia is derived from the Latin ward
"rupture"
• It is the protrusion of an organ or part of an organ
through a defect in the wall of the cavity normally
containing it.
• A hernia is an abnormal weakness or hole in an
anatomical structure which allows something
inside to protrude through.
• It is commonly used to describe a weakness in the
abdominal wall.

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

5. Hernia Characteristics
• Asymptomatic bulge most common
• Symptoms
– Physical effects of sac and contents on
surrounding tissues
– Obstruction and/or strangulation of hernia sac
contents

6. Causes of hernia:
Usually, there is no obvious cause of a hernia.
Sometimes hernias occur with
• heavy lifting,
•straining while using the toilet,
•or any activity that raises the pressure inside the
abdomen.
•Hernias may be present at birth, but the bulge
may not be noticeable until later in life.
• Some patients may have a family history of
hernias.

7. Incidence of hernia :
Hernias can be seen in
•infants and children.
•This can happen when there is weakness in the
abdominal wall.
•About 5 out of 100 children have inguinal
hernias (more boys than girls).
• Some children may not have symptoms until
they are adults.

8. In children,
• Specifically in infants, the parents―
observation of a swelling or protusion
may be the only positive feature.
• In the infancy may be Transilluminable

9. Indirect inguinal hernia
• Follows pathway that testicles made
during prebirth development.
• This pathway normally closes before
birth but remains a possible place for a
hernia.
• Sometimes the hernial sac may
protrude into the scrotum.
• This type of hernia may occur at any
age but becomes more common as
people become aged

10. Risk factors :
Any activity or medical problem that increases
pressure on the abdominal wall tissue and
muscles may lead to a hernia, including:
• Chronic constipation, straining to have
bowel movements
• Chronic cough
• Cystic fibrosis,
• Enlarged prostate, straining to urinate
• Extra weight

11. • Fluid in the abdomen,
• Heavy lifting,
• Peritoneal dialysis,
• Poor nutrition,
• Smoking,
• Overexertion,
• Undescended testicles.

12. Hernia composed of;
1.Sac: a folding of peritoneum consisting of a
mouth, neck, body and fundus.
2.Body: which varies in size and is not necessarily
occupied.
3.Coverings: derived from layers of the abdominal
wall.
4.Contents: which could be anything from the
omentum, intestines, ovary or urinary bladder.

15. Signs and tests
A health care provider can confirm that you have
a hernia during a physical exam. The growth may
increase in size when you cough, bend, lift, or
strain.
The hernia (bulge) may not be obvious in infants
and children, except when the child is crying or
coughing. In some cases, an ultrasound may be
needed to look for a hernia.
If you may have a blockage in your bowel, you
will need an x-ray of the abdomen.
CT scans are also very useful for finding some
hernias

16. The types of hernias are based on
where they occur:
• Femoral hernia appears as a bulge in the upper thigh,
just below the groin. This type is more common in
women than men.
• Hiatal hernia occurs in the upper part of the stomach. In
this hernia, part of the upper stomach pushes into the
chest.
• Incisional hernia can occur through a scar if you have
had abdominal surgery in the past.
• Umbilical hernia appears as a bulge around the belly
button. It occurs when the muscle around the navel
doesn't close completely

18. Inguinal hernia:
Makes up 75% of all abdominal wall
hernias and occurring up to 25 times more
often in men than women.
• Two types of inguinal hernias:
– Indirect inguinal hernia
– Direct inguinal hernia

20. • Sometimes the hernial sac may protrude
into the scrotum.
• This type of hernia may occur at any age
but becomes more common as people
age.
Indirect inguinal hernia

21. • Incidence: 25% of hernia cases
• The hernia contents enter the inguinal
canal.
• These hernias are generally considered to
be acquired, and may be associated with
heavy lifting, straining due to constipation,
coughing, or prostatic enlargement.
Direct Inguinal Hernia

22. Hiatus hernia
A hiatus hernia occurs when the upper part of
the stomach, which is joined to the
oesophagus (gullet), moves up into the chest
through the hole (called a hiatus) in the
diaphragm.
Hiatal hernia is a condition in which part of the
stomach sticks upward into the chest, through
an opening in the diaphragm. The diaphragm
is the sheet of muscle that separates the
chest from the abdomen. It is used in
breathing.
It is common and occurs in about 10 per cent
of people.

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

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

26. Causes, incidence, and risk factors:
The cause is unknown, but hiatal hernias may
be due to a weakening of the supporting tissue.
Increasing age, obesity, and smoking are known
risk factors in adults.
Children with this condition are usually born
with it (congenital). It often occurs
with gastroesophageal reflux in infants.
Hiatal hernias are very common, especially in
people over 50 years old. This condition may
cause reflux (backflow) of gastric acid from the
stomach into the esophagus.

27. Symptoms
•Chest pain
•Heartburn, worse when bending over or
lying down
•Swallowing difficulty
•A hiatal hernia by itself rarely causes
symptoms. Pain and discomfort are usually
due to the reflux of gastric acid, air, or bile.

28. Signs and tests
•Barium swallow x-ray
•Esophagogastroduodenoscopy (EGD)
Complications
•Pulmonary (lung) aspiration
•Slow bleeding and iron deficiency
anemia (due to a large hernia)
•Strangulation (closing off) of the hernia

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

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

32. Umbilica
l hernia

33. Paraumbilical Hernia:
• Affects adults.
• either supra or infraumbilical through
the linea alba.
• The female to male ratio is 20:1.
• Clolicky pain and/or irreducibilty due
to omental adhesions.

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

36. Incisional hernia
Incision

37. Spigelian hernia
This rare hernia occurs along the edge of the
rectus abdominus muscle, which is several
inches to the side of the middle of the
abdomen.

38. Obturator hernia
This extremely rare abdominal hernia
happens mostly in women.
This hernia protrudes from the pelvic cavity
through an opening in your pelvic bone
(obturator foramen).
This will not show any bulge but can act like a
bowel obstruction and cause nausea and
vomiting.

39. Epigastric hernia
Occurring between the navel and the lower
part of the rib cage in the midline of the
abdomen, these hernias are composed
usually of fatty tissue and rarely contain
intestine.
Formed in an area of relative weakness of the
abdominal wall, these hernias are often
painless and unable to be pushed back into
the abdomen when first discovered.

41. Hernia is classified into three types:
* Reducible, Hernias can be reducible if the hernia can be
easily manipulated back into place.
* Irreducible or incarcerated, this cannot usually be
reduced manually because adhesions form in the hernia
sac.
* Strangulated, if part of the herniated intestine becomes
twisted or edematous and causing serious complications,
possibly resulting in intestinal obstruction and necrosis.

42. Signs and Symptoms
• The signs and symptoms of a hernia can
range from noticing a painless lump to the
painful, tender, swollen protrusion of tissue
that you are unable to push back into the
abdomen—possibly a strangulated hernia.
Asymptomatic reducible hernia
Irreducible hernia
Strangulated hernia

43. Asymptomatic reducible hernia :
•New lump n the groin or other abdominal
wall area
•May ache but is not tender when touched.
•Sometimes pain precedes the discovery
of the lump.
• Lump increases in size when standing or
when abdominal pressure is increased
(such as coughing)
•May be reduced (pushed back into the
abdomen) unless very large

44. Irreducible hernia:
• Usually painful enlargement of a previous
hernia that cannot be returned into the
abdominal cavity on its own or when you push it
• Some may be long term without pain
• Can lead to strangulation
• Signs and symptoms of bowel obstruction may
occur, such as nausea and vomiting

45. Strangulated hernia
• Irreducible hernia where the entrapped intestine
has its blood supply cut off
• Pain always present followed quickly by
tenderness and sometimes symptoms of bowel
obstruction (nausea and vomiting)
• You may appear ill with or without fever
• Surgical emergency
• All strangulated hernias are irreducible (but all
irreducible hernias are not strangulated)

46. Treatment Options
• All hernias should be surgically corrected to
remove the risk of incarceration and strangulation.
• If there are compelling co-morbid medical
conditions that preclude surgery, then a truss, or
support hernia belt may be employed. A truss does
not repair the hernia defect, but will afford some
relief of symptoms.
• Modern methods of repair include open primary
closure of the defect with sutures (Shouldice or
"Canadian" Repair, Bassini Repair); patch closure
with prosthetic materials (Polypropylene or Gortex)
tension-free (Lichtenstein-type) and laparoscopic
repair.

47. PHS repair in femoral hernia surgery
December
2000:
a 55 years
old woman
with a large
strangulated
right femoral
hernia was
admitted at
BRITISH
HERNIA
INSTITUTE.

48. PHS repair in femoral hernia surgery
Once
opened the
hernia sac,
a small
bowel
necrotic
loop was
found

49. PHS repair in femoral hernia surgery
After bowel
resection, closu
re and
reduction of the
peritoneal
stump, the wall
defect
appeared too
large for an
usual mesh
plug repair, so
an underlay of
a PHS® device
was placed
deeply in the

50. PHS repair in femoral hernia surgery
The onlay
component of the
PHS® was cut off
and removed.
The connector
was fixed with
four prolene® 3-0
stitches (slow
absorbable
sutures in the
last 16 repairs),
to the lower edge
of the inguinal
ligament and to

51. Awareness:
Can a hernia kill you?
Yes, a hernia can kill you, but it isn't likely.
If a portion of the intestine goes out the
hernia, it can become strangulated and that
portion can die. That leads to infections,
bowel impaction and many other issues.