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Class Presentation on Hernia

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  1. 1. by Maria G. Nelson
  2. 2. <ul><li>Occurs when contents of a body cavity bulge out of the area where they are normally contained. </li></ul><ul><li>Term to denote bulges in other areas, but usually describes hernias of the lower torso (abdominal wall hernias) </li></ul><ul><li>May be asymptomatic </li></ul><ul><li>If blood supply of hernia sac contents is cut off – a medical and surgical emergency! </li></ul>
  3. 3. <ul><li>Inguinal (groin) </li></ul><ul><li>Femoral </li></ul><ul><li>Umbilical </li></ul><ul><li>Incisional </li></ul><ul><li>Epigastric </li></ul>
  4. 4. <ul><li>Inguinal Hernia (groin) </li></ul><ul><ul><li>75% of all abdominal wall hernias </li></ul></ul><ul><ul><li>Occurs 25% more often in men than women </li></ul></ul><ul><ul><li>2 types which occur both in the groin area where the skin crease at the top of the thigh joins the torso (inguinal crease) </li></ul></ul><ul><ul><ul><li>Indirect inguinal – hernia sac may protrude into the scrotum; may occur at any age </li></ul></ul></ul><ul><ul><ul><li>Direct inguinal hernia – middle-aged to elderly as their abdominal walls weaken with age </li></ul></ul></ul>
  5. 7. <ul><li>Femoral Hernia </li></ul><ul><ul><li>Femoral canal is the path through which the femoral artery, vein and nerve leave the abdominal cavity to enter the thigh </li></ul></ul><ul><ul><li>Causes a bulge just below the inguinal crease in roughly the mid-thigh area </li></ul></ul><ul><ul><li>Usually occurs in women </li></ul></ul><ul><ul><li>At risk of becoming irreducible (not able to be pushed back into place) and strangulated </li></ul></ul>
  6. 9. <ul><li>Umbilical Hernia </li></ul><ul><ul><li>Common hernias (10-30%) often noted at birth as a protrusion at the bellybutton (umbilicus) </li></ul></ul><ul><ul><li>Caused by an opening in the abdominal wall, which normally closes before birth, does not close completely </li></ul></ul><ul><ul><ul><li>Less than ½ inch – closes gradually by age 2 </li></ul></ul></ul><ul><ul><ul><li>Large hernias – surgery at age 2-4 years </li></ul></ul></ul><ul><ul><ul><li>Even if closed, may reappear later in life (weak spot in the abdominal wall) </li></ul></ul></ul><ul><ul><ul><li>Can occur in women who are having/have had children </li></ul></ul></ul>
  7. 11. <ul><li>Incisional Hernia </li></ul><ul><ul><li>Abdominal surgery causes flaw in the abdominal wall – create an area of weakness where hernia may develop </li></ul></ul><ul><ul><li>Occurs after 2-10% of all abdominal surgeries, although some people may be more at risk </li></ul></ul><ul><ul><li>May return even after surgical repair </li></ul></ul>
  8. 12. <ul><li>Epigastric Hernia </li></ul><ul><ul><li>Occurs between the navel and the lower part of the rib cage in the midline of the abdomen </li></ul></ul><ul><ul><li>Usually composed of fatty tissue and rarely contain intestine </li></ul></ul><ul><ul><li>Formed in the area of relative weakness of the abdominal wall </li></ul></ul><ul><ul><li>Often painless and unable to be pushed back into the abdomen when first discovered </li></ul></ul>
  9. 15. <ul><li>Any condition that increases pressure on the abdominal cavity </li></ul><ul><ul><li>Obesity </li></ul></ul><ul><ul><li>Heavy lifting </li></ul></ul><ul><ul><li>Coughing </li></ul></ul><ul><ul><li>Straining during a bowel movement or urination </li></ul></ul><ul><ul><li>Chronic lung disease </li></ul></ul><ul><ul><li>Fluid in the abdominal cavity </li></ul></ul><ul><li>Family history </li></ul>
  10. 16. <ul><li>Reducible hernia </li></ul><ul><ul><li>New lump in the groin or other abdominal wall area </li></ul></ul><ul><ul><li>May ache but not tender when touched </li></ul></ul><ul><ul><li>Sometimes pain precedes the discovery of the lump. </li></ul></ul><ul><ul><li>Lump increases in size when standing or when abdominal pressure is increased (ex. coughing). </li></ul></ul><ul><ul><li>May be reduced (pushed back into the abdomen) unless very large </li></ul></ul>
  11. 17. <ul><li>Irreducible hernia </li></ul><ul><ul><li>Occasionally painful enlargement of a previously reducible hernia that cannot be returned to the abdominal cavity on its own or when you push it. </li></ul></ul><ul><ul><li>Some may be long term without pain. </li></ul></ul><ul><ul><li>Also known as incarcerated hernia </li></ul></ul><ul><ul><li>Can lead to strangulation </li></ul></ul><ul><ul><li>Signs and symptoms of bowel obstruction may occur, such as nausea and vomiting. </li></ul></ul>
  12. 18. <ul><li>Strangulated hernia </li></ul><ul><ul><li>Irreducible hernia in which the entrapped intestine has its blood supply cut off </li></ul></ul><ul><ul><li>Pain is always present, followed quickly by tenderness and sometimes symptoms of bowel obstruction (nausea and vomiting). </li></ul></ul><ul><ul><li>The affected person may appear ill with or without fever. </li></ul></ul><ul><ul><li>Not all strangulated hernias are irreducible (but all irreducible hernias are strangulated). </li></ul></ul>
  13. 19. <ul><li>Diagnosis </li></ul><ul><ul><li>Simply by touch – cough, make it stick out </li></ul></ul><ul><ul><li>Barium Swallow and EGD </li></ul></ul><ul><li>Treatment </li></ul><ul><ul><li>Truss or abdominal support over the herniated area </li></ul></ul><ul><ul><li>Herniorrhaphy – surgical repair using a laparoscopic extraperitonial approach (LEP) after abdominal insufflation with carbon dioxide; 2-3 stab wounds instead of an incision; less pain & short recovery </li></ul></ul><ul><ul><li>Hernioplasty – if hernia has gone untreated for many years; reconstructive repair </li></ul></ul>
  14. 20. <ul><li>Client allowed out of bed on day of operation </li></ul><ul><li>Usually done on outpatient basis </li></ul><ul><li>Can have food and fluids </li></ul><ul><li>Void postoperatively – urinary retention is a common problem </li></ul><ul><li>Client to move around but avoid straining and lifting for several weeks or months </li></ul><ul><li>Return to routine activities occurs quickly </li></ul><ul><li>Return to work – depends on age, weight, type of work, nature and extent of hernia </li></ul><ul><li>Referral to vocational rehabilitation services </li></ul>