Fataq/ Hernia

Definition

• A hernia is the protrusion of a viscus or part of a viscus through an abnormal opening in its coverings

Types

Common

• Umbilical/para-umbilical.

• Inguinal (direct and indirect).

• Femoral.

• Incisional.

Uncommon

• Epigastric.

• Gluteal, lumbar, obturator.

Pathophysiology

• The defect in the abdominal wall may be congenital (e.g. umbilical hernia, femoral canal) or acquired (e.g. an incision) and is lined with peritoneum (the sac).

• Raised intra-abdominal pressure further weakens the defect allowing some of the intra-abdominal contents (e.g. omentum, small bowel loop) to migrate through the opening.

• Entrapment of the contents in the sac leads to incarceration (unable to reduce contents) and possibly strangulation (blood supply to incarcerated contents is compromised).

Clinical features

• Patient presents with a lump over the site of the hernia.

• Femoral hernias are below and lateral to the pubic tubercle, they usually flatten the groin crease and are 10 times more common in women than men. 50% present as a surgical emergency due to obstructed contents and 50% of these will require a small bowel resection. Femoral hernias are irreducible.

• Inguinal hernias start off above and medial to the pubic tubercle but may descend broadly when larger, they usually accentuate the groin crease. Most are benign and have a low risk of complications.

(a) Indirect inguinal hernias can be controlled by digital pressure over the internal inguinal ring, may be narrow necked and are common in younger men (3% per annum present with complications).

(b) Direct inguinal hernias are poorly controlled by digital pressure, are often broad necked and are commoner in older men (0.3% per annum strangulate).

• Incisional hernias bulge, are usually broad necked, poorly controlled by pressure and are accentuated by tensing the recti. Large, chronic incisional hernias may contain much of the small bowel and may by irreducible/unrepairable due to the ‘loss of the right of abode in the abdomen’ of the contents.

• True umbilical hernias are present from birth and are symmetrical defects in the umbilicus due to failure to close.

• Para-umbilical hernias develop due to an acquired defect in the periumbilical fascia.

Complications of surgery

• Haematoma (wound or scrotal).

• Acute urinary retention.

• Wound infection.

• Chronic pain.

• Testicular pain and swelling leading to testicular atrophy.

• Hernia recurrence (about 5%).

• ESSENTIAL MANAGEMENT• Assess the hernia for: severity of symptoms, risk of

complications (type, size of neck), ease of repair (size, location), likelihood of success (size, loss of right of abode).

• Assess the patient for: fitness for surgery, impact of hernia on lifestyle

(job, hobbies).• Surgical repair is usually offered in suitable patients for:(a) hernias at risk of complications whatever the symptoms;(b) hernias with previous symptoms of obstruction;(c) hernias at low risk of complications but symptoms

interfering with lifestyle, etc.Principles of surgery• Herniotomy: excision of the hernial sac.• Herniorrhaphy: repairing the defect.

Aqsam

• Fataq taam

• F. Naaqis

• F. Rajie

• F. Ghair Rajie

• F. mukhtaran

• F. Varmi

• F. Suddi

• F. medi

Asbab

Weakness

• Elderly

• Weakness of abdominal wall

• After surgery

• Any normal openings become broad

Increased abdominal pressure

• Lifting heavy objects

• Ascitis

• Hamal

• Qabz

• Excessive rutubat

• Flatulance

Alamat

• Abdominal pain

• Discomforts

• Sometimes vomiting

• Feacal incontinance

• Intestinal colic

• Frequent defeacation

• Incomplete emptyness

Fataq warmi

• Fever

• Vomiting

• Acute pain

• Inflammation

Fataq suddi

• Colic pain

Usoole ilaj

• Avoid vigorous physical activities

• Refrain from sexual intercourse

• Avoid drinking plenty of water

• Avoid flatulence producing food

• If it is reducible immediately reduce and prevent it by applying bandage

• Daf –e-alam

• huqna

Ilaj

• Mastagi, badiyan, anisoon each 1 g pasted well and mix with Gulqand 25 g , Arq-e-badiyan and arq-e-mako each 36 ml

• Kundoor, badang, kust, 6g each pasted and mixed with roghan-e-gao 125 ml given to drink to induce vomiting

• Pour hot water on the hernia or take hot abzan which make hernia soft then reduce it

• Then apply qabiz drugs

Mastagi, kundoor, aqaqiya, gulnar, dammulakhwain, murmakki, anzaroot, sibr, raswat, shab e yamani

Paste can be applied

apply

• Sare samagi + ab e makko sabz murawwaq

• Dammul akhwain + katheera + samag-e-arabi

• Behiroza khiushk + affiyoon water – paste

• Farfiyoon + jundube dastar + roghan-e-kunjad

Nutool

Gule baboonah, tukhm-e-sibbat, aqleelul mulk, brinjasif, marzanjosh,

Massage

• R. baboonah

• R. kist

• R. shibbat

• R. sadab

• Alone or mixed with jundube dastar and apply