HERNIA&

its treatment

BYSROTA DAWN.

M.PHARM(PHARMACOLOGY)

1

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.

• 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.

Hernia Characteristics

• Asymptomatic bulge most common• Symptoms– Physical effects of sac and contents on

surrounding tissues– Obstruction and/or strangulation of hernia

sac contents

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.

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.

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

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

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

• Fluid in the abdomen,

• Heavy lifting,

• Peritoneal dialysis,

• Poor nutrition,

• Smoking,

• Overexertion,

• Undescended testicles.

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.

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

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

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

• 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

• 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

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.

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).

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.

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.

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.

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

Femoral herniaThe 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.

Umbilical herniaThese 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.

Umbilical

hernia

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.

Incisional herniaAbdominal 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%).

Incisional hernia

Incision

Spigelian herniaThis rare hernia occurs along the edge of

the rectus abdominus muscle, which is several inches to the side of the middle of the abdomen.

Obturator herniaThis 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.

Epigastric herniaOccurring 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.

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 .

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 herniaIrreducible herniaStrangulated hernia

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

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

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)

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.

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.

PHS repair in femoral hernia surgery

Once opened the hernia sac, a small bowel necrotic loop was found

PHS repair in femoral hernia surgery

After bowel resection, closure 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 properitoneal

space

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 the pectineal fascia

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.

Thank you…….