Hernia
Supervised By DR/Enshrah Roshdy
Prepared By Asmaa Ahmed Master Degree (2019-2020)
Outlines:-
Introduction Definition
Risk factors Types
Clinical Manifestations
Diagnosis
Surgical Management Complication
Nursing Management
Factors contributing to failure of healing of abdominal
incisions
Objectives
presentation will be able to clarify
• Definition of hernia
• types of hernia
• risk factors and manifestation of hernia
• Perform abdomen assessment
• How to manage hernia.
• Complications of hernia.
Introduction
A hernia is a protrusion of the viscus (internal organ such as the
intestine) through an abnormal
opening or a weakened area in the wall of the cavity in which it is
normally contained..
Cont’
• A hernia may occur in any part of the body, but it usually occurs
within the abdominal cavity
• Hernias that easily return to the abdominal cavity are called
reducible. The hernia can be
reduced manually
Cont’
or may reduce spontaneously when the person lies down
.If the hernia cannot be placed back into the abdominal cavity, it is known
as irreducible or incarcerated.
con’
In this situation the intestinal flow
may be obstructed.
Definition:-
is the abnormal exit of tissue or an
organ, such as the bowel, through the wall of the cavity in which it
normally resides .
Risk factors
Chronic cough Smoking
Obesity
Straining while lifting heavy objects Straining during bowel movements
Types
1-The inguinal hernia
is the most common type of hernia( up to 75% of all abdominal hernias) and
occurs at the point of weakness in the
abdominal wall where the spermatic cord
(in men)
a. Indirect Inguinal Hernia
An indirect inguinal hernia occurs when any intra-abdominal structure protrudes through the deep inguinal ring entering the inguinal canal. is a congenital lesion. is relatively
common in males.
direct inguinal hernia :
occurs when the posterior abdominal wall is directly
penetrated at Hesselbach’s triangle by intraabdominal structures.
Unlike the indirect hernia, direct
hernias are acquired lesions.
inguinal
2-femoral hernia:
occurs when there is a protrusion through the femoral ring into the
femoral canal. It appears as a bulge below the inguinal ligament. It
easily becomes strangulated. It
occurs more often in women .
femoral
3-Umbilical Hernias
• are congenital in origin and often occur
during infancy; spontaneous closure by the
age of 2 years is common..
3-Umbilical
4-Incisional and Parastomal Hernias:-
protrusion of intra-abdominal
contents through a surgically formed defect.
, incisional hernias are usually diffuse bulges that are unlikely to result in
strangulation.
5-Diaphragmatic
hiatus hernia higher in the abdomen, an (internal) "diaphragmatic hernia"
results when part of the stomach or intestine protrudes into the chest
cavity through a defect in the
Diaphragm.
Other Hernia Sites
Epigastric:
occur in the linea alba. They are an acquired defect and are often
multiple in nature. In obese patients they can be difficult to appreciate
by palpation..
• either "sliding", in which the
gastroesophageal junction itself
slides through the defect into the
chest, or non-sliding (also known
as para-esophageal)
Cont ’
• Patients with epigastric hernias commonly complain of a painful tearing sensation in the midline on moving into a recumbent
position.
5-Diaphragmatic
b. Spigelian
• a defect at the semilunar line.
• The semilunar line is found on the lateral
boarder of the rectus abdominis muscle.
Men Women
Inguinal hernia is more common in men than in common in men than in women.
Femoral hernia is more common in women
(particularly older women) than in men.
The lifetime risk of developing
a groin hernia is approximately 25% in men.
The lifetime risk of developing
a groin hernia is <5% in women.
Clinical Manifestations
1-A hernia may be readily visible, especially when the person tenses the abdominal
muscles.
2-There may be some discomfort as a result of tension. If the hernia becomes strangulated
abdominal pain, and distention.
,( the patient will have severe pain and symptoms of a bowel obstruction) such as vomiting, cramping .
• Strangulated hernias or painful, inflamed hernias that cannot be
reduced require emergency surgery.
B-DIAGNOSTIC STUDIES
x-ray studies,
barium swallow,
and fluoroscopy.
Surgical Management
Laparoscopic surgery is the treatment of choice for hernias. The surgical repair of a hernia, known as a
herniorrhaphy, is usually an
outpatient procedure. Reinforcement of the weakened area with wire,
fascia, or mesh is known as a
hernioplasty.
• Strangulated hernias are treated immediately with resection of the involved area or a
temporary colostomy so that necrosis and gangrene do not occur.
Open surgery,
in which a cut is made into the body at the
location of the hernia. The protruding tissue is set back in place and the weakened muscle
wall is stitched back together. Sometimes a type of mesh is implanted in the area to
provide extra support.
Complication :-
Incarceration
a.
the confinement of a herniated structure in its protruded
position.Once incarceration has
occurred, strangulation may quickly intervene leading to a surgical
emergency.
b. Strangulation
pressure at the neck of the hernial defects exceeds venous outflow pressure the hernia quickly becomes engorged with blood.
leading the ischemia and subsequent edema and necrosis of tissue.
• peritonitis and sepsis.
•Inflammation
• Obstruction of any lumen, such as bowel
obstruction in intestinal hernias
• Hydrocele of the hernial sac
• Hemorrhage
• Autoimmune problems
Nursing Management
before surgery
• Patients encouraged to drink plenty of fluids for two days leading up to the operation.
• Patients should also eat plenty of fiber containing foods during this period
• Helps avoid constipation and pain after the operation.
• Patients can take laxatives if needed. Indeed gentle laxatives such as Lactulose taken for the first two days after the operation may help reduce pain and constipation.
After surgery
Patients should be encouraged to take any prescribed tablets for pain only if they
need them. Paracetamol is almost as effective.
Wound care: Patients should be
encouraged to bath at least daily after the operation.
Give a single dose of an appropriate
antibiotic to minimize any chance of
infection
• Mobility: this should be encouraged and patients should keep as active as possible Driving after the operation is difficult. No driving for the first 7-10 is probably
• After a hernia repair, the patient may have difficulty voiding.
• Measure intake and output and observe for a distended bladder.
• Scrotal edema is a painful complication after an inguinal hernia
repair.
• A scrotal support with application of an ice bag may help relieve pain and edema.
• Encourage deep breathing, but not coughing.
• Teach patients to splint the incision and keep their mouths open when coughing or sneezing are unavoidable.
• The patient may be restricted from heavy
lifting for 6 to 8 weeks.
• Apply an ice compress on the scrotal area if hydrocele is corrected and apply scrotal
support if appropriate.
• Provide support to the buttocks during lifting or position changes.
• Encourage parents to change diapers frequently.
• Provide toys, games for quiet play.
• Instruct parents to hold the infant during
feeding or when irritable, frequently burp to remove swallowed air.
• Educate parents on the causes of pain and interventions needed to relieve it.
related to Lack of Deficient Knowledge
. 2
knowledge about postoperative care.
• Assess parent’s knowledge of hernia including its causes, surgical management; Assess
parent’s willingness and interest to execute treatment regimen.
• Provide parents and child as appropriate with clear and precise information in
understandable language, utilizing teaching aids and encourage questions.
• Instruct in doing sponge baths till the incision heals.
Nursing Diagnosis
1. Acute Pain related to surgical repair intervention
• Assess incision pain and nonverbal signs of pain such as crying, lethargy, facial
grimace.
• Administer analgesic appropriate for the severity of pain and age.
• Maintain position of comfort.
• Inform to keep incision dressing until it peels off and to apply diaper so that it does not cover the incision.
• Encourage parents to increase fluid intake and protein-rich diet as ordered.
• Reassure parents that infant normally tolerates surgery well and recovers without incident and that this condition is one of the most usual
surgeries in infancy.
•
