HERNIA

-darshika bhanwar
12th A
What is HERNIA??
A bulging of an organ or tissue throughout
an abdominal opening

Typically,hernia involves stomach or

intestine. They are usually classified by
etiology and location.
Sites of HERNIA
Signs and Symptoms
A bulge
Swelling or pain

Pain areas: in abdomen,pelvis,testicle

Pain type: can be dull
Also common: abdominal discomfort
abdominal distension,groin discomfort or
tenderness
ETIOLOGY
Hernia are classified on the bases of etiology
depending upon whether the hernia is due to
congenital or acquired.
Congenital hernia: the defect in the abdominal wall is
present from birth.
Acquired hernia: the defect develops as a result of a
weakening or disruption of the fibromuscular tissue of
the abdominal wall due to connective tissue
abnormailities and abdominal wall trauma.
Types of Hernia
1.epigastric hernia
2.femoral hernia
3.hiatal hernia
4.incisional hernia
5.inguinal hernia
6.umbilical hernia
EPIGASTRIC HERNIA
An epigastric hernia occurs in the epigastric region of the
abdomen , which is located above the belly button and below the
rib cage they are caused by gap between 2 sides of the abdominal
muscle , which allows fat tissue to push through the abdomen.

About 2 to 3 percent of all abdominal hernias are epigastric

hernias. Some babies are born with epigastric hernias. Other
hernias develop in adults due to muscle weakness or straining.
If you have an epigastric hernia, you may be able to feel it when there is
pressure on the abdominal wall, such as when you:

● cough
● laugh
● bear down to have a bowel movement

You may also have some pain or tenderness around where the hernia is.

Many epigastric hernias are small and don’t cause symptoms. Larger hernias
that cause symptoms may require surgery.
Femoral Hernia
A femoral hernia occurs when tissue pushes through a weak point in the groin or inner thigh. The hernia may feel
like a small- to medium-sized lump in the groin.

An estimated 2 to 4 percent

Trusted Source

of all hernias that occur in the groin are femoral ones. This type of hernia is rare in children. Women experience
femoral hernias more often than men due to the larger width of the female pelvis. They can sometimes be linked
to straining during bowel movements or lifting heavy weights.

A femoral hernia can be a cause for concern due to the femoral artery and vein being nearby. It’s possible the
hernia could affect these blood vessels and block blood flow to and from the leg. Because of this, doctors almost
always try to quickly correct a femoral hernia with surgery.
Hiatal Hernia
A hiatal hernia is a condition that occurs when a person’s stomach bulges through a weak point in
the diaphragm. This muscle plays an important role in breathing and separates the lungs from the
abdominal organs.

If you have a hiatal hernia, symptoms may include heartburn and gastroesophageal reflux disease
(GERD).

Doctors aren’t sure what causes hiatal hernias. They’re quite common in older adults and are most
often seen in people who are:

● over age 50
● pregnant
● overweight
Hiatal hernias are classified into types — from type I to IV — depending on
where they are located.

An estimated 95 percent of hiatal hernias are type I. With these hernias, the
stomach remains in position, yet the area where the esophagus meets the
stomach slides above the diaphragm.

Most people only need treatment for hiatal hernias if they’re experiencing
symptoms. This may involve treatments to reduce heartburn or surgery in more
severe cases.
Incisional Hernia
An incisional hernia occurs after a person has stomach surgery. It usually involves an incision down the middle of
the stomach. If the surgical wound doesn’t heal completely, that person can be more vulnerable to developing a
hernia.

About 15 to 20 percent of people who undergo abdominal surgery experience incisional hernias. Risk factors
include:

● undergoing emergency surgery

● experiencing complications during or after surgery, including infection
● having certain chronic conditions, including diabetes and kidney failure
● having obesity
● smoking
● taking certain long-term medications, including steroids and immunosuppressants
Some doctors may use the terms “ventral hernia” and “incisional hernia”
interchangeably. A ventral hernia refers to any hernia type that occurs along
the midline of the stomach. However, not all ventral hernias are incisional
hernias.

Doctors may take a watch-and-wait approach with smaller incisional hernias.

Larger hernias may require surgery.
Inguinal Hernia
An inguinal hernia occurs when a portion of intestine or fat bulges through the lower stomach
wall. The bulge usually goes through the inguinal canal, which is located in the groin area.

An inguinal hernia can contain a portion of the small intestine or parts of the female
reproductive organs.

According to the National Institute of Diabetes and Digestive and Kidney Disease inguinal
hernias are a relatively common type of hernia in the groin region, usually on the right side.
An estimated 27 percent of men and 3 percent of women will develop an inguinal hernia in
their lifetime. They most often occur in children up to age 5 and adults from ages 75 to 80.
Sometimes it’s difficult to tell the difference between a femoral and inguinal hernia.
An inguinal hernia can cause a bulge not only in the groin but also in the scrotum.

Inguinal hernias usually need to be repaired with surgery. That’s because there’s a
risk that the hernia may contain parts of the small intestine that become stuck
outside the abdominal wall. If blood flow is cut off, this can lead to intestinal
obstruction and potentially death.
Umbilical Hernia
Umbilical hernia are those in which tissues in the body bulge through an area of weakness in the belly
button area (umbilicus). This hernia type causes a visible bulge in or around the belly button that’s usually
worse when you cough or strain when having a bowel movement.

According to the American College of Surgeons, an estimated 10 percent of all hernias in the abdominal
area in adults are umbilical hernias. They usually happen when muscles weaken with age.

Umbilical hernias are especially common in babies under 6 months old, occurring in about 20 percent of
infants. It occurs when the muscles surrounding the umbilical cord don’t close after birth. They usually repair
themselves by the time a child is 4 to 5 years old.

Most umbilical hernias aren’t painful and don’t cause problems. They may require surgery if they don’t go
away on their own or cause symptoms.
COMPLICATIONS:-
1.If the content of hernia cannot be returned to
abdominal cavity , it is said to be incarcerated.

2.Incarceraton increases the risk of complications

including obstruction and strangulation.

3.Obstruction hernia develops when blood supply

to bowel and other tissues in the hernia sac in
compromised ,leading to a necrosis.

4.The affected bowel can infarct ,leading to

perforation with contamination of the potential
cavity.
DIAGNOISTIC TESTS
1. Diagnostic made by physical examination:

a.the client is examined in a supine or standing position

B.the bulge may not be seen or felt when the client coughs .

2.diagnosis of hiatal hernia can be confirmed by:

a.X-ray

B.barium swallow

c.fluoroscopy
Medical and surgical managment
1.Surgical repair or herniorrhaphy , is the usual treatment for hernia

2.if incarceration has occurred or strangulation is suspected , the abdomen is explored at the time of surgery and any infarcted
bowel is restricted .

3.hiatal hernia:

● Frequent small feedings that can easily pass through the esophagus.
● The patient is advised not to recine for 1 hour after eating , to prevent reflux or movement of hernia
● The patient is advised to elevate the head of bed on 4-8 inches blocks to prevent the hernia from sliding upwords
● Surgery is isndicated in about 15% of patients
● May require emergency surgery to correct torsion(twisting)of the stomach or other body organ that leads to restriction of
blood flow to that area
NURSING PROCESS:-

assessment Nursing goal interventions outcome

diagnosis

Bulging at hernia The risk of Complications Watch for and There is no sign
site infective tissue will be avoided immediately of complications
perfusion related next 24 hors report signs of within 24 hours
to hernia and the incarceration and
possibility of strangulation
obstruction and
strangulation
 assessment Nursing goal interventions outcome
diagnosis

Patient siad that Risk of Client will be able 1.instruct to take Patient has no
he often has oral aspirationrelated to state the steps small frequent episode of oral
regurgitation to reflux of in preventing meals regurgitation
after meals gastric content aspiration after 2 After 2 hours of
hours of nursing 2.encourage not interventions
interventions to take melas 2
hours prier to
bedtime
Clinical case
Demographic and Administrative Information
age 35
Gender male
Nationality India
Date of
administration
03-12-2021
DATE OF DISCHARGE 05-12-2021
LABORATORY DATA:-

DATE RESULT NORMAL RANGE

WBC 7.56 (4-10)

RBC 5.4 (4.5=5.5)

MCH 29 (27-32)

MVC 89.3 (85=95)

K 4.68 (3.5-5)

CREATININE 86 (17-115)

ALT 57 (30-65)

AST 26 (17-37)
CHIEF COMPLAINT:-

Abdomen pain when coughing exercising or bending

over.
ACUTE MEDICAL THERAPY:-
● Paracetamol
● Omeprazole
VITAL SIGNS:-
DATE 03-12 04-12 05-12

TEMPERATURE 37.2 37.1 36.5

BP 119/79 126/82 128/88

PULSE 82 84 85

R.R 20 20 20
CURRENT DRUG THERAPY:-

Drug name / dose / strength / rout / indicatins start stop

freq.
Cefuroxime / 750mg / iv / tid Prophylaxis 03-12 04-12
antibiotics

paracetamol / 1g / iv / Q8H analgesic 03-12 04-12

Drug discharge
Adol 500mg TID analgesic For 5 days

Cefuroxime 250mg BID Prophylaxis antibiotic For 5 days

DRUG INTERACTION:-
No interaction of risk level A or greater identified
PHARMACIST’S CARE PLAN:-

the recommended antibiotic prophylaxis:

Preoperatively: Cefazolin 2 mg IV as single dose (maybe
repeated in 4hours intraoperatively)
Postoperatively: 0.5=1 g IV q6-8 hours for 24 hours
Bibliography
1.national library of medicine
https://pubmed.ncbi.nlm.nih.gov/22824990/

2.healthline: www.healthline.com

3.Dr.Mumta vishvakarma (surgical specialist)