Hernia

Under the supervision of :

Dr . Mona Gaber
 ‫‪Prepared by :‬‬

‫عبدالناصر صفوت محمد‬ ‫‪.16‬‬ ‫‪ .1‬عبدالرحمن مسلم عيد‬

‫عبير ابراهيم محمود‬ ‫‪.17‬‬ ‫‪ .2‬عبدالرحمن هاشم‬
‫عبير محمد ربيع‬ ‫‪.18‬‬ ‫درويش‬
‫عزت عياد بكري‬ ‫‪.19‬‬ ‫‪ .3‬عبدالرحمن يحي‬
‫عزه عبدالخالق كامل‬ ‫‪.20‬‬ ‫عبدالعزيز‬
‫عزه فرحات عبدالمجيد‬ ‫‪.21‬‬ ‫‪ .4‬عبدالعظيم أحمد‬
‫عزيزه رفاعي عبدالمحسن‬ ‫‪.22‬‬ ‫عبدالعظيم‬
‫عصام عرفه محمد‬ ‫‪.23‬‬ ‫‪ .5‬عبدهللا رجب عبدهللا‬
‫عال ثابت مصطفي‬ ‫‪.24‬‬ ‫‪ .6‬عبدهللا رمضان فتح‬
‫عال محمد حامد‬ ‫‪.25‬‬ ‫الباب‬
‫عال محي الدين سيد‬ ‫‪.26‬‬ ‫‪ .7‬عبدهللا سمير سيد‬
‫عال بدر الدين محمد‬ ‫‪.27‬‬ ‫‪ .8‬عبدهللا شعبان قرني‬
‫عالء خليفة محمد‬ ‫‪.28‬‬ ‫‪ .9‬عبدهللا عادل سعدالدين‬
‫عالء ربيع احمد‬ ‫‪.29‬‬ ‫‪ .10‬عبدهللا عبدالمقصود‬
‫علي رمضان جاب هللا‬ ‫‪.30‬‬ ‫صابر‬
‫‪ .11‬عبدهللا فتحي عبدهللا‬
‫‪ .12‬عبدهللا محمد عبدهللا‬
‫‪ .13‬عبدهللا محمود توفيق‬
‫‪ .14‬عبدهللا يوسف ابراهيم‬
‫‪ .15‬عبدالمنعم شعبان‬
‫حجازي‬

‫‪Outlines:‬‬
1. Introduction
2. Definition
3. Causes
4. Clinical picture
5. Diagnosis
6. Types
7. Treatment
8. Complications
9. Pre-operative
10. Post-operative
11. Nursing care plan
Introduction
Hernia happens when an internal organ pushes through
a weak spot in your muscle or tissue. There are several
types of hernia that you can experience including,
inguinal hernias, femoral hernias, umbilical hernias and
hiatal hernias. If you have a hernia, it’s important to
treat quickly.

You may have a hernia if you can feel a soft lump in your
belly or groin or in a scar where you had surgery in the
past. The lump may go away when you press on it or lie
down. It may be painful, especially when you cough,
bend over, or lift something heavy.

Definition:
A hernia is a bulge caused by tissue pushing through the
wall of muscle that’s holding it in. Most hernias are
abdominal hernias. This means they happen in the belly
and groin areas.
Causes
Hernias occur more often in children who have one or
more of the following risk factors:

o prematurity. o a parent or sibling who had a

hernia as an infant.
o Cystic fibrosis. o developmental dysplasia of
the hip.
o undescended testes.
o abnormalities of the genitourinary system
o Picking up heavy objects (especially lifting them
in the wrong way and with weak muscles)
o Overusing the same muscle.
o Straining during coughing, sneezing, diarrhea, or
constipation.
o Being overweight or having poor nutrition.
o Using tobacco

Types of hernia:

Femoral hernia :
A femoral hernia usually occurs when fatty tissue or a
part of your bowel pokes through into your groin at the
top of your inner thigh. It pushes through a weak spot in
the surrounding muscle wall (abdominal wall) into an
area called the femoral canal.

Inguinal hernias :
Inguinal hernias are the most common type of hernia.
They occur when the intestines Push through a weak spot
or tear in the lower abdominal wall, often in the inguinal
Canal.
-The inguinal canal is found in your groin. In men, it’s
the area where the spermatic Cord passes from the
abdomen to the scrotum. This cord attaches to the
testicles.
In Women, the inguinal canal contains a ligament
(called the round ligament) that helps Hold the uterus in
place.
-Inguinal hernias are more common in men because the
testicles descend through the Inguinal canal shortly after
birth. The canal is supposed to close almost completely
behind them. Sometimes the canal doesn’t close properly,
leaving aweakned area .

Sliding hernia is a protrusion through an abdominal

wall of a retroperitoneal
Gastric hernia hiatal hernia occurs when the upper
part of your stomach bulges through your diaphragm into
your chest cavity. A hiatal hernia occurs when the upper
part of your stomach bulges through the large muscle
separating your abdomen and chest (diaphragm
Diaphragmatic hernia:

1-Congenital diaphragmatic hernia (CDH) : occurs when

there is a hole in the Diaphragm, which is the thin sheet
of muscle separating the chest from the abdomen.
When this gap forms during a fetus’s development in the
womb, the bowel, stomach or even the liver can move
into the chest cavity. The presence of these abdominal
organs in the chest limits the space for the lungs and can
result in respiratory complications. Because CDH forces
the lungs to grow in a compressed state, several aspects
of their function may not develop normally until after
the birth of the baby.

2-An acquired diaphragmatic hernia (ADH): is usually the

result of a blunt or penetrating injury. Traffic accidents
and falls cause the majority of blunt injuries.
Penetrating injuries are usually due to stab or gunshot
wounds. Surgery on the abdomen or chest may also
cause accidental damage to your diaphragm. Rarely, the
diaphragmatic hernia may occur without a known reason
and go undiagnosed for a Period of time, until it
becomes severe enough to cause symptoms
Umbilical hernia:
-Umbilical hernias can affect children and babies. They occur
when the intestines bulge through the abdominal wall near the
belly button. You may notice a bulge in or near your child’s
belly button, especially when they’re crying.
-An umbilical hernia is the only kind that often goes away on its
own as the abdominal wall muscles get stronger. This typically
happens by the time the child is 1 or 2 years old Trusted
Source. If the hernia hasn’t gone away by 5 years of age,
surgery can be Performed to correct it.
-Adults can also have umbilical hernias. They can occur from
repeated strain on the abdomen due to conditions such as
obesity, fluid in the abdomen (ascites), or Pregnancy.
Incisional hernia:
An incisional hernia is a protrusion of tissue that forms at
the site of a healing surgical scar. This type of hernia
accounts for 15-20 percent of all abdominal hernias. At
Mount Sinai, our expert surgeons are highly trained all
facets of incisional hernia repair.
Clinical picture:
1. increase in intra-abdominal pressure from crying or straining.
2. abdominal distention.
3. vomiting , tachycardia.
4. obvious bulge at the internal or external ring within the
scrotum.
5. scrotal color changes ( redness) , pain , intense, inconsolable,
irritability.
6. The sliding sensation of the sac and cord structures over the
pubic bone.
7. severe respiratory distress , cyanosis, tachypnea, retractions.
8. strangulated Hernia present with pain , vomiting, swelling of
hernial sac , lower abdominal signs of peritoneal irritation
fever
9. abdomen is scaphoid.
10.inguinal hernia appears as a bulge in the groin that becomes
more prominent and swelling on crying or straining

Diagnosis:
History:
1: family history of hernia 2: COPD.
3: obesity 4: congenital anomalies
5: straining and constipation

1. Prenatal diagnosis:
The diagnosis can be made in the antenatal period by
ultrasonography. The bowel loops can be located in the
thoracic cavity. Mothers have polyhydramnios in 80%
cases.

2. Neonatal diagnosis:
The newborn child develops respiratory distress at
variable intervals after birth. More severe defects
present sooner and carry poor prognosis. The
respiratory distress is characterized by cyanosis,
gasping, sternal retraction and poor respiratory efforts.
The abdomen appears scaphoid. Bowel sounds can be
heard in the chest. X-ray chest demonstrates air-filled
loops of intestines on the side of the defect Contrast
swallow studies can be done to confirm the diagnosis
3. Later diagnosis:
Me children present in the later life with mild
respiratory symptoms, effusion or gastric volvulus.

Diagnostic tests:
Abdominal ultrasound. Abdominal ultrasound uses
highfrequency sound waves to create an image of the
structures inside the body.
 Abdominal CT scan. Abdominal CT scan combines X-
rays with computer technology to produce an image.
Abdominal MRI scan. Abdominal MRI scan uses a
combination of strong magnets and radio waves to
create an image.
Endoscopy. During an endoscopy, a healthcare
professional threads a small camera attached to a tube
down your throat and into your esophagus and
stomach.
Treatment:
1.Femoral hernia:
- Femoral hernias can be repaired using surgery to push the
bulge back into place and strengthen the weakness in the wall
of the tummy. Unlike some other types of hernia, treatment of
femoral hernias is almost always recommended straight away
because there's a higher risk of complications developing in
these case

2.UMBILICAL HERNIA

- The use of binders ,tape or other materials to

flatten the protrusion don’t aid in closing The
defect .
- Most umbilical hernias disappear
spontaneously by 3 to 4 years of age .
- If the hernia persists beyond this age ,if it
Becomes strangulated ,or if it grows larger , it’s
surgically corrected .
3.INGUINAL HERNIA

- the treatment of inguinal hernia is surgical

repair by a procedure called herniotomy .
 - in most cases ,it can be performed as a day
care procedure .
- the operation for hernia should be done as
soon as the diagnosis is made .
- surgery for hydrocele can be delayed till two
years of age as some cases can improve
Spontaneously .
- If hydrocele does not resolve , herniaotomy is
performed

4.DIAPHRAGMATIC HERNIA

-mortality rate is high “40%_60%” despite

advances in current treatment modalities . -
some fetuses are diagnose prenatally by
ultrasound in which case surgical repair is
performed in utero .if not diagnosed and
repaired at this time .
- the new born is stabilized before surgery
.
- Ventilator support is required to manage
respiratory compromise .
- metabolic acidosis is corrected with the
administration of bicarbonate .
- If stabilization is not possible,
extracorporeal membrane oxygenation is
required in most cases .
- the surgery involves repositioning the
abdominal contents into the abdomen
and closing the defect
 5_incisional HERNIA
Incisional hernia repair involves placing a mesh and
is performed either as an open procedure
(morphological and functional abdominal wall
reconstruction with sublay mesh placement) or as a
minimally invasive procedure (laparoscopic surgery
with mesh placed in the intraperitoneal onlay mesh
[IPOM] position

Surgical treatment methods:

Inguinal hernia repairs are of the following three general types

Herniotomy (removal of the hernial sac only)

Herniorrhaphy (herniotomy plus repair of the posterior wall of the

inguinal canal)

Hernioplasty (herniotomy plus reinforcement of the posterior wall of the

inguinal canal with a synthetic mesh)

Complicatns Complications
Pre-operative:
• anxiety and fear can arise from many factors. Particularly
in a Hernia Repair patients often feel scared of how the
surgery will affect their lifestyle. Reassure your patient,
that he will be able to return to his normal daily activities
within 4-6 weeks after the surgery.
• Encourage your patient to verbalise his fears and answer
any questions that he might have. Explain to him that he
can contact you or the clinic at any time if he wants.
Advise your patient that you have additional healthcare
staff who can help him, including social workers, spiritual
advisors, psychologists and support groups.
• Managing Symptoms
• Depending on which type of hernia your patient has, he
might experience different symptoms. Such as pain,
vomiting and constipation. In such cases, you should
discuss your patient’s symptoms with the doctor to
 formulate a plan of medications that can ease the
symptoms.
• Preparation on the Day of Surgery
• The final step is to make sure that your patient is ready
for surgery from the medical perspective. Your patient
should be starved for at least 6 hours before the surgery,
and make sure that he is kept hydrated through
adequate IVI infusions.
• Check that the incision site is marked and confirm
whether shaving is required
• Finally, make sure that your patient has the following:
• Identification Bracelet
• Allergy Bracelet (if applicable)
• Changed into a hospital gown and removed her
underwear
• Removed all jewellery/ foreign teeth/ hearing aid/
contact-lenses/ glasses/ make-up
• Before going down to the Operating Theatre, your
patient’s file should have:
• All medical notes and treatment charts
• A signed consent form
• Pre-operative medical assessment
• An ECG done in the last 2weeks
• Blood results, and Blood type from the past 3 days (often
found online).

Post-operative: Post-operative
1.Relieving Pain and Discomfort
• Moderate to low pain is expected after a Hernia Repair,
depending on which method was used. Particularly, if
your patient had laparoscopic surgery, you should
encourage him to mobilise and lay on his side. These will
help her pass flatus and decrease abdominal distention.
• Administer the prescribed analgesia regularly to keep
your patient from experiencing spikes of pain.
2. Patient Education
• Given that a Hernia Repair takes 4 – 6 weeks to heal
fully, it is vital to educate your patient about home care.
This will decrease the chance of experiencing
postoperative complications such as surgical site
infection, or a recurrent hernia.
• You should tailor your methods according to the patient’s
learning needs. Make use of images, videos and written
notes to ensure that your patient can understand you.
• Start by advising your patient to rest and engage in light
physical activity when he returns home, heavy lifting and
vigorous movements should be avoided. The incision site
must be kept clean and dry, with regular check-ups at the
clinic. Post-operative constipation can be avoided by
eating a high fibre diet and plenty of water. This will
decrease the pain associated with straining when
passing stools.
• Lastly, make sure to explain any medication that the
patient has to take at home, such as analgesia or
possibly anti-biotics.
• Post Hernia Repair Discharge Planning
• Before sending your patient home, make sure that:
• Anxiety is under control
Nursing care plans for hernia :
r References–
 Hernia Types, Symptoms, Causes, Treatment, and
Surgery)
)http://www.emedicinehealth.com/hernia/page7_em.htm(
- Operation Brochures for Patients
)http://www.facs.org/public_info/operation/hernrep.pdf(
- Hernias
(http://www.kidshealth.org/teen/sexual_health/guys/herni
)as.html
-Hernia (Abdominal Hernia) 9 Types, Symptoms,
Causes, and Surgery
)http://www.medicinenet.com/hernia/article.htm(
- Abdominal Hernias
)http://www.emedicine.com/emerg/topic251.htm(