Definition

• A hernia is a protrusion of an organ tissue or structure through the wall

of the cavity in which it is normally contained.
• Hernias most commonly occur in the abdominal cavity when a section
of the bowel protrudes through as a result of a congenital or acquired
weakness of abdominal musculature.
Epidemiology
• About 75% of all hernias happen in the inguinal region.
• 90% of them are in men and 10% in women.
• 70% of femoral hernia repairs occur in women (although the
prevalence of inguinal hernia in women is 5 times that of femoral
hernia.
 Pathophysiology
• Defects in the muscular wall may be congenital and due to weakened
tissue or may be caused by trauma.
• Intra-abdominal pressure increased with pregnancy obesity, heavy lifting
coughing and traumatic blunt pressure, when two of these factors consist
with some tissue weakness, a hernia may occur.
• Types of Hernia
1. Inguinal Hernia: Hernia into the inguinal canal is more common in
males.
a. Direct inguinal hernia: A direct inguinal hernia penetrates directly
through the wall of your inguinal canal. This type of hernia occurs in
adults over time, from a combination of weakening abdominal muscles
and chronic pressure on the muscle wall.
b. Indirect inguinal hernia: is one that occurs as a congenital lesion. It
occurs as a result of the deep inguinal ring failing to close during
embryogenesis after a testicle has moved through it. Once bowel or
other abdominal tissue moves into and enlarges the empty space, a
visible bulge forms and the hernia becomes clinically evident.
• Femoral hernias
• Femoral hernias also happen when fatty tissue or part of your bowel pokes through into your groin at the top of your
inner thigh.
• They're much less common than inguinal hernias and tend to affect more women than men.
• Like inguinal hernias, femoral hernias are also associated with ageing and repeated strain on the tummy.
• Umbilical hernias
• Umbilical hernias occur when fatty tissue or part of your bowel pokes through your tummy near your belly button.
• This type of hernia can occur in babies if the opening in the tummy that the umbilical cord passes through does not seal
properly after birth.
• Adults can also be affected, possibly as a result of repeated strain on the tummy.
• Hiatus hernias
• Hiatus hernias occur when part of the stomach pushes up into your chest by squeezing through an opening in the
diaphragm, the thin sheet of muscle that separates the chest from the tummy.
• This type of hernia may not have any noticeable symptoms, although it can cause heartburn in some people.
• It's not exactly clear what causes hiatus hernias, but it may be the result of the diaphragm becoming weak with age or
pressure on the tummy.
• EtiologyInguinal hernia has two etiologies:
• A) Congenital
• B) Acquired
• A) Congenital Hernia: Congenital hernia consists most of the cases of pediatric
hernias.
• In the descent of the testes from the abdomen to the scrotom in the third
trimester, a part of the perituneum descends with it which is called the
process vaginalis.
• In the weeks 36-40 of gestation this process vaginalis closes.Lack of closure of
process vaginalis results in a patent process vaginalis which is a reason for the
high prevalence of inguinal hernia in the preterm neonates.
• B) Acquired Hernia:
• It seems that most cases of hernia come from an acquired defect in the
abdominal wall and the reason for its formation is multifactorial:
1-Strenuous physical activity can be a factor but it is not known whether the
hernia is just from physical activity or in the setting of a patent process vaginalis.
2- A positive family history which can increase its incidence 8 times.
3- COPD increases the direct hernia risk.
4- Collagen deficiency associated diseases like collagen type I deficiency relative
to type5- An association exists between aneurisms and hernias.Being overweight
is to some extent protective (maybe it is from the more difficult diagnosis of
hernia)VeBeBuinteaVet
• Clinical Manifestations
• 1. Bulging over herniated area appears when the patient stands or
strains and disappears when supine
• 2. Hernia tends to increase in size and recurs with intra-abdominal
pressure.
• 3. Strangulated hernia presents with pain, vomiting swelling of hernial
sac peritonial irritation, fever.
• Diagnostic
• Abdominal x-rays reveal abnormally high level of gas in the bowel.
• Laboratory studies (complete blood count, electrolytes)
Investigation done in my patient
• Complete blood count
• Kidney function test
• Serology test
• ECG
 Complete blood count (2079/10/29)
Investigation Result Normal value Interpretati
on
Haemoglobin 13 gms% 13-18 Normal
RBC Count 4.33 millions/cumm 4.44-5.61 Normal
Platelet count 173000 cells/cumm 150000-400000 Normal
Total leukocyte count 5900 cells/cumm 4000-11000 Normal

Polymorphs 70% 40-70 Normal

Lymphocytes 24% 20-45 Normal
Monocytes 2% 2-10 Normal
Eosinophils 4% 1-6 Normal
Basophils 0% 0-1 Normal
 ABO blood grouping and RH Typing (2079/10/29)
• ABO Blood Grouping : B+
• Rh Typing : Positive
Kidney Function Test (2079/10/29)
Investigation Result Normal Interpretat
value ion
Sodium (Na+) 136 mg/dl 135-150 Normal
Potassium (K+) 4.60 mg/dl 3.5-5.5 Normal
Blood Urea 18 mg/dl 10-45 Normal
Serum Creatinine 0.69 mg/dl 0.6-1.3 Normal
Random blood sugar 86 mg/dl 70-140 Normal
Serology test (2079/10/29)

Investigation Result

HIV(1 &2 ) Antibody Non-Reactive

HCV antibody Non-Reactive

HBsAg Non-Reactive
Date Investigation Result Normal value Interpretation

2079/11/1 Hemoglobin (Hb) 12.4 gms% 13-18 Low

2079/11/3 Microbiology No any Normal

1. Gram staining organism seen
(specimen
type sputum)
organisms

2079/11/3 ZN staining for AFB not seen Normal

AFB
Pharmacological treatment provided to my
patient
Name of the Dose Route Time
medicine1

1. Inj clavum 1.2 gm i.v TDS

2. Inj keterol 30 mg i.v TDS
3. tab. Pantop 40 mg PO BD
4. tab. allegra 180mg PO OD
5. Tab. flexon 1 tab PO TDS
6. Syp TUSQ 10 ML PO TDS
Name of drug’s Dosages/ Uses Side effect Contraindication Nursing responsibility
Route/Frequency
Mechanism of action

Inj clavum 1.2 gm/iv/ TDS Treatment • Diarrhea • Hepatitis • Encourage to drink
Amoxicillin and
Clavulanic acid and • Thrush (candida • Kidney disease plenty of water or fruit
Mechanism of action: prophylaxis fungal infection) • Jaundice juices to keep you
Clavum 1.2gm Injection management • Rashes, itching, hives • Allergy hydrated.
helps in treating of various (raised itch rashes) • Diarrhoea
bacterial infection bacterial • Urticaria • Monitor signs of
where Amoxicillin infections. • Nausea and vomiting pseudomembranous
works by inhibiting • Dizziness, headache colitis, including
penicillin- binding • Indigestion diarrhea, abdominal pain,
proteins (which are • Abnormal liver fever, pus or mucus in
involved in the enzymes stool, and other severe or
Synthesis of the prolonged GI problems
bacterial cell wall) (nausea, vomiting,
leading to the activation heartburn).
of autolytic enzymes in • Monitor a skin rash; itching;
the bacterial cell wall. shortness of breath; trouble
with breathing; trouble with
swallowing; or any swelling
of your hands, face, mouth,
or throat .
Name of drug’s Dosages/ Uses Side effect Contraindication Nursing responsibility
Route/Frequency
Mechanism of action

Tab flexon 500MG PO/ TDS • Pain • Nausea Hypersensitivity • Monitor the patient cardiac
flexon tablet is a • Inflammation • Headache status BP, pulse, edema,
combination of two • Fever • Indigestion tachycardia.
• Document any changes in liver
medicines: Ibuprofen • Gout • Rash function .
and Paracetamol It • Menstrual • Fatigue • Notify physician if indigestion,
works by blocking the cramps • Abnormal epigastric pain, unusual
release of Certain blood count bleeding.
chemical messengers • Heart burns
that cause fever, pain • Constipation
and inflammation • Loss of appetite
(redness & swelling).