HERNIA Presenter: GolnazMalekzadeh
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. Defenition:
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. Signs and Symptoms
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.
Any condition that increases the pressure of the abdominal cavity may contribute to the formation or worsening of a hernia. • Obesity • Heavy lifting • Coughing • Straining during a bowel movement or urination • Chronic lung disease • Fluid in the abdominal cavity • Hereditary Causes of Hernias
lordosis • Constipation • Urine retention • Difficulty in breathing • Compartment syndrome • And …. Complications
1. External 2. Internal 3.intermittent Types Of Hernia
1. reducible hernia is one in which the contents of the sac return to the abdomen spontaneously or with manual pressure when the patient is recumbent. 2. irreducible hernia is one whose contents or part of contents cannot be returned to the abdomen, without serious symptoms. hernias are trapped by the narrow neck Clinical types of Hernia
incarcerated hernia: is one whose contents cannot be returned to the abdomen, with severe symptoms. strangulated hernia: denotes compromise to the blood supply of the contents of the sac. incarcerated hernia and strangulated hernia are the two stages of a pathologic course Richter’s hernia (intestinal wall hernia ) a hernia that has strangulated or incarcerated a part of the intestinal wall without compromising the lumen. Sliding herniais one in which the wall of a viscus forms a portion of the wall of the hernia sac. It is may be colon ( on the left), caccum (on the right) or bladder (on either side) . Belongs to irreducible hernia Littre hernia: a hernia that has incarcerated the intestinal diverticulum (usually Meckel diverticulum). Clinical types , continued…
Occurring 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. • Men > Women • these hernias are often painless and unable to be pushed back into the abdomen when first discovered. Epigastric Hernia
Umbilical Hernia 1- Congenital 2- Adault acquired
Common in infants • Close spontaneously if <1.5 cm • Repair if > 2 cm or if persists at age 5 years • Repair primarily or with mesh Congenital Umbelical Hernia
Women > men • Risk factors • Multiple Pregnancies • Prolonged labor • Ascites • Large Abdominal Tumors-CT scan may be indicated for some patients • Activities which result in strenuous physical activity(occupational or recreational :example weight lifting) Umbelical Hernia
Morbitiy and incarceration rate considered to be high enough to warrant repair. One study showed incarceration twice that of femoral hernia . • Unfortunately, recurrence rates as high as 20 -28 % have been recorded. • patients with ascites ??? Umbelical Hernia repair
Rare • Hernia through subumbilical portion of semi-lunar line • Difficult to diagnose –Abdominal pain or mass noted in abdominal wall. Frequently tender over area • Clinical suspicion (location) • CT scan • Repair primarily or with mesh Spigelian Hernia
Inguinal Hernia a protrusion of part of the contents of the abdomen through the inguinal region of the abdominal wall.