Hernia for TCH

8/8/2019 Hernia for TCH

1/26

Submitted By:Balacang, Karen L.

N-416 Group A

Cluster 2Submitted To:Mr. Raymund P. Bautista RN

MAN

Clinical Instructor at TCH


2/26


3/26


4/26

Classifications

Congenital

* Umbilical Hernia

Acquired

e.g., Pelvic Hernia, Diaphragmatic Hernia, Ventral Abdominal Hernia.

Based on Location:

*Umbilical hernia

* Scrotal Hernia

* Inguinal Hernia

*Ventral Abdominal Hernia

* Diaphragmatic Hernia


5/26

Classifications

Complete or Incomplete

-If the part/ contents are partially or completely protruding.

Internal or External

-external ones herniate to the outside world, whereas internalhernias protrude from their normal compartment to another

Intraparietal hernia

-hernia that does not reach all the way to the subcutis, but only

to the musculoaponeurotic layer. An example is a Spigelianhernia. Intraparietal hernias may produce less obvious

bulging, and may be less easily detected on clinical

examination.


6/26

Classifications

Irreducible (also known as incarcerated)- the hernial contents cannot be returned to their normal site

with simple manipulation

Types of Irreducible

Hernia:

Com

plicated Uncomplicated


7/26

Classification of Irreducible Hernia:

strangulation: pressure on the hernial contents may

compromise blood supply (especially veins, with their low

pressure, are sensitive, and venous congestion often results) and

cause ischemia, and later necrosis and gangrene, which maybecome fatal.

obstruction: for example, when a part of the bowel herniates,

bowel contents can no longer pass the obstruction. This results in

cramps, and later on vomiting, ileus, absence of flatus and

absence of defecation. dysfunction: another complication arises when the herniated

organ itself, or surrounding organs, start to malfunction(for

example, sliding hernia of the stomach causing heartburn, lumbar

disc hernia causing sciatic nerve pain, etc.).


8/26

Contents of Hernia

Enterocele- Intestines

Epileplocele- Omantum

Gastrocele- Stomach

Vesicocele- Bladder

Hepatocele- Liver

Hysterocele- Uterus


9/26

Treatments Treatment of a hernia depends on whether it is reducible or

irreducible and possibly strangulated.

Reducible hernia

-treated without surgery, perhaps using abdominal binders.

-treatment of every hernia is individualized.

-Herniotomy=excision of sac(in infants & children this is all that is

necessary)

-Herniorrhaphy=closure of defect

- Hernioplasty=by a mesh eg.Polypropylene mesh

Irreducible hernia

- herniorrhaphy


10/26

Repair ofInguinal

Hernia


11/26


12/26

Types of HerniaInguinal Hernia Groin hernia

Most common site for hernias todevelop in adults, and are second

only to Umb

ilical Hernias in infantsand children.

Common in men, they do occur inwomen as well

Result of a weakness, tear, gap or

opening in the muscle wall of thelower abdomen or groin, in aregion called the MyopectinealOrifice.


13/26

Types of HerniaInguinal Hernia contents of the abdomen, such as

intestine, may protrude through

the opening creating a pain and a

bulge. pain and bulge may be constant, or

intermittent in duration.

located in the lower abdomen

(right side, left side or both), justabove the leg crease, near or

adjacent to the pubic area.

Can occur bilaterally.


14/26

Types of Hernia

Umbilical Hernia Paraumbilical Hernias

A Congenital (present since birth)

weakness in the naval area exists

his was the area at which thevessels of the fetal and infant

umbilical cord exited through the

muscle of the abdominal wall.

signs and symptoms include pain

at or near the navel area as well

as the development of an

associated bulge or navel

deformity.


15/26

Types of HerniaUmbilical Hernia often appearing at or just after

birth, these hernias can alsooccur at any time during laterlife.

In INFANTS, these hernias maygradually close by age 3 or 4 andsurgery can often be delayeduntil then, unless the hernias arecausing problems or enlarging.

In ADULTS however, umbilicalhernias cannot "heal", and dogradually increase in size andoften become problematic.Incarceration or Strangulationmay occur.


16/26

Types of Hernia

Incisional Hernia INCISIONAL or Ventral Hernias

may occur in the area of anyprior surgical incision, and can

vary in size from

very sm

all, tovery large and complex.

result of disruption along oradjacent to the area ofabdominal wall suturing, often

subsequent TENSION placedon the tissue or otherinhibition to adequate healing(infection, poor nutrition,obesity, or metabolic

diseases).


17/26

Types of Hernia

Incisional Hernia present as a bulge or

protrusion at or near the areaof the prior incision scar.

Hernias in this area have ahigh rate of recurrence ifrepaired via a simple suturetechnique under tension and itis especially advised that these

be repaired via a TENSIONFREE repair method usingmesh These hernias maydevelop soon after the originalsurgery, or at any time

thereafter.


18/26

Types of Hernia

Incisional Hernia gradually increase in size once

they develop and become

progressively symptomatic.

Tension creates poor healing,

swelling, wound separation

and eventual Incisional Hernia

formation.


19/26

Types of Hernia

Femoral Hernia like Inguinal Hernias develop

in the groin area, but occurabout 5 times more commonly

in fem

ales than they do inmales.

develop at or very near the legcrease itself

difficult to differentiate

clinically between these andInguinal Hernias onexamination by those notexperienced in herniaevaluation.


20/26

Types of Hernia

Femoral Hernia The defect itself occurs in an

anatomic triangular-shaped

"gap", located between the

following 3 structures:

the inguinal ligament (a

tendinous cord that creates

the leg crease),

the lower side of thepubic bone

The femoral vein (the

major vein of the leg)


21/26

Types of HerniaFemoral Hernia This gap is somewhat larger in

females due to the shape andangle of the pelvis, thereforemaking femoral hernias more

common in females. NOTE: thecongenital gaps and weak areas of the inguinalcanal are somewhat larger in males, makingInguinal Hernias more common in men.

acutely painful lump or bulge onthe leg crease, adjacent to the

pubic region These hernias are more prone to

develop INCARCERATION and/orSTRANGULATION as an earlycomplication than are InguinalHernias.


22/26

Types of Hernia

Epigastric Hernia develop in the mid upper

abdomen, anywhere along a

line drawn from the lower

point of the breastbonestraight down to the

Umbilicus.

not-too-uncommon hernias

arise in a defect of the mid-line fascia or tendon that is

present between the two

rectus or six-pack muscles

(called the linea alba).


23/26

Types of Hernia

Epigastric Hernia small in size and localized,

rarely larger thatn the size of a

golf-ball.

the contents are easily

pinched and these hernias

therefore can cause a great

deal ofpain.

repair using a Tension Freemethod.


24/26


25/26

Types of Hernia

Spigelian/ Semilunar

Hernia

symptoms may vary from well-

localised constant abdominalpain with or without palpable

lump to vague inconstant

ache.

Ultrasound or CTScan are the

goldstandard investigational

imaging studies used for the

diagnosis of Spigelian hernia


26/26

Hernia for TCH

Documents

Transcript of Hernia for TCH