Hernias.ppt Yenni

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Suryani Countri Permadi


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Hernia is classified into three types:

* Reducible, Hernias can be reducible if the herniacan be easily manipulated back into place.

* Irreducible or incarcerated, this cannot usually be

reduced manually because adhesions form in the

hernia sac.

* Strangulated, if part of the herniated intestine

becomes twisted or edematous and causing serious

complications, possibly resulting in intestinal

obstruction and necrosis.


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Types of herniaInguinal

Indirect or indirect Inguinal hernias can be direct which is herniation through

an area of muscle weakness, in the inguinal canal,

and inguinal hernias indirect herniation through theinguinal ring. Indirect hernias, the more common form,can develop at any age but are especially prevalent ininfants younger than age 1. This form is three times morecommon in males.

Femoral Herniation through the femoral canal


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Types of hernia Incisional Herniation

through an area weakened by a scar

Umbilical Paraumbilical

Acquired defect above or below the umbilicus

Epigastricin the midline of abdomen above the umbilicuscaused by a defect in linea alba.


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Groin Hernias

Incidence:

- Groin hernias are found in 5% of male population.

- Represents 86% of all hernia cases.- It occurs 5 times more often in males than females.

- Inguinal 96% ( indirect 75%, direct 25%).

- Bilateral in 20% of cases

- Right sided hernias are more frequent than leftsided ones

- Femoral 4%.


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Direct Inguinal Hernia

Incidence: 25% of hernia cases

The hernia contents enter the inguinal canal.

These hernias are generally considered to be acquired,and may be associated with heavy lifting, straining dueto constipation, coughing, or prostatic enlargement.


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Groin HerniasEmbryology

& Anatomy The processus vaginalis is present in the

developing fetus at 12 weeks in utero.

The processus is a peritoneal diverticulum thatextends through the external inguinal ring.

As the testis descends at the 7th to 8th month, aportion of the processus attaches to the testis, as

it exits the abdomen and is dragged into thescrotum with the testis.


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Bilateral Hernia

Definition: Simultaneous Right and Left InguinalHernia

Common in children and elderly men If a left inguinal hernia is present, there is a 25% risk of

an occult right inguinal hernia


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Groin Hernia - Incidence The incidence approximately 1 to 5%.

Male to Female ratio is 8:1 to 10:1.

Premature infants 7%-17%-30% in males

and 2% in females,

Risk of incarceration exceed 60%


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Associated disease with high incidence of

Inguinal Hernia

Cystic Fibrosis

Disorders of connective tissue formation

Ehlers-Danlos syndrome

Hunter-Hurler syndrome Congenital dislocation of Hip

Chronic Peritoneal Dialysis

Preterm infants with intraventricular hemorrhage

Children with myelomeningocele with VP-shunt


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Incarcerated Inguinal Hernia Treatment:

Manual Reduction

Incomplete Reduction

Reduction of Compromised Bowel Iatrogenic Perforation of Bowel

IV Fluids

IV AB

NGT

Warming


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Surgery

Herniotomy

Resection & Anastomosis

Resection & Stoma


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Surgery Complications

Cord Injury

Hematoma of Scrotum

Hydrocele Testicular Atrophy

Recurrence


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Symptoms

A. Often asymptomatic (especially in direct hernias)B. Pain or dull sensation in groin


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Complications

A. Bowel incarcration ( acute, chronic ): The trappingof abdominal contents within the Hernia itself

B. Strangulation: pressure on the hernial contents maycompromise blood supply (especially veins, with theirlow pressure, are sensitive, and venous congestion

often results) and cause ischemia, and later necrosisand gangrene, which may become fatal.

C. Small Bowel Obstruction
http://en.wikipedia.org/wiki/Necrosishttp://en.wikipedia.org/wiki/Gangrenehttp://en.wikipedia.org/wiki/Gangrenehttp://en.wikipedia.org/wiki/Necrosis


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FEMORAL HERNIA

I. Epidemiology

A. Accounts for 4% of Groin Hernias (96% are inguinal)

B. More common in elderly women

C. Gender predisposition: Female by 3 to 1 ratio1. Femoral seen less than Inguinal Hernia even in women

II. Pathophysiology

A. Associated with increased intraabdominal

pressure

B. Hernia sac bulges into femoral canal

. Femoral canal lies immediately medial to femoral vein


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INCISIONAL HERNIA I. Pathophysiology

A. Type of Ventral Hernia

B. Develops in scar of prior laparotomy or drain siteC. Risks for postoperative hernia development1. Vertical scar more commonly affected than horizontal2. Wound infection3. Wound dehiscence4. Malnutrition5. Obesity6. Tobacco abuse


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Treatment Options

All hernias should be surgically corrected to remove therisk of incarceration and strangulation.

If there are compelling co-morbid medical conditions that

preclude surgery, then a truss, or support hernia belt maybe employed. A truss does not repair the hernia defect, but

will afford some relief of symptoms.

Modern methods of repair include open primary closure of

the defect with sutures (Shouldice or "Canadian" Repair,Bassini Repair); patch closure with prosthetic materials(Polypropylene or Gortex) tension-free (Lichtenstein-type)and laparoscopic repair.


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Assessment

Inspection may reveal an obvious swelling in theinguinal area. If he has a small hernia, the affectedarea may simply appear full.

As part of your inspection, have the patient lie down. Ifthe hernia disappears, it's reducible

Auscultation should reveal bowel sounds. Theabsence of bowel sounds may indicate incarceration or

strangulation. Palpation helps to determine the size of an obvious

hernia. It also can disclose the presence of a hernia in amale patient.


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Primary Nursing Diagnosis: Pain related to swelling and pressurePrimary nursing Outcomes: Pain, disruptive effects; pain levelPrimary nursing Interventions: Analgesic administration; painmanagement

Common Nursing diagnoses found on Nursing care plan for InguinalHerniaActivity intolerance

Acute pain

Ineffective tissue perfusion: GI Risk for infection Risk for injury
http://nurse-thought.blogspot.com/2009/06/pain-nursing-care-plan.htmlhttp://nurse-thought.blogspot.com/2009/03/nursing-care-plans-for-activity.htmlhttp://nurse-thought.blogspot.com/2009/03/nursing-care-plans-for-activity.htmlhttp://nurse-thought.blogspot.com/2009/03/nursing-care-plans-for-activity.htmlhttp://nurse-thought.blogspot.com/2009/03/nursing-care-plans-for-activity.htmlhttp://nurse-thought.blogspot.com/2009/06/pain-nursing-care-plan.html


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Hernias.ppt Yenni