Hernia ppt

PRESENTED BY
MR.ROMAN BAJRANG
RELIANCE INSTITUTE OF NURSING

 A hernia is protrusion of an organ or the muscular wall of anorgan through the
cavity that normally contains it .
 It is an abnormal protrusion of the intestine or other abdominal organ through a
weakness or defect in the musculature in to another cavity .
INTRODUCTION

 “According to Brunner & suddarh”
The medical condition in which on organ inside the
body for example the stomach pushes through the wall of muscle which surrounds it .
 “According to K. P. PARK”
A hernia is an abnormal protrusion of avicus through the wall of a cavity whichnormally
contains it .
 “According to BT basavanthappa”
A hernia is the protrusion of an organ through its contwning wall .
DEFINITION

 Hernia can occur at any age and either sex .
 Indirect inquinal hernias are the most the hypically occur in men .
 Direct hernia arefound mor community in older adult .
 Incisional or ventral hernia occar most after in dient .
 75–80% are inguinal or femoral.
 2% are incisional or ventral.
 3–10% are umbilical, affecting 10-20% of newborns; most close by themselves by 5 years of age.
 1–3% are other types.
INCIDENC
ES
INCIDENCES

ANATOMY & PHYSIOLOGY OF
ABDOMINAL WALL
ANATOMY & PHYSIOLOGY OF
ABDOMINAL WALL

 In anatomy, the abdominal wall represents the boundaries of the abdominal cavity. The
abdominal wall is split into the anterolateral and posterior walls.
 There is a common set of layers covering and forming all the walls: the deepest being the visceral
peritoneum, which covers many of the abdominal organs (most of the large and small intestines,
for example), and the parietal peritoneum- which covers the visceral peritoneum below it, the
extraperitoneal fat , the transversalis fascia, the internal and external oblique and transversus
abdominis aponeurosis, and a layer of fascia ,which has different names according to what it
covers (e.g., transversalis, psoas fascia).
 In medical vernacular, the term 'abdominal wall' most commonly refers to the layers composing the
anterior abdominal wall which, in addition to the layers mentioned above, includes the three
layers of muscle: the transversus abdominis (transverse abdominal muscle), the internal (obliquus
internus) and the external oblique (obliquus externus).

 In human human anatomy the layers of the anterolateral abdominal wall are (from superficial to deep)
 Skin
 Subcutaneous tissue
 Fascia
 Camper's fascia - fatty superficial layer.
 Scarpa's fasciau- deep fibrous layer.
 Muscle
 External oblique abdominal muscle
 Internal oblique abdominal muscle
 Rectus abdominis
 Transverse abdominal muscle
 Pyramidalis muscle
 Transversalis fascia
 Extraperitoneal fat
 Peritoneum

 There are many different kinds of hernias that are able to
affect different arers of the body each hernia will be one
of there types .
1. Reducible .
2. Irreducible .
3. Stranguluted .
TYPES OF HERNIA

REDUCIBLE HERNIAS
REDUCIBLE HERNIAS

 When the hernias is reducible it has the ability to be pushed back inside of the
abdominal cavity .
 It may apperx as a new lump in the groin or other abdominal area .
 It may be reduced( pushed back in to the abdomen ) untess very large .

IRREDUCIBLE HERNIASSTRANGULATED

When the hernia is strangulated surgery is only the option this is when the hernia has become
twisted with anintestine and is cutting off its blood supply cut off .
 This is an irreducible hernia in which the entrapped intestine has it blood supply cut off .
 Sometimes symptoms of bowel obstruction ( nausea and vomiting .
 This condition is a surgical emergency .

 Hernia can be classified according to
their anatomical location :-
 Inguinal hernia .
 Femoral hernia .
 Umbilical hernia .
 Incisional hernia .
 Hiatal hernia .
Other types of hernias include:-
 Epigastric hernia .
 Ventreal hernia .
 Obturator hernia .
 Herniation of intervertebrrl disc .
CLASSIFICATION OF HERNIA

A condition in which soft tissue bulges through a weak point in the abdominal
muscles .
 The soft tissue is often part of the intestine its easy to see and feel the bulge , although not all
are visible by the patient especially when obese .
 The intestine push through a weak or tear into the lower abdominal wall .
 75% of all abdominal wall hernias .
 Occurs 25 % more often in men than women .
 In men, the inguinal canal is a passageway for the spermatic cord and blood vessels leading to the
testicles. In women, the inguinal canal contains the round ligament that gives support for the womb.
In an inguinal hernia, fatty tissue or a part of the intestine pokes into the groin at the top of the
inner thigh. This is the most common type of hernia, and affects men more often than women.
 2 type :-
(1) Indirect inguinal hernia .
(2) Direct inguinal hernia .

(1) INDIRECT INGUNAL HERNIA :-
 Muscle weakness at the inguinal ring causes failure closure of the
deep inguinal ring .
 When icreased intra – abdominal pressure and contents to enter the channel .
 The protrusion passes through the dep inguinal ring and is located lateral to the
inferior epigastric artery .

(2) DIRECT INGUNAL HERNIA :-
 It pass through a weak ponit in the fascia of abdominal wall and at the medial to the
inferior astric artery .

A femoral hernia usually occurs when fatty tissue or part of your bowel pokes through into your
grain at the top of uour inner thigh .
1 .It pushes through a weak spot in the swrounding muscle wall into an area called the femoral canal .
2. A plug of fats in the femorl canal enlarged and pull the peritoneum and often the urinary bladder
into sac .
3. More frequently in women because of the wider of the femal pelvis .
4. Common in obese or preganat women .
5.Fatty tissue or part of the intestine protrudes into the groin at the top of the inner thigh. Femoral
hernias are much less common than inguinal hernias and mainly affect older women.
FEMORAL HERNIA

 Part of small intestine passes through the abdominal
wall near the navel , umbilical hernias are most
comon in children .
 An umbilical hernia occurs when intestine , fat or
fluid pushes through a weal=k spot in the belly .
 This causes abulge near the belly button , or navel .
 Fatty tissue or part of the intestine pushes through
the abdomen near the navel (belly button).
 CONGENITAL :- Appear in infancy .
 ACQUIRED:- Increased in intaabdominal pressure
common seen in obese or pregnant women .
UMBILICAL HERNIA

HIATAL HERNIA
 A hiatal hernia develops in a small opening in the diaphragm through which the esophagus passes that
allows the upper part of the stomach to move up into the chest .
 Part of the stomach protrudes up diaphragm into the chest .
 Part of the stomach pushes up into the chest cavity through an opening in the diaphragm (the
horizontal sheet of muscle that separates the chest from the abdomen).
 2 types histal hernia .
(1) SLIDING HIATUS HERNIA :- the distal oesophagus and cardia slides inti the thorax
with an intact gastro – oesophagel junction and therfore usually asymptomatic .
(2) ROLLING HIATUS HERNIA :-
most of the stomach rolls into the thorax , the stomach may also
undergo a twist
.

 The intestine pushes through the abdominal wall at the site of
previous abdomonal surgery . This types is most common in
elderlg or overweight pepople who are inactive after abdominal
surgery
.
 Tissue protrudes through the site of an abdominal scar from a
remote abdominal or pelvic operation.
 Incisonal / ventral hernia (occur at the site pf previous
surgical incision ) results from inadequate healing of the
incision .
 Cause be postoperative wound infection
,indequate , nutrition , and obesity .
INCISIONAL HERNIA

 This types of hernia occurs as a result of a weaknessin the muscles of the upper –
middle abdominal .
 Fatty tissue protrudes through the abdominal area between the navel and lower part of
the sternum (breastbone).

 A ventral hernia is a bulge of tissues through an opening of weakness with in your abdominal to
move up into the chest .
 he intestine pushes through the abdomen at the side of the abdominal muscle, below the navel.

HERNIATION OF INTERVERTEBRRL DISC
The nucleus of disc protrudes into the annulus with subsequent never
compression

pregnancy
smoking
Obesit
Heavy
wight
lifting
Muscle
wekness
Congenital
defect
constipation
Risk factor
Damage
from injury
or surgery
Chronic
cough

ETIOLOGY
Any condition that increases the pressure in the intra – abdominal cavity may contribute to the formation
of a hernia including the following .
A) Any condition that is increases pressure on abdominal cavity :-
Combination of muscle weakness and strain .
 Marked Obesity .
Heavy lifting .
Presistant coughing or sneezing .
Pregnancy .
Straining during bowel movement or urination .
Diarhea or constipation .
Ascites – fluid in the abdominal cavity .
Chronic obstructive pulmonary disese (COPD) .
Poor nutrition .
Smoking .
B) family history of hernias .

congenital
Pregnancy
Trauma
Obesity
Defects in
mascular
walls
Increased
intr-
abdominal
pressure
Hernia
PATHOPHYSIOLOGY

 Fever .
 Pain of discompart .
 Nausea and vomiting .
 Bowel obstruction .
 Tachycardia .
 Burning or aching at hernia site .
 Bulging .
 Tenderness .
 Constipation .
 Sever and sudden pain .
CLINICAL MANIFESTATION

 Physical examination .
 Complete blood count ( CBC) & WBC .
 MRI .
 Urinalysis .
 Uttrosonography .
 Upright chest radiogroph .
 CT scanning .
 Electolytes BUN and geatinine levels .
 X- ray abdomen .

 Goal of management :-it is to improve symprons and the quality of life in general and to
prevent.
• adverse envents the rate of surgical complication .
 General maneagement :-
open surgery –it is sugery in which a cut made into the body at location of hernia .
laparscopic surgery – it indude as some type of repairs in surgery .
Rabotic hernia – like laparoscopic surgery uses a laparosocpeand is performed with small incisions .
MANAGEMENTT

 Propylatic antibiatics are given .
 Maintainence of intrrvenous fluids are administred .
 The patient is tough to apply truss daily .
 Hernias that are not strangalate can be mechaniclly reduced .
 Intrunt the patient to inspect the skin under the truss for any
manifestation of skin break down .
 Neonates with intact omphalocel are usually in no distress unless
associated with pulmonary hypoplasia .
 The baby should be cerefully examined to be detect any associated
problems .
 Maintainense of intravenous fluids are administered .
 Prophylatic antibiotics are given .
MEDICAL MANAGEMENT

 ANTIBIOTIC
(Used if the patient has strangulated hernia )
i. IV cefoxitin ( mefoxin ) 1g 6-8 hourly .
ii. Cap . Ampicilln 250 -500 mg 6 hourly .
 H2 RECETOR BLOCKER
( Used if the patient with hiatal hernia)
i. Tab . Famotidine 40 mg dly .
ii. Tab . Ranitdine 150 mg BD .

 PPT
( Used if the patient with hiatal hernia )
i. Tab . Lansoprazole (prevacid ) 15 -30 mg dly .
ii. Cap . Osomeprazole ( nexium ) 20- 40 mg dly .
iii. Cap . Omeprazole ( prilosec) 20-40 mg dly .
iv. Tab . Pantoprazole (controloc ) 20-40 mg dly .
 ANTIANXIMETYAGENTS
( indicated for patient who may experience significant anxiety before a surgery )
1. Tab . Dormicum 7.5-15 mg PRN.
 NONSTEROIDAL ANTI –INFLAMMATORY DRUGS (NSAIDs)
( for patients with mild to moderate pain )
I. Tab. Ibuprofen (Advil) 100 mg 6 hourly .
II. Tab . Ketoprofen 50-75 mg 6 hourly .

 NON – PHARMACOLOGICAL MANAGEMENT :-
1) Avoid food that cause acid reflux or heartburn such as
spicy food .
2) Don’t lie down or bend over after a meal .
3) Exercise .
4) Stop smoking .
5) Avoid gassy drinks .
6) Avoid life heavy object .

Laparoscopic ( LEP)
9
SURGICAL MANAGEMENT
Nissen fundoplication
Herniohaphy ( hernia repairs)

 Non – surgical management :-
 Truss( Inginal hernia) :- A pad made with firm material that will held in place over the hernia with
belt to help the abdominal contents from protruding into the hernia sac .

NURSING MANAGEMENT
1) Reduce the anxiety of patient .
2) To provide clean environment .
3) To improve the knowledge of the disease .
4) To provide the psychological support of the patient .

1.Post herniarrhaphy pain syndrome / inguinodynia .
2.Hernia recurrence .
3.Wound infection .
4.Ischemia .
5.Necrosis .

 MEDICAL TREATMENT:-
• hernia that are not strangulated can be mechanically reduced .
•Truss ( firm pad ) held by a belt to keep the hernia in place or reduced .
•The hernia patient is taught to apply the truss daily .
•Instruct the patient to inspect the skin under the truss for any manifestation of skin breakdown
•If patient has preexisting medical conditions that make surgery unafe , doctor may not repair
hernia but will watch it closely .
•Some hernia have very large openings in the abdominal wall , and closing the opening is
compliated may be treated without surgery ,using abdominal binders .
•Some doctors feel that the hernia with large openings have a low risk of strangulation .
•An attempt to ( push back ) the hernia will generally be made , often after giving medicine for
pain and muscle relaxation .

 SURGICAL TREATMENT :-
1) A hernia repair is performed using a small incision directly over the weakened area . The
intestine is then returned to the perineal cavity , yhe hernial sac excised and the muscle
closed tightly over the area .
2) Hernia in the ingunial region are usually repaired under spinal or local anesthesia .
3) Some repair is difficult becsuse there is insufficient muscle to keep the intestines in place . So
steel mesh
grafts are used to reinforce the rea of herniation .
4) Clients with difficult repairs are usually hospitalized for 1 to 2 days to prophylactic antibiotics .
5) If the intestinal contents of the hernia had the blood supply cut off , the development of dead
( gangrenous) bowel is possible in as little as six hours .

PRE –OPERATIVE FOR HERNIA REPAIR:-
1) Fear and anxiety related to undegoing surgery .
POST - OPERATIVE FOR HERNIA REPAIR:-
2) Acute pain related to surgical intervention .
3) Risk of infection related to surgical site .
HIATAL HERNIA :-
Risk for aspiration related to reflux of gastric content .

HEALTH EDUCATION
Intake output:-
Drink safe water.
Drink water 50ml/dl.
Use chlorine in drinking water.
Hygiene:-
maintain person hygiene.
Wash the hand before intake water and food.
Excersize:-
Active and pasive excersize.
To protecte the injury.
To maintain health.
Rest and sleep:-
Giving the active in patient to feel better in rest, sleep. Rest for 8-10 hour.

Hernia ppt

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Hernia ppt