hernia

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HERNIA

• BY
• BURNETT CHIONA

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SPECIFIC OBJECTIVES

• Define hernia
• Explain the causes of hernia
• List the symptoms of hernia
• Mention the classification of hernia
• Explain the types of hernia
• Explain the nursing and medical management of
  hernia
• List the complications of hernia

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DEFINITION

• It is the protrusion of an organ or part of an
  organ through a defect in the wall of the cavity
  normally containing it.

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PHYSIOLOGY OF HERNIA

• The abdominal wall has natural areas of potential
  weakness that are present from birth
• Other areas of weakness develop due to a variety
  of factors, such as surgery, injury, pregnancy,
  aging, or muscle strain.
• Most hernias that occur in adults result from
  strain on abdominal muscles that have been
  weakened by age or congenital factors.

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• Hernias can also occur near the site of previous
  trauma to the abdomen or an incision from a prior
  surgery.
• Muscles that heal after an incision can sometimes
  break down, and a hernia can form.
• Patients who develop these types of hernias may
  have multiple incisions in the same place.
• When the hernia forms, a hole in the abdominal
  wall muscle develops, allowing the inner lining
  of the abdomen to push through the weakened area.
  

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• A loop of intestine or fatty tissue may push
  against this lining, forming a sac.
• At this point, you may have no idea you're
  developing a hernia, although you may feel
  burning or tingling

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CAUSES OF HERNIA

• These activities and events may aggravate or lead
  to the discovery of a hernia
• Lifting
• Twisting, pulling, or muscle strains
• Weight gain
• Chronic constipation
• Chronic cough

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SIGNS AND SYMPTOMS

• The symptoms of a hernia can appear gradually or
  suddenly and can cause varying degrees of
  discomfort or pain
• Possible symptoms include
• Weakness, pressure, burning, or pain in the
  abdomen, groin , or scrotum
• A bulge or lump in the abdomen, groin, or scrotum
  that is easier to see when a person cough and
  disappears when you lie down

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• Pain when straining, lifting, or coughing
• The feeling that something has ruptured
• These symptoms may be mild at first, but they
  progressively worsen and cause increasing
  discomfort.
• The pain may be present in the directly affected
  area but may also radiate to the hip, back, leg,
  or even the genitalia
• In strangulated hernia severe pain, symptoms of
  bowel obstruction e.g. vomiting, cramping
  abdominal pain and distension.

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CLASSIFICATION OF HERNIAS

• Reducible
• Hernias can be reducible if the hernia can be
  easily manipulated back into place.
• Irreducible or incarcerated
• This cannot usually be reduced manually because
  adhesions form in the hernia sac

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• Strangulated
• If part of the herniated intestine becomes
  twisted or oedematous and cause serious
  complications.
• Can possibly result in intestinal obstruction and
  necrosis

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TYPES OF HERNIA

• Inguinal
• Most common type especially in men
• Occurs at the point of weakness in the abdominal
  wall where the spermatic cord in men and the
  round ligament in women emerge.

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• Right sided inguinal hernias are more frequent
  than left sided ones
• Simultaneous Right and Left Inguinal Hernia can
  occur- common in children and elderly men

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• Femoral
• A protrusion through the femoral ring into the
  femoral canal, below the inguinal ligament as a
  bulge.
• This becomes strangulated easily and is common in
  elderly women.
• Associated with increased intra-abdominal
• pressure

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• Incisional
• Occur due to weakness of the abdominal wall at
  previous incision site.
• Vertical scar more commonly affected than
  horizontal

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• Umbilical
• Occurs when rectus muscle is weak or when the
  umbilical opening fails to close after birth.
• Occur near the bellybutton, which has a natural
  weakness from the blood vessels of the umbilical
  cord.
• These hernias may occur in infants at or just
  after birth, and may resolve at three or four
  years of age.

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• However, the area of weakness can persist
  throughout life, and can occur in women, men, and
  children at any time.
• In adults, umbilical hernias will not resolve and
  may progressively worsen over time.
• They are sometimes caused by abdominal pressure
  due to being overweight, excessive coughing, or
  pregnancy.
• Common in infants and under-five children

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Medical management

• All hernias are surgically corrected to remove
  the risk of incarceration and strangulation.
• Two types of surgery are done to repair inguinal
  hernias
• Open Inguinal Hernia Repair (Herniorrhaphy,
  Hernioplasty)
• Laparoscopic Inguinal Hernia Repair ( see video)

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• Strangulated hernias are treated immediately with
  resection of the involved area or a temporary
  colostomy so that necrosis and gangrene do not
  occur.
• Most hernias that will recur do so within 5 years
  after surgery.

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Nursing management

• Assessment
• Inspection may reveal an obvious swelling in the
  inguinal area. If it is a small hernia, the
  affected area may simply appear full.
• As part of inspection, have the patient lie down.
  If the hernia disappears, it's reducible
• Auscultation should reveal bowel sounds. The
  absence of bowel sounds may indicate
  incarceration or strangulation.

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• Palpation helps to determine the size of an
  obvious hernia. It also can disclose the presence
  of a hernia in a male patient

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Nursing Diagnosis

• Nursing problems- pre- operative
• Pain related to swelling and pressure
• Risk for injury
• Anxiety
• Nursing problems- pre- operative
• Pain
• Risk for infection
• Risk for injury
• Anxiety

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Nursing interventions after operation

• Patient may have difficulties in voiding
  therefore
• Observe for a distended bladder.
• Monitor and record intake and output accurately.
• In inguinal hernia repair, consider relieving
  scrotal pain by application of ice bag to relieve
  pain and edema.

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• Discourage coughing and encourage deep breathing
  and turning
• Splint the incision area if patient wants to
  cough or sneeze.
• Encourage sneezing with an open mouth to reduce
  pressure on incision site.
• Inform patient to avoid heavy lifting for 6 to 8
  weeks.

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Prevention

• The most important thing one can do to prevent a
  hernia is to stay healthy.
• Practice good nutrition. Eating right will help
  you avoid the constipation (no increased intra
  abdominal pressure). It will also help keep
  muscles healthy.
• Maintain a healthy weight. If overweight, try to
  lose some weight to ease the pressure on your
  abdominal muscles.
• Do regular, gentle exercises to tone and
  strengthen abdominal muscles

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• Use proper lifting techniques and avoid lifting
  weights that are too heavy- good body mechanics
• Don't smoke. Chronic coughing from lung
  irritation can put one at increased risk for a
  hernia.

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Complications

• A. Bowel incarcération ( acute, chronic ) The
  trapping of abdominal contents within the Hernia
  itself
• B. Strangulation pressure on the hernia
  contents may compromise blood supply and cause
  ischemia, and later necrosis and gangrene, which
  may become fatal.
• C. Small bowel Obstruction

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REFERENCES

• LeMone, P., Burke, K. (2007). Medical-surgical
  nursing. Vol. 1 and 2 (4th Edition). New Jersey
  Prentice Hall.
• Lewis, S., Heitkemper, M., Dirkson, S. and
  OBrien, P. (2007). Medical-surgical nursing.
  Assessment and management of clinical problems.
  (7th Edition). Oxford Mosby Press