Definition of Hernia – This course is designed to understand the concept of community health nursing: nurses’ roles and interventions in family health, school health, occupational health, environmental health, elderly health care, gender issues, disaster management and principles and terminology of epidemiology. The aim of the course is to acquire knowledge and skills in community health nursing.
Definition of Hernia
A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides
Or,
A hernia occurs when the contents of a body cavity bulge out of the area where they are normally contained. These contents, usually portions of intestine or abdominal fatty tissue, are enclosed in the thin membrane that naturally lines the inside of the cavity.
Or,
A hernia is a protrusion of a viscous or part of a viscous through an abnormal opening in the walls of its containing cavity.
Types of Hernia:
Common types of abdominal wall hernias include the following:
1. Inguinal (groin) hernia: Making up 75% of all abdominal wall hernias and occurring up to 25 times more often in men than women, these hernias are divided into two different types, direct and indirect
a) Indirect inguinal hernia: An indirect hernia follows the pathway that the testicles made during fetal development, descending from the abdomen into the scrotum.
b) Direct inguinal hernia: The direct inguinal hernia occurs slightly to the inside of the site of the indirect hernia, in an area where the abdominal wall is naturally slightly thinner.
2. Femoral hernia: The femoral canal is the path through which the femoral artery, vein, and nerve leave the abdominal cavity to enter the thigh. Although normally a tight space, sometimes it becomes large enough to allow abdominal contents (usually intestine) to protrude into the canal.
3. Umbilical hernia: These common hernias (10%-30%) are often noted in a child at birth as a protrusion at the belly button (the umbilicus). An umbilical hernia is caused when an opening in the child’s abdominal wall, which normally closes before birth, doesn’t close completely. If small (less than half an inch), this type of hernia usually closes gradually by age 2.
4. Incisional hernia: Abdominal surgery causes a flaw in the abdominal wall. This flaw can create an area of weakness through which a hernia may develop. This occurs after 2%-10% of all abdominal surgeries, although some people are more at risk. Even after surgical repair, incisional hernias may return.
5. Spigelian hernia: This rare hernia occurs along the edge of the rectus abdominus muscle through the spigelian fascia, which is several inches lateral to the middle of the abdomen.
6. Obturator hernia: This extremely rare abdominal hernia develops mostly in women. This hernia 6 protrudes from the pelvic cavity through an opening in the pelvic bone (obturator foramen).
7. Epigastric hernia: Occurring between the navel and the lower part of the rib cage in the midline of the abdomen, epigastric hernias are composed usually of fatty tissue and rarely contain intestine. Formed in an area of relative weakness of the abdominal wall, these hernias are often. painless and unable to be pushed back into the abdomen when first discovered.at
8. Hiatal hernia: This type of hernia occurs when part of the stomach pushes through the diaphragm. The diaphragm normally has a small opening for the esophagus.
9. Diaphragmatic hernia: This is usually a birth defect causing an opening in the diaphragm, which allows abdominal content to push through into the chest cavity.
Causes of a Hernia:
1. Weakness of the abdominal wall
A. Congenital:
- Presence of congenital sac (indirect inguinal hernia-male)
- Patent canal of Neck (indirect inguinal hernia- female)
- Failure of transversalis fascia
B. Acquired:
- latrogenic: surgical incision
- Muscle weakness following obesity, repeated pregnancy, nerve division, wasting disease.
2. Continued & repeated raised intra-abdominal pressure:
- Chronic cough e.g, chronic bronchitis, smokers
- Constipation
- Urinary obstruction
- Vomiting Ascites
- Severe Muscular effort
3. Genetic: High incidence seen in Eskimos
4. Collagen metabolic abnormality: Generalized deficiency in collagen particularly smokers
5. Others (direct inguinal hernia):
- Aging
- Smoking
- Failure of posterior inguinal wall or fascia
- Failure of medial half of transversalis fascia
Signs and Symptoms/Clinical Feature:
Symptoms:
- Sudden severe pain which at first situated over the hernia, is followed by generalized abdominal pain
- Pain is paroxysmal (colicky) in character and often located mainly at umbilicus
- Vomiting is forcible and usually often repeated nausea
- Patient may say that the hernia has recently become large
Signs:
- Hernia is tense and extremely tender, edematous, swollen
- Hernia is irreducible
- There is no expansile cough impulse
- There may be signs of peritonitis
- Discomfort or pain
- A lump
- Feature of toxic shock like –
- ↑ Pulse rate
- ↓ BP
- Shallow breathing
- ↓ Urinary output
- Patient become restless
- There may be sign of perforation
Management of Hernia Anguinal Hernia:
General Management
1. Provide comfortable rest to the patient
2. To Nothing by mouth (NPO)
3. To give NG suction for 1-3 hours
4. First control of the all precipitating factors-
- Chronic cough
- Constipation
- Obesity
- Smoking etc.
Specific Management
1. Relief of obstruction
2. Testing the viability of the gut:
- If viable returning of the gut into abdomen
- If non- viable resection and end to end anastomosis the gut
3. IVV fluid and Electrolyte should be given by the doctors order
4. To provide Prophylactic antibiotic
5. Catheterization, if necessary
Post-Operative Complications of Inguinal Hernia:
Early:
- Retention of urine
- Hematoma of the cord & scrotum
- Wound infection
Late
- Recurrence
- Neuralgic pain due to involvement of ilio-inguinal nerve in the suture.
- Sinuses
- Painful scar
- Atrophy of the testis due to injury to testicular artery or due to compression of the spermatic cord following narrowing of the internal ring too much
- Epidermoid cysts – When the skin flap is used for plastic repai.
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