Hernia:
A hernia is a protrusion of an
organ, tissue or structure through the wall of the cavity in which it is
normally contained.
Etiology:
1.
Congenital weakness of the abdominal
valve
2.
Acquired causes (traumatic injury, aging)
3.
Increased intra-abdominal pressure
due to heavy lifting, obesity, pregnancy, straining and chronic coughing
Types of hernia:
1.
Reducible: The
protruding mass can be placed back into the
abdominal cavity.
2.
Irreducible: The
protruding mass cannot be moved back into
the abdomen.
3.
Incarcerated: An
irreducible hernia in which the intestinal
flow is completely obstructed.
4.
Strangulated: An
irreducible hernia in which the blood and
intestinal flow are completely obstructed. Develops when the loop of intestine
in the sac becomes twisted or swollen and a constriction is produced at the
neck of the sac.
Classification
of hernia by site:
1.
Inguinal hernia:
Hernia into the inguinal canal (more common in males.)
Indirect inguinal hernia: Due to weakness of the
abdominal wall at the point through which the spermatic card emerges in the
male and the round in the female.
Through this opening the hernia extends down, the inguinal
canal and often into the scrotum or the labia.
Direct
inguinal hernia: Passes through the posterior inguinal wall.
2.Femoral
hernia:
Hernia into two femoral canals
appearing below the inguinal ligament that is below the groin.
3. Umbilical hernia:
Protrusion of part of the intestine at the umbilicus due to
failure of umbilical orifice will close. Occurs most often in obease women, in
children and in patients with increased intra abdominal pressure from cirrhosis
and ascites
4. Ventral (or) incisional hernia:
Hernia through the weak abdominal
wall may occur after impaired healing of incision due to infection.
5. Diaphragmatic (or) hiatus hernia
(or) oesophageal hernia:
It is the protrusion of a part of
the stomach that slides or follows the normal path of the esophagus and enters
into the thoracic cavity through an enlarged hiatal opening.
Signs and symptoms:
1.
Bulging over herniated area when
patient stands or strains, and disappears when supine.
2.
Hernia tends the increase in size
and recurs with intra abdominal pressure.
3.
Strangulated hernia presents with
pain, vomiting, swelling of hernial sac, peritoneal irritation and fever.
4.
In hiatus hernia the patient
complaints of heart burn after large meals and during the night, food may be
regurgitated
Diagnosis:
1.
Based on signs and symptoms.
2. Abdominal
X-rays: Reveals abnormally high level of gas in the bowel.
3.
Laboratory studies: Complete
blood count and electrolytes may
show haeconcentration (increased hematocrit), dehydration (increased or
decreased sodium) and leucocytosis.
Management:
1.Mechanical:
A truss is an appliance with a pad
and belt that is holding snugly over a hernia to prevent abdominal contents
from entering the hernia sac.
Surgical management:
Recommended to correct hernia before strangulation.
Strangulation of hernia is an emergency condition that
necessitates emergency laparotomy.
2.Herniorrhaphy:
Removal of hernial sac, contents replaced into the abdomen,
layers of muscle and fascia sutured.
Laparoscope Herniorrhaphy is a possibility is often
performed on outpatient basis.
3. Hernioplasty:
Involves reinforcement of suturing
(often with mesh) for extensive hernia repair.
c. Strangulated:
Strangulated hernia requires
resection of ischemic bowel in addition to repair of hernia.
Nursing management:
1.Achieving comfort of the patient:
Fit patient with truss or belt when hernia is reduced, if
ordered.
Trendelenburg' s position may reduce pressure on hernia,
when appropriate.
Emphasize
patient to wear truss under clothing and to apply before getting out of the bed
when hernia is reduced.
2. Post operative care:
· Encourage the patient to splint the incision
site with hand or pillow when coughing to lessen pain and protect the site from
increased intra-abdominal pressure and wound dehiscence.
1.
Administer analgesics as ordered.
2.
Teach about bed rest, intermittent
ice packs. Scrotal elevation is done with T bandage to reduce scrotal edema or
swelling after repair of an inguinal hernia.
3.
Encourage ambulation as soon as
permitted.
4.
Advise patient that difficulty in
urinating is common after surgery; promote
elimination to avoid discomfort, and catheterise if necessary.
3. Prevention of infection:
1.
Monitor the vital signs
2. Check dressings for drainage and incision for redness and
swelling.
3. Monitor for other signs and symptoms of infections; fever,
chills, malaise, diaphoresis.
4.
Administer prescribed antibiotics.
4. Patient
education on discharge:
1.
Advise that pain and scrotal
swelling may be present for 24 to 48 hours after repair of an inguinal hernia.
2.
Apply ice intermittently.
3.
Elevate scrotum by using scrotal
support.
4.
Take prescribed medication to
relieve discomfort.
5.
Inform that heavy lifting should be
avoided for 4-6 weeks.
6.
Athletics and extremes of extension
are to be avoided for 8 to 12 weeks postoperatively.
Complications:
1.
Bowel obstruction.
2.
Gangrene formation
3.
Wound dehiscence
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