Hernia Presen.pptx
- 1. TOPIC- HERNIA By:- Niharika Mishra RN, IPCN.
- 2. INTRODUCTION A Condition in which part of an organ is displaced and protrudes through the wall of the cavity Containing it(often involving the intestine at weak point in the abdominal wall). The most important elements in the development of hernia are congenital or muscle weakness and increased of the intra abdominal pressure
- 3. DEFINITION A hernia is a abnormal exit of tissue or an organ ,such the bowel,through the wall of the cavity in which it normally resides.
- 6. TYPES OF HERNIA INGUINAL HERNIA 1. Direct Inguinal hernia 2. Indirect Inguinal hernia HIATAL HERNIA UMBILICAL HERNIA (congenital/acquired) FEMORAL HERNIA INCISIONAL HERNIA (occurs at the site of previous surgical incisional ).
- 8. Types of Hernias Inguinal hernia: Makes up 75% of all abdominal wall hernias and occurring up to 25 times more often in men than women. Two types of inguinal hernias: indirect inguinal hernia and direct inguinal hernia. Indirect inguinal hernia Muscle weakness at the inguinal ring causes failure closure of the deep inguinal ring. When increased intra abdominal pressure and dilation of inguinal ring allow abdominal contents to enter the channel.
- 9. Cont. The protrusion passes through the deep inguinal ring and is located lateral to the inferior epigastric artery. Direct inguinal hernia It pass through a weak point in the fascia of abdominal wall and at the medial to the inferior epigastric artery. The direct hernia almost always occurs in the middle-aged and elderly because their abdominal walls weaken as they age.
- 11. Types Cont. Hiatus hernia A hiatus hernia occurs when the upper part of the stomach, which is joined to the oesophagus (gullet), moves up into the chest through the hole (called a hiatus) in the diaphragm. It is common and occurs in about 10 per cent of people.
- 13. Hiatus hernia
- 14. Hiatus hernia It is most common in overweight middle- aged women and elderly people. It can occur during pregnancy. The diagnosis is confirmed by barium meal X-rays or by passing a tube with a camera on the end into the stomach (gastroscopy).
- 15. Treatment for Hiatus Hernia Losing weight nearly always cures it. Eating small meals each day instead of 2 or 3 large ones helps. Avoid smoking. Take antacid. Avoid spicy food. Avoid hot drinks. Avoid gassy drinks.
- 16. Types Cont. Femoral hernia The femoral canal is the way that 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) into the canal. This hernia causes a bulge below the inguinal crease in roughly the middle of the thigh. Rare and usually occurring in women, these hernias are particularly at risk of becoming irreducible and strangulated.
- 18. Types Cont. Umbilical hernia These common hernias (10-30%) are often noted at birth as a protrusion at the bellybutton (the umbilicus). This is caused when an opening in the abdominal wall, which normally closes before birth, doesn’t close completely. Even if the area is closed at birth, these hernias can appear later in life because this spot remains a weaker place in the abdominal wall. They most often appear later in elderly people and middle-aged women who have had children.
- 20. Types Cont. Incisional Hernia(occur at the site of previous surgical Incision ) Results from inadequate healing of incision. This flaw can create an area of weakness where a hernia may develop. This occurs after 2-10% of all abdominal surgeries, although some people are more at risk. Cause be postoperative wound infection, inadequate nutrition and obesity.
- 22. CAUSES/ETIOLOGY a. Any condition that is increases pressure on abdominal cavity: Combination of muscle weakness and strain. Obesity Heavy lifting Persistant coughing or sneezing Pregnancy Straining during bowel movement or urination b. Family History
- 23. SIGNS AND SYMPTOMS Small to moderate size hernia Large hernia may be noticeable and cause some discomfort. Pain when lifting heavy objects Tenderness Bulging
- 24. SEVERE SYMPTOMS Severe sudden pain Nausea Vomiting Constipation
- 26. Signs and Symptoms The signs and symptoms of a hernia can range from noticing a painless lump to the painful, tender, swollen protrusion of tissue that you are unable to push back into the abdomen—possibly a strangulated hernia. Asymptomatic reducible hernia New lump n the groin or other abdominal wall area May ache but is not tender when touched. Sometimes pain precedes the discovery of the lump.
- 27. Cont. Lump increases in size when standing or when abdominal pressure is increased (such as coughing) May be reduced (pushed back into the abdomen) unless very large Irreducible hernia Usually painful enlargement of a previous hernia that cannot be returned into the abdominal cavity on its own or when you push it Some may be long term without pain
- 28. Cont. Can lead to strangulation Signs and symptoms of bowel obstruction may occur, such as nausea and vomiting Strangulated hernia Irreducible hernia where the entrapped intestine has its blood supply cut off Pain always present followed quickly by tenderness and sometimes symptoms of bowel obstruction (nausea and vomiting) You may appear ill with or without fever
- 29. Cont. Surgical emergency All strangulated hernias are irreducible (but all irreducible hernias are not strangulated)
- 30. Diagnosis PHYSICAL EXAMINATION BARIUM MEAL X- RAY ABDOMEN BLOOD TEST Complete blood count White blood count
- 31. MANAGEMENT MEDICAL PHARMACOLOGICAL TREATMENT 1. Antibiotic (used if the patient has strangulated hernia)Ex:= Iv Mefoxin 1g 6- 8 hourly. 2. H2 Receptor blocker ( used if the patient with hiatal hernia)EX.= Tab.rantidine 150 mg 12 hourly 3. Antacids( used if the patient with hiatal hernia). 4. Non steroidal Anti inflammatory Drugs(NSAIDs)for patient with mild to moderate pain. Ex.=Tab. Ibuprofen 100mg 6 hourly
- 32. Non Pharmacological management 1. Avoid food that cayuses acid reflux or heartburn such as spicy food 2. Don’t lie down or bend over after a meal. 3. Stop smoking 4. Avoid lift heavy objects 5. Avoid gassy drinks
- 33. NON SURGICAL MANAGEMENT TRUSS( INGUINAL HERNIA)a pad made with firm material that will held in place over the hernia with belt to keep the abdominal contents from protruding into the hernia sac. SURGICAL MANAGEMENT Nissen fundoplication Herniorrhaphy
- 34. NURSING DIAGNOSIS Fear and anxiety related to undergoing sugery. Acute pain related to surgical intervention Risk of infection related to surgical site. Risk for aspiration related to reflux of gastric content.
- 35. HEALTH EDUCATION Educate patient to assess for any signs and symptoms of infection such as redness, severe itchiness and condition at the surgical site. Advise patient come for follow up to monitor patient progess/condition. Educate patient to avoid wearing tight clothing to minimize abdominal pressure. Use proper lifting techniques
- 36. Encourage patient avoid lifting heavy objects Lose weight Exercise regularly Advise patient to eat a vitamin rich diet such as vitamin-C and protein to promote wound healing Encourage patient to take high fiber food to prevent constipation.
- 37. References http://www.emedicine.com/aaem/topic248 .htm Osburn, Kimberly Pagewise 2002 Medline Plus American Medical Assosiation
- 38. Thank you