Inguinal Hernia And Umbilical Hernia j6q3c

INGUINAL HERNIA

TYPE OF HERNIA

UMBILICAL HERNIA

OVERVIEW

An inguinal hernia is a protrusion

Congenital umbilical hernia is a congenital malformation, especially common in infants

of abdominal-cavity contents through the inguinal canal. They are very common (lifetime risk 27% for men, 3% for women[1]), and their repair is one of the most frequently performed surgical operations. There are two types of inguinal hernia, direct and indirect, which are defined by their relationship to the inferior epigastric vessels. Direct inguinal hernias occur medial to the inferior epigastric vessels when abdominal contents herniate through the external inguinal ring. Indirect inguinal hernias occur when abdominal contents protrude through the deep inguinal ring, lateral to the inferior epigastric vessels; this may be caused by failure of embryonic closure of the processus vaginalis. Origin In men, indirect hernias follow the same route as the descending testes, which migrate from the abdomen into the scrotum during thedevelopment of the urinary and reproductive organs. The larger size of

of African descent. Among adults, it is three times more common in women than in men; among children, the ration is roughly equal. An acquired umbilical hernia directly results from increased intra-abdominal pressure and are most commonly seen in obese individuals. Presentation A hernia is present at the site of the umbilicus (commonly called a navel, or belly button) in the newborn; although sometimes quite large, these hernias tend to resolve without any treatment by around the age of 5 years.[citation needed] Obstruction and strangulation of the hernia is rare because the underlying defect in the abdominal wall is larger than in an inguinal hernia of the newborn. The size of the base of the herniated tissued is inversely correlated with risk of strangulation (i.e. narrow base is more likely to strangulate). Babies are prone to this malformation because of the process during fetal development by which the abdominal organs form outside the abdominal cavity, later returning into it through

their inguinal canal, which transmitted the testicle and accommodates the structures of the spermatic cord, might be one reason why men are 25 times more likely to have an inguinal hernia than women. Although several mechanisms such as strength of the posterior wall of the inguinal canal and shutter mechanisms compensating for raised intraabdominal pressure prevent hernia formation in normal individuals, the exact importance of each factor is still under debate.

an opening which will become the umbilicus.

Subtypes

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protrude s through the inguinal ring and is ultimatel y the indir result of ect the ingui failure of Lateral nal embryon hern ic ia closure of the internal inguinal ring after the testic le es through it

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Congenita l

The cause of inguinal hernia in children can be termed an abnormality of embryologic development of the fetus. However, some children may present with an acquired form of inguinal hernia, also called a direct inguinal hernia. In this type of hernia, weakness of the inguinal floor is present, which allows for protrusion of viscera from the abdominal cavity. The hernia sac is composed of the peritoneal fold that contains the hernia. Anatomically speaking, indirect and direct inguinal hernias differ in that the direct hernia bulges through the inguinal floor medial to the inferior epigastric vessels and the indirect hernia arises lateral to the inferior epigastric vessels. Either hernia may cause fullness or a palpable bulge in the inguinal region, and distinguishing between the two types on the basis of physical examination findings may be difficult. The clinician may assume, until proven otherwise, that the pediatric patient with an inguinal hernia has indirect inguinal hernia. •

The following are associated with an increased risk of inguinal hernia: o Prematurity and low birth weight (Incidence approaches 50%.) o Urologic conditions  Cryptorchidism  Hypospadias

CAUSES

An umbilical hernia in an infant occurs when the muscle through which blood vessels to feed the developing fetus doesn't close completely. Umbilical hernias are common in infants. They occur slightly more often in African Americans. Most umbilical hernias are not related to disease. However, umbilical hernias can be associated with rare conditions such as mucopolysaccharide storage diseases, Beckwith-Wiedemann syndrome, and Down syndrome.

Epispadias Exstrophy of the bladder Ambiguous genitalia Patent processus vaginalis, which may be present because of increased abdominal pressure due to ventriculoperitoneal shunts, peritoneal dialysis, or ascites Abdominal wall defects  Gastroschisis  Omphalocele Family history  Meconium peritonitis  Cystic fibrosis  Connective tissue disease  Mucopolysaccharidosis  Congenital dislocation of the hip  Ehlers-Danlos syndrome  Marfan syndrome  Cloacal exstrophy  Fetal hydrops  Liver disease with ascites  Ventriculoperitoneal shunting for hydrocephalus   

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Hernias present as bulges in the groin area that can become more prominent when coughing, straining, or standing up. They are

CLINICAL MANIFESTA TION

A hernia can vary in width from less than 1 centimeter to more than 5 centimeters. There is a soft swelling over the belly button that often bulges when the baby sits up, cries, or

rarely painful, and the bulge commonly disappears on lying down. The inability to "reduce", or place the bulge back into the abdomen usually means the hernia is 'incarcerated' which is a surgical emergency. Significant pain is suggestive of strangulated bowel (an incarcerated indirect inguinal hernia). As the hernia progresses, contents of the abdominal cavity, such as the intestines, can descend into the hernia and run the risk of being pinched within the hernia, causing an intestinal obstruction. If the blood supply of the portion of the intestine caught in the hernia is compromised, the hernia is deemed "strangulated," and gut ischemia and gangrene can result, with potentially fatal consequences. The timing of complications is not predictable; some hernias remain static for years, others progress rapidly from the time of onset. Provided there are no serious co-existing medical problems, patients are advised to get the hernia repaired surgically at the earliest convenience after a

strains. The bulge may be flat when the infant lies on the back and is quiet.

diagnosis is made. Emergency surgery for complications such as incarceration and strangulation carry much higher risk than planned, "elective" procedures. Laboratory Studies •

No laboratory studies are needed in the assessment of a patient with a suspected inguinal hernia and/or hydrocele.

Imaging Studies Imaging studies are generally not indicated to assess for inguinal hernia. However, ultrasonography can be helpful in the assessment of selected patients. •

Ultrasonography: Some advocate the use of ultrasonography to differentiate between a hydrocele and an inguinal hernia. Ultrasonography is capable of finding a fluid-filled sac in the scrotum, which would be compatible with a diagnosis of hydrocele. However, if the patient has an incarcerated inguinal hernia, ultrasonography may not be sensitive enough to differentiate between the two conditions. Thus, this study is rarely helpful in the treatment of a pediatric patient with a suspected

DIAGNOSTI C EVALUATIO NS

Importantly this type of hernia must be distinguished from a paraumbilical hernia, which occurs in adults and involves a defect in the midline near to the umbilicus, and from omphalocele. The doctor can find the hernia during a physical exam.

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inguinal hernia. When presentation and examination suggest a diagnosis other than hernia or hydrocele, appropriate imaging, including ultrasonography, may be necessary. An enlarged inguinal lymph node can mimic an incarcerated inguinal hernia, and surgical exploration may occasionally be necessary to confirm the diagnosis. Peritoneography: Injection of contrast in the peritoneal cavity has been used to determine the presence of a patent processus vaginalis. Although this test is very sensitive, its use is limited. Because of possible complications, including bowel perforation and sepsis, injection of contrast is rarely performed today.

Procedures •

Laparoscopy: Diagnostic laparoscopy is a very effective method for determining the presence of an inguinal hernia but is used only selectively because it requires anesthesia and surgery. Laparoscopy can be useful to assess the contralateral side (see Treatment) or to evaluate for presence of a recurrent inguinal hernia in patients with a history of operative repair.

Surgical correction of inguinal hernias, called a herniorrhaphy or hernioplasty, is now often performed as outpatient surgery. There are various surgical strategies which may be considered in the planning of inguinal hernia repair. These include the consideration of mesh use, type of open repair, use oflaparoscopy, type of anesthesia, appropriateness of bilateral repair, etc. During surgery conducted under local anaesthesia, the patient will be asked to cough and strain during the procedure to help in demonstrating that the repair is "tension free" and sound.[3] Non-surgical treatment The hernia truss (medicine) is intended to contain a reducible inguinal hernia within the abdomen. This device fell out of favour with the advent of hernia surgery. It is not considered to provide a cure, and if the pads are hard and intrude into the hernia

THERAPEUT IC MANAGEME NT

When the orifice is large (< 1 or 2 cm), 90% close within 3 years (some sources state 85% of all umbilical hernias, regardless of size), and if these hernias are asymptomatic, reducible, and don't enlarge, no surgery is needed (and in other cases it must be considered). In some communities mothers routinely push the small bulge back in and tape a coin over the palpable hernia hole until closure occurs. This practice is not medically recommended as there is a small risk of trapping a loop of bowel under part of the coin resulting in a small area of ischemic bowel. The use of bandages or other articles to continuously reduce the hernia is not evidencebased. An umbilical hernia can be fixed 2 different ways. The surgeon can opt to stitch the walls of the abdominal or he/she can place mesh over the opening and stitch it to the abdominal walls. The latter is of a stronger hold and is commonly used for larger tears in the abdominal wall. Most surgeons will repair the hernia 6 weeks after the baby is born.

aperture they may cause scarring and enlargement of the aperture. In addition, most trusses with older designs are not able effectively to contain the hernia at all times, because their pads do not remain permanently in with the hernia. The more modern variety of truss (medicine) is made with non-intrusive flat pads and comes with a guarantee to hold the hernia securely during all activities. Although there is as yet no proof that such devices can prevent an inguinal hernia from progressing, they have been described by s as providing greater confidence and comfort when carrying out physically demanding tasks. Their popularity is likely to increase, as many individuals with small, painless hernias are now delaying hernia surgery due to recently published reports on the incidence of Post Herniorrhaphy Pain Syndrome. Prompt recognition of an inguinal hernia is imperative. The hernica may first be noticed when infant is crying or 1.

NURSING MANAGEME NT

1. The appearance of an umbilical hernia may be disconcerting to parents; therefore they need reassurance that the defect is not

straining stool (Valsalva manuever). Nursing care of the infant or child with an inguinal hernia involves preoperative preparation of the infant and appropriate explanation to the parents of the child’s expected postoperative status. Most hernia repairs can be managed in an outpatient basis. The preterm infant usually will have hernia repair several days before discharge from the neonatal intensive care unit. The former preterm infant diagnosed after discharfe is itted the day of surgery and after repair is observer 12 to 24 hours for occurences of apnea and bradycardia. 2. Postoperatively the wound is kept dry and clean, and the infant;s pain is managed appropriately. In infants and small childrenm who are not yet toilet trained, the wound may be covered with an occlusive fressing or left without a dressing. Changing diapers as soon as they become damp helps reduce the chances of irritation or infection of the incision 3. Parents are instructed to give child sponge baths for 2 to 5 days to change diapers frequently. There are no restrictions placed on the infant’s or toddler’s activity, but older children are cautioned against lifting, pushing,

harmful. Tapping or strapping the abdoment of latten the protrustion does not aid in resolution and can produce skin irritation. 2. Nursing care of the child with an umbilical hernia repair is essentially the same as that for other minor GI surgery. The procedure may be performed on an outpatient basis, and a pressure dressing is maintained for approximately 48 hours postoperatively. The child may resume a normal diet and activity postoperatively, howeverm strenuous activity or play is restricted for 2 to 3 weeks.

wrestling, or fighting, cycling, and atlethics for at least 3 weeks. 4. If surgery is postponed, parents need to be taught the signs of incarcerated hernia, simple measures to reduce it (a warm bath, avoidance of upright positioning, and comfort measures to reduce crying) and where to call for assistance if relief is not obtained in reasonably short time. 5.