What is a hernia

 Hernia is derived from the Latin for "rupture"

It is the protrusion of an organ or part of an organ

through a defecte in the wall of the cavity normally
containing it.
Hernia is classified into three types:

* 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.

* Strangulated, if part of the herniated intestine

becomes twisted or edematous and causing serious
complications, possibly resulting in intestinal
obstruction and necrosis.
Types of hernia
Inguinal
Indirect or indirect
 Inguinal hernias can be direct which is herniation through
an area of muscle weakness, in the inguinal canal,
 and inguinal hernias indirect herniation through the
inguinal ring. Indirect hernias, the more common form,
can develop at any age but are especially prevalent in
infants younger than age 1. This form is three times more
common in males.

 Femoral Herniation through the femoral canal

Types of hernia
 Incisional Herniation
through an area weakened by a scar
 Umbilical
 Paraumbilical
Acquired defect above or below the umbilicus
 Epigastric
in the midline of abdomen above the umbilicus
caused by a defect in linea alba.
Groin Hernias

 Incidence:
- Groin hernias are found in 5% of male population.
- Represents 86% of all hernia cases.
- It occurs 5 times more often in males than females.
- Inguinal 96% ( indirect 75%, direct 25%).
- Bilateral in 20% of cases
- Right sided hernias are more frequent than left
sided ones
- Femoral 4%.
Direct Inguinal Hernia

 Incidence: 25% of hernia cases

 The hernia contents enter the inguinal canal.
 These hernias are generally considered to be acquired,
and may be associated with heavy lifting, straining due
to constipation, coughing, or prostatic enlargement.
Bilateral Hernia

 Definition: Simultaneous Right and Left Inguinal

Hernia
 Common in children and elderly men
 If a left inguinal hernia is present, there is a 25% risk of
an occult right inguinal hernia
 Symptoms

A. Often asymptomatic (especially in direct hernias)

B. Pain or dull sensation in groin
Complications

A. Bowel incarcération ( acute, chronic ): The trapping

of abdominal contents within the Hernia itself
B. Strangulation: pressure on the hernial contents may
compromise blood supply (especially veins, with their
low pressure, are sensitive, and venous congestion
often results) and cause ischemia, and later necrosis
and gangrene, which may become fatal.
C. Small Bowel Obstruction
FEMORAL HERNIA
 I. Epidemiology
A. Accounts for 4% of Groin Hernias (96% are inguinal)
B. More common in elderly women
C. Gender predisposition: Female by 3 to 1 ratio
1. Femoral seen less than Inguinal Hernia even in women
 II. Pathophysiology
A. Associated with increased intraabdominal
pressure
B. Hernia sac bulges into femoral canal
. Femoral canal lies immediately medial to femoral vein
INCISIONAL HERNIA
 I. Pathophysiology
A. Type of Ventral Hernia
B. Develops in scar of prior laparotomy or drain site
C. Risks for postoperative hernia development
1. Vertical scar more commonly affected than horizontal
2. Wound infection
3. Wound dehiscence
4. Malnutrition
5. Obesity
6. Tobacco abuse
Treatment Options

 All hernias should be surgically corrected to remove the

risk of incarceration and strangulation.
 If there are compelling co-morbid medical conditions that
preclude surgery, then a truss, or support hernia belt may
be employed. A truss does not repair the hernia defect, but
will afford some relief of symptoms.
 Modern methods of repair include open primary closure of
the defect with sutures (Shouldice or "Canadian" Repair,
Bassini Repair); patch closure with prosthetic materials
(Polypropylene or Gortex) tension-free (Lichtenstein-type)
and laparoscopic repair.
Assessment

 Inspection may reveal an obvious swelling in the

inguinal area. If he has a small hernia, the affected
area may simply appear full.
 As part of your 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.
 Palpation helps to determine the size of an obvious
hernia. It also can disclose the presence of a hernia in a
male patient.
Primary Nursing Diagnosis: Pain related to swelling and pressure
Primary nursing Outcomes: Pain, disruptive effects; pain level
Primary nursing Interventions: Analgesic administration; pain
management

Common Nursing diagnoses found on Nursing care plan for

Inguinal Hernia
Activity intolerance
Acute pain
Ineffective tissue perfusion: GI
Risk for infection
Risk for injury