Suryani Countri Permadi

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.

Groin Hernias Embryology & Anatomy

The processus vaginalis is present in the

developing fetus at 12 weeks in utero. The processus is a peritoneal diverticulum that extends through the external inguinal ring. As the testis descends at the 7th to 8th month, a portion of the processus attaches to the testis, as it exits the abdomen and is dragged into the scrotum with the testis.

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

Groin Hernia - Incidence

The incidence approximately 1 to 5%. Male to Female ratio is 8:1 to 10:1.
Premature infants

7%-17%-30% in males and 2% in females, Risk of incarceration exceed 60%

Associated disease with high incidence of Inguinal Hernia

Cystic Fibrosis Disorders of connective tissue formation Ehlers-Danlos syndrome Hunter-Hurler syndrome Congenital dislocation of Hip Chronic Peritoneal Dialysis Preterm infants with intraventricular hemorrhage Children with myelomeningocele with VP-shunt

Incarcerated Inguinal Hernia

Treatment:

Manual Reduction Incomplete Reduction Reduction of Compromised Bowel Iatrogenic Perforation of Bowel IV Fluids IV AB NGT Warming

Surgery Herniotomy Resection & Anastomosis Resection & Stoma

 Surgery Complications

Cord Injury Hematoma of Scrotum Hydrocele Testicular Atrophy Recurrence

 Symptoms

A. Often asymptomatic (especially in direct hernias) B. Pain or dull sensation in groin

Complications
A. Bowel incarcration ( 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

Terimakasih.