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CHINCHU M
Definition
A hernia is a protrusion
of an organ or part of an
organ through an
abnormal opening in the
walls of its containing
cavity .
repeated INCREASE in
abdominal pressure is
Chronic cough
usually
due to
Straining
Bladder
neck or urethral
obstruction
Pregnancy
Vomiting
Sever muscular effort
Ascetic fluid
Types
Inguinal
Femoral
Epigastric
Para
umbilical
Umbilical
Incisional
Congenital diaphragmatic hernia
Inguinal hernia
Examination:
1.Inspection
color.
2.Palpation for surface, temp,
tenderness, composition and
reducibility.
3.Expansible cough impulse.
4.General exam: for common causes
of increase intra abdominal pressure
Direct
Femoral hernia
Small femoral hernia may be
unnoticed by the patient or
disregarded for years perhaps
until the day it strangulates.
Adherence of the greater
omentum sometimes causes a
dragging pain. Rarely a large sac
is present .
Femoral hernia
Umbilical hernia
Signs
and symptoms
Age ; doesnt appear until the
umbilical cord has separated and
healed .
No specific symptoms
Have wide neck and reduce easily ,
rarely give intestinal obstruction.
Nature history ; 90 % disappear
spontaneously during the first year.
Examination
Inspection
Site ; in the center of the
Size and shape ; size can
umbilicus
vary from vary
small to very large . Shape is usually
hemispherical.
Palpation
Composition ; contain bowel , which makes
it resonant to percussion . They reduce
spontaneously when the child lies down .
Reducibility ; easy
Cough impulse; invariably present .
Incision hernia
Signs
and symptoms
Previous operation or accidental
trauma
Age ; all ages , but more common
in old age.
Symptom ; lump ,pain ,intestinal
obstruction ( distention ,colic,
vomiting ,constipation , sever
pain in the lump )
Pathophysiology
During fetal development, out pouching
of peritoneum originates at the
inguinal ring
Extends medially down into the
scrotum or labia majora
Failure to close process vaginalis results
in potential sac, and abdominal
contents herniates into the sac
Clinical features
Swelling
Pain
Tenderness
Irritability
Abdominal
distension
Diagnosis
History
Physical
examination
Blood examination
Urine examination
Imaging studies
Manageme
nt and
repair
Preoperative assessment
proper
Preoperative assessment
Investigation
1. Lab :
* CBC : to check hemoglobin level anemia
and WBCs infections
* LFTs : indicated in jaundiced patients and
suspected hepatitis or any clotting problems
* PT & PTT
* ABG
* grouping and cross matching
2. Imaging :
* Chest X ray : for all patients
3. ECG : for any patient who is more than 40
years of age
Pre op preparation
Most
Reduction
Uncomplicated:
Manual
Complicated
(strangulated):
no attempt should be made to reduce
the hernia
DIRECT:
Too broadly
McVay:
TF is sutured to cooper
ligament.
Shouldice:
TF is incised and
reapproximated.
Complications
Scrotal
hematoma
Retention of urine
Wound infection
Recurrence
Thank
You