HERNIA
PRESENTED BY
Mr.JEYAPRAKASH
M.Sc (N) IInd Year
V.M.A.C.O.N, SALEM
HERNIA
Definition:
• A protrusion of a portion of an organ
or tissue through an abnormal
opening .
TYPES OF HERNIA
• Classification according to site of hernia
• Classification according to reducibility
Site of Hernia
• Diaphragmatic hernia
• Umbilical Hernia
• Strangulated hernia
• Gastroscehisis
• Inguinal Hernia
• Femoral Hernia
• Incisional Hernia
DIAPHRAGMATIC HERNIA
Definition
• A Protrusion of an abdominal organ
through the diaphragm into the
chest cavity congenital
posterolateral diaphragmatic hernia
with extrusion of bowel and other
abdominal viscera into the thorax
due o failure of closure of the
pleuroperitoneal hiatus through the
diaphragm.
UMBILICAL HERNIA
• The protrusion of abdominal
organs into the umbilical cord
due to a defect in embryonic
development.
STRANGULATED
HERNIA
• An irreducible hernia in which
the blood and intestinal flow are
completely obstructed develops
when the loop of intentional sac
becomes twisted or swollen and
a constriction is produced at
the neck of the sac.
GASTROSCHISIS
• It is a paramedian defect on
the abdominal wall with
extrusion of bowel which is not
covered by peritoneum, thus
making it very vulnerable to
infection and injury
INGUINAL HERNIA
• The protrusion of a sac of
peritoneum containing fat or
part of the bowel, through the
lower abdominal wall
• Hernia into the inguinal canal.
FEMORAL HERNIA
• The protrusion of part of the
bowel at the top of the thigh,
through the point at which the
femoral artery passes from the
abdomen to the thigh.
• Protrusion of a loop of
intestine into the femoral
canal
INCISIONAL HERNIA
• A Hernia occurring at the site
of an surgical incision.
• One occurring through an old
abdominal incision.
• Classification according to
reducibility.
REDUCIBLE HERNIA
• The Protruding mass can be placed back
into abdominal cavity.
• One that can be returned by
manipulation.
• Irreducible Hernia
• The protruding mass cannot be moved
back into the abdomen
INCARCERATED HERNIA
• An irreducible Hernia in which
the intestinal flow is completely
obstructed.
• Hernia so occluded that it
cannot returned by manipulation.
It may or may not be
strangulated
DIAPHRAGMATIC HERNIA:
Definition
• A protrusion of an abdominal
organ through the diaphragm
into the chest cavity.
Causes:
• Congenital
• Weakening of diaphragmatic
muscles
PATHOPHYSIOLOGY:
Failure of the pleuroperitoneal
canal in the posterior lateral
segment of the diaphragm to
close
Herniation of abdominal organ or
there may be an extreme
protrusion of abdominal contents
into the thoracic cavity at birt
CLINICAL MANIFESTATION
Depending on the extent which
abdominal contents have displaced
(stomach, intestine, spleen, descending
colon) into thoracic cavity.
• Tachycardia, Dyspnea
• Cyanosis
• Broad chest and scaphoid abdomen
• Reduced chest movement and reduced
breath sound on the affected side
• Peristalsis may be heard in the chest on
the affected side
• Crying, hypoxia
• Shock
DIAGNOSISTC EVALUATION:
Physical assessment:
• Diagnosed after birth
• Affected side does not expanded
• Chest X-ray reveal opaque,
hemithorax mediastinal shift, air
filled intestinal loop.
• Abdominal x-ray – empty abdomen
with gas shadows.
SURGICAL
MANAGEMENT
• Abdominal organ are replaced
and diaphragmatic defect is
corrected. Thoracic drainage
may be continued.
• This may be done by either the
thoracic or abdominal route
• Gastrostomy
POST OPERATIVE MANAGEMENT:
• The lung is allowed to inflated slowly.
• The nurse maintains the functioning of the
chest tube and determines whether they are
draining adequately until they are removed
few days.
• The nurse is responsible for preventing
further respiratory embarrassment by careful
nasogastic suctioning.
• Frequently change of position
• Chest physiotheray and endotracheal suction
if the infant has been intubated.
• Forceful efforts to inflate the lungs are not
made because of the danger of
pneumothorax.
• The gastrostomy tube drains by gravity
immediately post operatively.
• The infant receives intravenous infusion
until gastrostomy feeding can be given.
• Since the infant may be discharged on
partial oral and gastrostomy feeding, the
parent must be taught these proecedures.
• The infant can be fed by gastrostomy until
general condition improves and breast
milk or formula is better accepted.
• Care of thoracic drainage by observing
fluid column oscillation and maintaining
asepsis.
• Observation of incisional wound.
• Maintaining body temperature.
INGUINAL HERNIA
Definition:
• The protrusion of a sac of
peritoneum containing fat or part
of the bowel through the lower
abdominal wall.
Causes:
Failure of tube closes
PATHOPHYSIOLOGY
Normally, this tube closes completely
when it has failed to close partially
or completely descent of the
intestine into it is possible
Weakness of the tissue around the
round ligament along with
increased abdominal pressure
HERNIA
INGUINAL HERNIA
Clinical manifestations:
• Bulge seen in the groin
• A palpable defect in the inguinal ring
thickening of the spermatic cord is
rubbed under ones fingers.
Diagnosis:
• Physical examination
• Scan
TREATMENT
• An inguinal hernia usually is reduced
easily,. Reduction is more difficulty when
the inguinal ring is small because
pressure on the herniated bowel simply
pushes the bowel. So that is mushroom
against the external inguinal ring.
• Reduction is facilitated by providing
lateral pressure in the bowel with the
fingers at the base of the mass in the
order to elongate the bowel at this point
and “funnel” is through the opening.
SURGICAL TREATMENT
• Hernia repair. It is usually done as soon
as possible after diagnosis.
POST OPERATIVE
• Keeping the wound clean until
healing has taken place
• The water proof collodion dressing
is left in place until it peels off
naturally
• Infant should be sponged, bathed &
should not receive tub bath until the
incision
NURSING DIAGNOSIS
Pre operative:
• Ineffective breathing pattern related to
shifting of abdominal organ into
diaphragm
• Potential in comfort pain related to
swelling
• Potential for fluid volume deficit related to
decreased oral fluid intake.
POST OPERATIVE
• Alternation in comfort pain
related to incision
• Potential for fluid volume deficit
related to decreased oral fluid
intake
• Impaired skin integrity related to
surgical incision
• Parental anxiety related to lack of
knowledge about child condition
