Introduction to Hernia, its types, mechanism of development, signs, symptoms and treatment

OBJECTIVES:

• What is meant by hernia
• The mechanism of developing a hernia
• Signs and symptoms produced by a hernia
• The types of hernia
• Complications produced as a result of hernia
• Treatment of hernia
• Preventive measures against development of hernia
  

DEFINITION:
A hernia is a protrusion of any viscus from its proper cavity. The protruded parts are generally contained in a sac-like structure, formed by the membrane with which the cavity is naturally lined.

MECHANISM:
The wall of the abdomen, the gastro-oesophageal valves, and other areas of the body, comprising muscle and tendon, performs several functions, one of which is to provide strong support to the internal organs which are exerting significant outward pressure. The opening of a gap in the tissue can occur of its own accord at a point of natural weakness, or by over-stretching a part of the tissue. Overexertion can cause a hernia eg, lifting heavy loads or chronic cough

TYPES OF HERNIA:

• Groin hernia (inguinal, femoral, scrotal)
• Umbilical
• Incisional
• Hiatal
• Congenital diaphragmatic
• Ventral / Epigastric Hernia
• Spigelian Hernia
• Recurrent Hernia
• Stoma Hernia
  

1. INGUINAL HERNIA:

A portion of intestine or internal fat protrudes through a weakness in the inguinal canal.
Appears at the groin crease.
May be DIRECT or INDIRECT.
More common in males.

2. FEMORAL HERNIA:
Hernia through the femoral canal in the femoral triangle.
Appears between the thigh and groin region.
More common in females.

3. UMBILICAL HERNIA:
Hernia in the abdominal wall from or around the umbilicus (paraumbilical)

4. INCISIONAL HERNIA:
From defects created due to previous surgeries

5. HIATAL HERNIA:
Stomach passes from the gastro oesophageal sphincter into the oesophagus

6. EPIGASTRIC:
From a defect between the umbilicus and xiphisternum in the midline

7. SPIGELIAN:
This rare hernia occurs along the edge of the rectus abdominus muscle, which is several inches to the side of the middle of the abdomen.

8. OBTURATOR HERNIA:
This hernia protrudes from the pelvic cavity through an opening in the pelvic bone (obturator foramen).
Causes no bulge
Difficult to diagnose

9. RECURRENT HERNIA:
Occurs at the site of previous hernia repair

10. CONGENITAL DIAPHRAGMATIC HERNIA:
A diaphragmatic hernia is a birth defect in which there is an abnormal opening in the diaphragm

11. STOMA HERNIA:
Occur at the site of surgical stoma

RISK FACTORS:

• Family history
• Overweight or Obesity
• Undescended testes (groin hernias)
• Gastro-oesophageal reflux disease (GERD)
• Any condition that increases the abdominal pressure:e.g.,
  

– chronic coughing,
– chronic constipation
– enlarged prostate causing straining with urination,
– carrying or pushing heavy loads

SYMPTOMS:

• Lump
• Painful swelling
• Nausea/ vomiting
• Sepsis
  

SIGNS:

• Lump

– Reducible/ irreducible: can or cannot be pushed back to its original position
– Direct/ indirect (inguinal hernia): comes through the abdominal wall (direct) or through the inguinal canal (indirect)
– Tender

• Fever
• Signs of Intestinal obstruction
• Sepsis
  

COMPLICATIONS:

• Incarceration:

– Hernia contents get “stuck” in the hernia sac causing irreducibility

• Obstruction:

– Intestinal obstruction as a result of incarceration

• Strangulation:

– Blood circulation to the hernial contents is compromised
– Necrosis/ gangrene formation
– Sepsis


DIAGNOSIS:

• Clinical, based on physical examination
• U/S
• C.T. scan
• Fetal U/S for congenital defect
  

TREATMENT:

1. CONSERVATIVE:
2. DEFINITIVE:

Surgical repair

PREVENTION:

• Few preventive measures

Avoid heavy weight lifting and straining
Avoid food that precipitate reflux from stomach into oesophagus (hiatal hernia)