HERNIAS

By: Farid Indra Sukmawan Nur Alva Rachmawati Reni Octaviani Sigit Agus Gunawan
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DEFINITION
A hernia is a protrusion of a tissue, structure, or part of an organ through the muscular tissue or the membrane by which it is normally contained. The hernia has three parts: the orifice through which it herniates, the hernial sac, and its contents.
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ETIOLOGY
Two main factors predisposing to hernia are:
Increased intra cavity pressure A weakened abdominal wall

In abdomen, increase pressure occurs as

Heavy lifting COPD Straining to pass urine Straining to pass feces Abdominal distention/change the abdominal content
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TYPES OF HERNIAS
Inguinal Hernias Femoral Hernias Umbilical Hernias Insicional Hernias Diaphragmatic Hernias Other types of Hernias

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1. Inguinal Hernias
Indirect Which the inguinal canal is entered via a congenital weakness at its entrance (the internal inguinal ring) Direct Where the hernia contents push through a weak spot in the back wall of the inguinal canal. More common in men.
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Direct Hernia

Indirect Hernia

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2. Femoral Hernias
It occurs when abdominal contents pass into the weak area at the posterior wall of the femoral canal. It is common in women.

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3. Umbilical Hernias
It involves protrusion of intraabdominal contents through a weakness at the site of passage of the umbilical cord through the abdominal wall. It is happened in infants of Africa, and occur more in boys. In adult, it is happened in obese and pregnant woman
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4. Incisional Hernias
An incisional hernia occurs when the defect is the result of an incompletely healed surgical wound. When these occur in median laparotomy incisions in the linea alba, they are termed ventral hernias.

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5. Diaphragmatic Hernias
When part of the stomach or intestine protrudes into the chest cavity through a defect in the diaphragm

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Contd
1. Sliding Which the gastroesophageal junction itself slides through the defect into the chest. 2. Non Sliding Which case the junction remains fixed while another portion of the stomach moves up through the defect
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6. Other types of hernias

Brain hernia Cooper's hernia Epigastric hernia Littre's hernia Lumbar hernia Obturator hernia Pantaloon hernia Perineal hernia Properitoneal hernia
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Sliding hernia Sciatic hernia Spigelian hernia Sports hernia Velpeau hernia Spinal disc herniation Double hernia Richter's hernia

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COMPLICATIONS
An untreated hernia may complicate by: Inflammation Irreducibilty Obstruction Strangulation Hydrocele of the hernial sac

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TREATMENTS
Herniorrhaphy
Principally repaired by pushing back the herniated tissue, and then mending the weakness in muscle tissue. It is performed for uncomplicated hernias.

Tension Free
Modern muscle reinforcement techniques involve synthetic materials (a mesh prosthesis) that avoid over-stretching of already weakened tissue
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Tension Free

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ASSESSMENT
Subjective data: Pain at the site of the hernias. Objective: There is a bulge through the abdominal wall.

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NURSING DIAGNOSIS
Acute pain related to tissue edema. Ineffective tissue perfusion (gastrointestinal) related to strangulation.

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INTERVENTIONS
Dx 1: Acute pain related to tissue edema. Administer analgesics as ordered. Evaluate aggravating activities. Educate regarding sign of complication and when to notify staff of symptom.

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Contd
Dx 2: Ineffective tissue perfusion related to strangulation Assess abdomen for bowel sounds every 4 hours. Insert NGT to decrease abdominal distention as ordered. Prepared client for surgery as ordered. Administer IV hydration as ordered.
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