Dr. Ibrahim Bashayreh RN, PhD 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. 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  Symptoms A. Often asymptomatic (especially in direct hernias) B. Pain or dull sensation in groin Complications A. Bowel incarcération ( 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