presented by:RN.mustapha muhammad labaran
updated by:Rn.abubakar usman
07 june 2021
OUTLINE TOPIC
▪️ Introduction.
▪️ Incidence.
▪️ Definition.
▪️ Types.
▪️Causes.
▪️ Sign and symptoms.
▪️ Management Both Medical, Surgical and Nursing management.
▪️Diagnosis.
▪️ Prevention.
▪️ Treatment.
▪️ Complication.
▪️ Introduction
Hernia as the word hernia means weakness in the layers of the abdominal wall. The hernia mean the pressure from the inside of the abdomen that pushes the lining of the abdominal wall. The peritoneum out through this area of the weakness, leading to bulge under the skin. The hernia sac may start as a small lump which disappear when the patient is lying down and May only be appear when standing or straining that's ( Coughing). Hernia may typically increase in size and become quite large due to pressure from abdomen pushing intra abdominal fat and intestine ( bowel ) out which can get struck in the hernia sac that's incarcerated and potentially strangulated. This is the reason most Hernia require surgical repair to alleviate Symptoms and prevent possible complication.
INCIDENCE
1 inv every 2,500 live births.
40% occur with other birth defects, mostly of the heart.
Occurs equally in males and female.
: GENERAL PRINCIPLE OF HERNIA
➖ Reducible:- Hernia content can be pushed back abdomen.
➖ Incarcerated:- Hernia can not be pushed back to abdomen.
➖ Strangulated:- Tissue within Hernia become ischemic/ necrotic due to blood loss or Flow of blood around the area Sign include pain, fever, nausea, vomiting. And this is emergency surgical.
➖ Obstructed:- Small bowel become obstructed due to herniation.
▪️ Definition
Hernia is an abdominal protusion of the content of the closed cavity through the potential or can an abdominal opening.
Or
Hernia is a protuyof an organ through the wall that normally contain it.
▫️The wall can be abdominal wall, muscle fascia, diaphragm,or foramen vof magnum.
▫️ Hernia can be congenital or acquired.
▪️Types of hernia
▫️ Inguinal Hernia.
The most common type of hernia is inguinal hernia which is define as the extrosion of abdominal content through defect in the abdominal wall. The inguinal hernia has about 73%.
It has two types.
➖ Direct Hernia
➖ Indirect Hernia
▫️ Direct Hernia:- This type if inguinal hernia it occur in the inguinal triangle usually in the old age ( weak muscle). The medical sac found medical to inferior epigastric artery.
▫️ Indirect Hernia:- This type of inguinal hernia occur in the inguinal canal and mostly it occur in Young male lateral to inferior epigastric.
⭕ Sign And symptoms of direct and indirect Hernia.
⭕ Direct Hernia
▫️ Sudden pain at the goin.
▫️ Swelling in the inguinal canal which …extend into scrotum.
▫️ Become visible when patient stand or cough.
▫️ Dragging discomfort.
▫️ palpable cough impulse.
▫️ Audible bowel sound.
⭕ Indirect Hernia
▫️Seen protruding directly forward.
▫️ Usually readily reducible.
▫️ Gradual onset.
▫️ severe pain is rare if there is no complication such as incarcerated, strangulated,and obstructed.
▫️ Femoral Hernia.
Here is the types of hernia Femoral Hernia are rare type of groin hernia. in contract to inguinal hernia. Mostly it occur in female due to pelvic being wider.in a Femoral content.the Femoral hernia has about 17%.
▫️ Umblical Hernia.
The Umblical Hernia is a types of ventral hernia which is located in the central aspect of the umblicus. They are also commonly refers to as a "belly button" or "navel" hernia.they are mostly present from birth and is about 85% of cases will closely spontaneously, but in adult Umblical Hernia occur around the umblicus as " paraumblical hernia" but apart of pregnancy the don't disappear and surgery is usually recommended.
▫️Incisional Hernia.
As the term incision. This may occur or develop due to incomplete healing up of an abdominal wound.or complication of abdominal surgery occur of about 5-10% of incision.
⭕ The Factors associated with increase risk of incisional hernia.
▫️ Multiple abdominal operation.
▫️Poor nutrition.
▫️ Activities in the post operation period associated with increase abdominal pressure.
▫️ Obesity.
⭕ Others types of hernia.
▫️ Ventral hernia.
▫️ Giant abdominal hernia.
▫️ epigastric hernia.
▫️ Hiatal Hernia.
▫️parastomal hernia.
▫️spigelian hernia.
▫️ Recurrent hernia.
▫️ Sportsman hernia.
▫️ Strangulated hernia.
▪️ Causes Of Hernia
▫️ Abdominal straighten (heavy lifting, constipation, urinary retention).
▫️ persistent cough.
▫️ Smoking.
▫️Poor nutrition.
▫️Ascitis ( accumulation of fluid in the abdominal wall).
▫️ Obesity
▫️ Peritoneal dialysis.
▫️ Physical exercise.
▫️ Sudden weight gain.
▫️ Family history.
▫️Age.
▫️Undescended taste.
[ ▪️ General Sign and symptoms of hernia.
▫️Pain
▫️ Nausea
▫️ Vomiting
▫️ obstipation (absence of flatus or bowel sound).
▫️ Hiatus Hernia can produce symptoms acid reflux, producing heart burn, when stomach acid get into the oesophagus.
▪️ Management
⭕ Medical management.
▫️Antibiotics
▫️Analgesic
▫️Antipyretic
▫️Protom pump inhibitor In case of hiatus hernia.
⭕ Surgical Management.
▫️Hernioplasty
▫️ Herniorrhaphy.
⭕ Nursing management.
Both Pre and post opative Hernia
▫️ Monitor Vital sign for pre and post operation depending upon the surgery.
▫️ Served Medication on time.
▫️ Watch for any side effect or any reaction.
▫️ Daily dressing depending upon the surgery.
▫️ Reassure the patient and support him.
▫️ Input and output chart maintain.
▫️ Psychological care
▫️ Physical care such as bed birth,oral care and others.
▪️ Diagnosis
1.Laboratory.
▫️ Alpha-fetoprotein test(AFP) during the second trimester of pregnancy before delivery [the result will shows low levels of maternal alpha-fetoprotein] have been associated with congenital diaphragmatic hernia.
2.Arterial blood gas analysis(ABG) test
Is a test that measures the acidity(PH) and the levels of oxygen and carbondioxide in the blood from an artery,[the result will shows respiratory acidosis[A condition that occurs when the lungs cannot remove enough carbondioxide produced by the body] and hypoxemia[A low level of oxygen in
blood
▫️ Chromosome studies [To identify possible chromosomal abnormalities].
▫️ Serum lactate level is used to assess severe hypoxemia and circulatory insufficiency.
3.Imaging
▫️ Chest radiography[will shows herniation of abdominal contents].
▫️ Computed tomography scan(CTscan) will shows the significance or extent of the hernia].
▫️ Magnetic resonance imaging(MRI) can differentiate congenital diaphragmatic hernia from other chest masses.
4.Diagnostic Procedures
▫️ Abdominal and chest radiography after delivery shows the hernia.
▫️ Fetal ultrasound shows the hernia
5.Echocardiography
[ is a test that uses sounds waves to produce live images of the heart] is perform to detects any associated cardiac anomalies
▪️ Prevention
▫️ Stop Smoking
▫️ Avoid lifting weigh
▫️ Maintain healthy body weigh
▫️ perform exercise that help to strengthen the muscle of your abdomen
▫️Eat enough high fiber food to prevent constipation.
TREATMENT
General
▫️ Intubation and mechanical ventilation
▫️Insertion of nasogastric tube connected to continuous suction
▫️ Umbilical artery line[is a catheterization that provides direct access to the arterial system that allows for accurate measurement of arterial blood pressure] is placed for frequent monitoring of blood gases and blood pressure
▫️ Umbilical vein catheter[is a catheter that is inserted onto one of the two arteries or the vein of the umbilical cord] for administration of fluids and medications
Diet
▫️ Nothing by mouth until repair is completed[patient is to be place on nil per os (NPO).
Activity
▫️ limited based on respiratory status
▫️ increase activity as tolerated
Medications
▫️ Analgesics for postoperative pain
Surgery
▫️ Reduction of the abdominal viscera and primary closure of the diaphragmatic defect
▫️ intrauterine or fetal surgery depending on severity
▪️ Complication
▫️ Incarceration
▫️ Strangulation
▫️ Obstruction