Ms. Niharika Mishra RN, IPCN TUTOR, LUCKNOW UTTAR PRADESH.

1. TOPIC- HERNIA
By:- Niharika Mishra
RN, IPCN.

2. INTRODUCTION
 A Condition in which part of an organ is
displaced and protrudes through the wall
of the cavity Containing it(often involving
the intestine at weak point in the
abdominal wall).
 The most important elements in the
development of hernia are congenital or
muscle weakness and increased of the
intra abdominal pressure

3. DEFINITION
 A hernia is a abnormal exit of tissue or an
organ ,such the bowel,through the wall of
the cavity in which it normally resides.

4. CLASSIFICATION

6. TYPES OF HERNIA
 INGUINAL HERNIA
1. Direct Inguinal hernia
2. Indirect Inguinal hernia
 HIATAL HERNIA
 UMBILICAL HERNIA
(congenital/acquired)
 FEMORAL HERNIA
 INCISIONAL HERNIA (occurs at the site
of previous surgical incisional ).

8. Types of Hernias
 Inguinal hernia: Makes up 75% of all abdominal
wall hernias and occurring up to 25 times more
often in men than women.
 Two types of inguinal hernias: indirect inguinal
hernia and direct inguinal hernia.
 Indirect inguinal hernia
 Muscle weakness at the inguinal ring causes failure
closure of the deep inguinal ring.
 When increased intra abdominal pressure and dilation
of inguinal ring allow abdominal contents to enter the
channel.

9. Cont.
 The protrusion passes through the deep inguinal ring and
is located lateral to the inferior epigastric artery.
 Direct inguinal hernia
 It pass through a weak point in the fascia of abdominal
wall and at the medial to the inferior epigastric artery.
 The direct hernia almost always occurs in the middle-aged
and elderly because their abdominal walls weaken as they
age.

11. Types Cont.
 Hiatus hernia
 A hiatus hernia occurs when the upper part of
the stomach, which is joined to the
oesophagus (gullet), moves up into the chest
through the hole (called a hiatus) in the
diaphragm.
 It is common and occurs in about 10 per cent
of people.

13. Hiatus hernia

14. Hiatus hernia
 It is most common in overweight middle-
aged women and elderly people.
 It can occur during pregnancy.
 The diagnosis is confirmed by barium meal
X-rays or by passing a tube with a camera
on the end into the stomach
(gastroscopy).

15. Treatment for Hiatus Hernia
 Losing weight nearly always cures it.
 Eating small meals each day instead of 2 or 3
large ones helps.
 Avoid smoking.
 Take antacid.
 Avoid spicy food.
 Avoid hot drinks.
 Avoid gassy drinks.

16. Types Cont.
 Femoral hernia
 The femoral canal is the way that the femoral artery,
vein, and nerve leave the abdominal cavity to enter
the thigh.
 Although normally a tight space, sometimes it
becomes large enough to allow abdominal contents
(usually intestine) into the canal.
 This hernia causes a bulge below the inguinal crease
in roughly the middle of the thigh.
 Rare and usually occurring in women, these hernias
are particularly at risk of becoming irreducible and
strangulated.

18. Types Cont.
 Umbilical hernia
 These common hernias (10-30%) are often noted
at birth as a protrusion at the bellybutton (the
umbilicus).
 This is caused when an opening in the abdominal
wall, which normally closes before birth, doesn’t
close completely.
 Even if the area is closed at birth, these hernias can
appear later in life because this spot remains a
weaker place in the abdominal wall.
 They most often appear later in elderly people and
middle-aged women who have had children.

20. Types Cont.
 Incisional Hernia(occur at the site of previous
surgical Incision )
 Results from inadequate healing of incision.
 This flaw can create an area of weakness where a
hernia may develop.
 This occurs after 2-10% of all abdominal surgeries,
although some people are more at risk.
 Cause be postoperative wound infection, inadequate
nutrition and obesity.

22. CAUSES/ETIOLOGY
a. Any condition that is increases pressure on
abdominal cavity:
 Combination of muscle weakness and strain.
 Obesity
 Heavy lifting
 Persistant coughing or sneezing
 Pregnancy
 Straining during bowel movement or urination
b. Family History

23. SIGNS AND SYMPTOMS
 Small to moderate size hernia
 Large hernia may be noticeable and cause
some discomfort.
 Pain when lifting heavy objects
 Tenderness
 Bulging

24. SEVERE SYMPTOMS
 Severe sudden pain
 Nausea
 Vomiting
 Constipation

26. Signs and Symptoms
 The signs and symptoms of a hernia can range
from noticing a painless lump to the painful,
tender, swollen protrusion of tissue that you are
unable to push back into the abdomen—possibly
a strangulated hernia.
 Asymptomatic reducible hernia
 New lump n the groin or other abdominal wall area
 May ache but is not tender when touched.
 Sometimes pain precedes the discovery of the lump.

27. Cont.
 Lump increases in size when standing or when
abdominal pressure is increased (such as
coughing)
 May be reduced (pushed back into the abdomen)
unless very large
 Irreducible hernia
 Usually painful enlargement of a previous hernia
that cannot be returned into the abdominal cavity
on its own or when you push it
 Some may be long term without pain

28. Cont.
 Can lead to strangulation
 Signs and symptoms of bowel obstruction may
occur, such as nausea and vomiting
 Strangulated hernia
 Irreducible hernia where the entrapped intestine
has its blood supply cut off
 Pain always present followed quickly by tenderness
and sometimes symptoms of bowel obstruction
(nausea and vomiting)
 You may appear ill with or without fever

29. Cont.
 Surgical emergency
 All strangulated hernias are irreducible (but all
irreducible hernias are not strangulated)

30. Diagnosis
 PHYSICAL EXAMINATION
 BARIUM MEAL
 X- RAY ABDOMEN
 BLOOD TEST
 Complete blood count
 White blood count

31. MANAGEMENT
MEDICAL PHARMACOLOGICAL TREATMENT
1. Antibiotic (used if the patient has strangulated
hernia)Ex:= Iv Mefoxin 1g 6- 8 hourly.
2. H2 Receptor blocker ( used if the patient with
hiatal hernia)EX.= Tab.rantidine 150 mg 12
hourly
3. Antacids( used if the patient with hiatal hernia).
4. Non steroidal Anti inflammatory
Drugs(NSAIDs)for patient with mild to
moderate pain. Ex.=Tab. Ibuprofen 100mg 6
hourly

32. Non Pharmacological
management
1. Avoid food that cayuses acid reflux or
heartburn such as spicy food
2. Don’t lie down or bend over after a meal.
3. Stop smoking
4. Avoid lift heavy objects
5. Avoid gassy drinks

33. NON SURGICAL MANAGEMENT
 TRUSS( INGUINAL HERNIA)a pad made
with firm material that will held in place
over the hernia with belt to keep the
abdominal contents from protruding into
the hernia sac.
 SURGICAL MANAGEMENT
 Nissen fundoplication
 Herniorrhaphy

34. NURSING DIAGNOSIS
 Fear and anxiety related to undergoing
sugery.
 Acute pain related to surgical intervention
 Risk of infection related to surgical site.
 Risk for aspiration related to reflux of
gastric content.

35. HEALTH EDUCATION
 Educate patient to assess for any signs
and symptoms of infection such as
redness, severe itchiness and condition at
the surgical site.
 Advise patient come for follow up to
monitor patient progess/condition.
 Educate patient to avoid wearing tight
clothing to minimize abdominal pressure.
 Use proper lifting techniques

36.  Encourage patient avoid lifting heavy
objects
 Lose weight
 Exercise regularly
 Advise patient to eat a vitamin rich diet
such as vitamin-C and protein to promote
wound healing
 Encourage patient to take high fiber food
to prevent constipation.

37. References
 http://www.emedicine.com/aaem/topic248
.htm
 Osburn, Kimberly Pagewise 2002
 Medline Plus American Medical
Assosiation

38. Thank you