Abdominal hernias are one of the most common surgical problems. By definition, a hernia is an abnormal protrusion from one anatomic space to another, with the protruded parts generally contained in a saclike structure formed by the membrane that naturally lines the cavity. They are a one of the leading causes of morbidity and can be lethal.
The hernia presents as a protrusion that gets bigger with increased intraabdominal pressure such as during coughing. They patient may present in an emergency situation with a strangulated hernia, or it may be found on routine examination. The protrusion may be intermittent or constant.
If strangulated, there is pain, swelling and erythema at the hernia site. There may be associated symptoms of intestinal obstruction like abdominal pain, vomiting and nausea. There may be peritonitis if the bowel gets gangrenous and perforates .
Entire Body System
Pressure may come from: constant coughing or sneezing being overweight lifting, carrying or pushing heavy loads constipation, leading to straining on the toilet pregnancy. [healthnavigator.org.nz]
If blood stops flowing through an incarcerated bowel, this results in strangulation, which is accompanied by pain, often with nausea, vomiting, or constipation. [jamanetwork.com]
Relieve or avoid constipation by eating plenty of fiber, drinking lots of fluid, going to the bathroom as soon as you have the urge, and exercising regularly. Men should see their provider if they strain with urination. [mountsinai.org]
Examples include obesity, lifting heavy objects, constipation, smoking, poor nutrition or persistent coughing. [diagnose-me.com]
April-June 2019 Vol 2 Issue 2 Review Article The breakthrough on evaluation and treatment in incisional hernia with loss of domain Part of the patients with incisional hernia (IH) suffered from constipation or even circulatory impairment, which is called [herniasurgeryjournal.org]
The usual history is of repeated attacks of abdominal pain or discomfort, usually accompanied by distention, varying in periodicity and intensity, with or without nausea or vomiting, and not accompanied by laboratory data or clinical signs indicative [ncbi.nlm.nih.gov]
If you have a hernia and significant abdominal pain, pain over the hernia, or nausea or vomiting, you should seek medical care immediately. [jamanetwork.com]
You may also be given nausea medication if you have experience nausea or vomiting from taking your pain medication. It is common to have some constipation after surgery, especially when taking narcotic pain medications. [augusta.edu]
Symptoms may include: Nausea and vomiting Not being able to pass gas or have bowel movements When this occurs, surgery is needed right away. Exams and Tests The health care provider can usually see or feel a hernia when you are examined. [mountsinai.org]
Patients suffering from crampy, intermittent abdominal pain whose routine radiographic gastrointestinal studies are unrevealing often are labeled as having psychogenic disorders. [ncbi.nlm.nih.gov]
Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. Abdominal pain is a common problem … Wikipedia Abdominal wall — Body cavities Diagram of sheath … Wikipedia [medicine_en_ru.academic.ru]
The main symptom is intermittent signs of intestinal obstruction, but acute abdominal pain is also possible. The condition can be identified by a CT scan or diagnostic laparoscopy. [tidsskriftet.no]
There may be associated symptoms of intestinal obstruction like abdominal pain, vomiting and nausea. There may be peritonitis if the bowel gets gangrenous and perforates. [symptoma.com]
In the investigation of an abdominal mass, the presence of changing cystic or tubular internal components and a surrounding membrane should arouse suspicion of an internal hernia. [ncbi.nlm.nih.gov]
Advantages of CT include more accurate identification of hernias and their contents and differentiation of hernias from other abdominal masses (tumors, hematomas, abscesses, undescended testes and aneurysms)[ 8 ]. [wjgnet.com]
Risk factors for the development of adult umbilical hernias include obesity, multiparity, ascites, and large abdominal masses. Adult umbilical hernias exhibit a female-to-male predominance and occur most commonly in those aged 50 to 70. [ahcmedia.com]
Severe Abdominal Pain
On the third day he awoke with severe abdominal pain. During hospital examination on the same day, he was nauseated. His abdomen was slightly distended and he had tenderness on palpation of the right iliac fossa. [tidsskriftet.no]
Other symptoms of a strangulated hernia include severe abdominal pain, profuse sweating, rapid heartbeat, severe nausea, vomiting and high fever. In many cases, a hernia can be diagnosed through a physical examination of the abdomen. [ucsfhealth.org]
You have severe abdominal pain with nausea or vomiting. You stop having bowel movements and passing gas. You have blood in your bowel movement. When should I contact my healthcare provider? You have a fever. You have nausea or are vomiting. [drugs.com]
Identification of the presence of incarceration: incarcerated hernia is associated with poor prognosis, and it should be thus suspected with any of the following clinical manifestations: (I) severe abdominal pain, with persistent pain during the interim [ncbi.nlm.nih.gov]
CT scan, ultrasound and radiographs are not usually required but may be used to confirm the diagnosis if there is doubt. The bulk of the diagnosis is clinical. In acquired hernias, workup of the underlying cause will have to be searched for, for example ascites .
In adults most hernias should be repaired to prevent complications. Reduction should be avoided if there are signs of inflammation or strangulation. Usually all inguinal hernias should be repaired. Umbilical hernia repair should be carried out in adults. In children most will close by the age of five, unless they are large. Elective repair is preferred to acute repair. There are number of methods that can be used, for example the use of meshes and special suturing techniques.
This is dependent on the type of hernia present and its size and location. The largest risk is strangulation of intestines and if not repaired in time, it may lead to mortality rates as high as 10%. Uncomplicated hernias have a good prognosis if repaired appropriately .
The congenital hernias are caused by small defects that occur during embryogenesis. Acquired hernias are caused by an increase in the abdominal cavity pressure that may weaken the wall and cause the protrusion. Risk factors for this include ascites, weight lifting, coughing, peritoneal dialysis and obesity  .
As many as 10 to 13% of people will have a hernia at one time in their life. The most common hernia being inguinal taking up about 75% of all hernias of which 50% are indirect, 14% are umbilical, 10% are ventral and 3 to 5% femoral . Inguinal hernias are more common in males, with 25% of males having one in their life time.
- Groin hernias are the commonest hernias of the abdominal wall. The inguinal hernia is caused by weakened musculature that usually causes a shutter effect during straining. Repeated straining that increases the intraabdominal pressure causes protrusion. Direct inguinal hernia is caused by weakness in the transversalis fascia area of the Hesselbach triangle. An indirect hernia follows the tract of the inguinal canal and it is caused by a persistent processus vaginalis.
- Epigastric hernias are located in the midline between the umbilicus and the xiphoid process and are usually >1cm. The cause of this may be a combination of congenital and acquired factors such as muscle weakens or increased intraabdominal pressure. These are usually asymptomatic and bowel strangulation is rare.
- Flank hernias, even being outside the anatomical abdominal wall, are still classified as such. There are two types, the superior and inferior triangle hernias. These can be acquired; usually after surgeries such as nephrectomies.
- Umbilical hernias in adults are usually acquired and associated with obesity, ascites, and pregnancy. This may present with strangulation of intestinal contents .
There are a number of different abdominal hernias and they are classified by their anatomical locations:
- Groin hernia is a hernia that occurs in the lower part of the abdomen where the thigh and the hip meets. There can be inguinal and femoral hernias.
- Pelvic hernias are protrusions through the foramina of the pelvis.
- Flank hernias protrude through weakened areas of back muscles. Included in this are the inferior and superior lumbar triangle hernias.
- Ventral hernias occur anteriorly, such as umbilical and epigastric hernias.
The internal organs are held in a cavity with a wall (abdominal). Defects in the wall may cause protrusion of the contents of the cavity. This causes a visible bulge in the defect. There many different types of abdominal wall hernias. The most common being inguinal hernia, which are more common in men. These occur around the groin area.
They are two types; defects in the wall that you are born with, so when the pressure in the abdomen increases the contents are pushed through this defect. The second are caused by having conditions that weaken the abdominal wall and increase the pressure within, like a chronic cough, or chronic straining while urination.
These may present as a bulge in the trunk of the body that increases in size on coughing or straining. The protrusion may balloon out into a sac that may hold intestines. The intestines may get jammed up in the sac and swollen and compressed. This is an emergency and can be fatal.
Hernias are diagnosed by your doctor just by examination, the doctor may order some scans, but this is not routinely done.
Hernias are repaired by surgery. There are two ways this may be done. Open surgery and laparoscopic or keyhole surgery. This will depend on the size and location of the hernia. They may also use meshes to strengthen the defect in the wall to prevent it coming back again.
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