Hernias

1. Hernias By: Yoshua Arseneault Drew Maynard

2. What is it? • An opening or weakness in the muscular structure of the wall of the abdomen which causes a bulging of the abdominal wall. • These contents, usually portions of the intestine or abdominal fatty tissue, are enclosed in the thin membrane that naturally lines the inside of the cavity. • Bulging is more noticeable when the abdominal muscles are tightened which increases the pressure in the abdomen.

3. Different types of Hernias • Inguinal hernia (groin) • Most common location for a hernia • Hiatal hernia • Forms at the opening in your diaphragm where your food pipe joins your stomach • Umbilical hernia (navel)

4. Inguinal Hernias • Occurs when soft tissue (usually part of the intestine) protrudes through a weak point or tear in your lower abdominal wall. Can be especially painful when you cough bend over or lift a heavy object.

5. Inguinal Hernias • In many people the abdominal wall weakness that leads to an inguinal hernia occurs at birth when the abdominal lining doesn’t close properly • Other inguinal hernias develop as muscles weaken or deteriorate due to things such as: aging, strenuous physical activity, or coughing that accompanies smoking

6. Inguinal Hernias SXS • Some don’t cause any symptoms, and may not know you have one until your doctor discovers it during a medical exam • Often though can see and feel the bulge • Pain or discomfort in your groin especially when bending over, coughing or lifting • A heavy or dragging sensation in your groin • Occasionally in men pain and swelling in the scrotum around the testicles when the protruding intestine descends into the scrotum

7. Inguinal Hernias Causes • Some have no apparent cause • Most occur as a result of increased pressure within the abdomen, a pre-existing weak spot in the abdominal wall or a combination of the two • Can happen after an injury or operations in the abdominal cavity • In men the weak spot usually occurs along the inguinal canal, this is the area where the spermatic cord, which contains the vas deferens, the tube that carries sperm, enters the scrotum • In women the inguinal canal carries a ligament that helps hold the uterus in place and hernias sometimes occur where connective tissue from the uterus attaches to tissue around pubic bone

8. Inguinal Hernias • More Common in Men • Men more likely to have an inherent weakness along the inguinal canal than women because of the way males develop in the womb. • In the male fetus the testicles form within the abdomen and then move down the inguinal canal into the scrotum, after birth the inguinal canal closes almost completely but leaves just enough room for the spermatic cord to pass through • Sometimes the canal doesn’t close properly leaving a weakened area, however in female babies less chance that the inguinal canal wont close after birth

9. Inguinal Hernias Risk Factors • Being a male • Family history • Medical conditions • Chronic cough • Chronic constipation • Excess weight • Certain occupations • Premature birth • Previous hernias

10. Inguinal Hernias Diagnosis • Physical exam usually all that’s needed to diagnose inguinal hernias • Doctor may ask about signs and symptoms and check for a bulge in groin area • May be asked to cough as part of physical exam since coughing can make a hernia more easily recognized

11. Inguinal Hernias Complications • Most inguinal hernias enlarge over time if they aren’t repaired surgically • Large hernias can put pressure on surrounding tissues in men may extend into the scrotum causing pain and swelling • Serious complication occurs when a loop of intestine becomes trapped in the weak point in the abdominal wall • This may obstruct the bowel leading to severe pain, nausea, vomiting, and inability to have bowel movement • Can also diminish blood flow to the trapped portion of the intestine, called strangulation • May lead to the death of the affected bowel tissues • Is life threatening and requires immediate surgery

12. Inguinal Hernias Treatment • If it’s small and isn’t a problem doctor may recommend a watch and wait approach • Growing or painful hernias usually require surgery • Two general types of hernia operations • Herniorrhaphy: surgeon makes an incision in your groin and pushes the protruding intestine back into your abdomen then repairs the weakened or torn muscle by sewing it together • Hernioplasty: surgeon inserts a piece of synthetic mesh to cover the entire inguinal area. Often done laparoscopically using several small incisions instead of one large one. A fiber optic tube with a tiny camera is inserted into your abdomen through one incision and miniature instruments are inserted through the other incisions. Your surgeon than performs the operation using the video camera as a guide

13. Inguinal Hernias Prevention • Can’t prevent inguinal hernias, but can take steps to reduce strain on your abdominal muscles and tissues • Maintain healthy weight • Eat foods high in fiber • Lift heavy objects carefully • Don’t smoke

14. Hiatal Hernias • Forms at the opening of the diaphragm where your esophagus joins your stomach. Part of the stomach pushes through this opening causing a hiatal hernia • Most small hiatal hernias don’t cause problems, but large ones can allow food and acid to back up into your esophagus leading to heartburn and chest pain

15. Hiatal Hernias SXS • Heartburn • Belching • Chest pain • Nausea • Usually become worse when you lean forward, strain, lift heavy objects or lie down • Rare cases part of your stomach that protrudes into your chest cavity may become twisted or have its blood supply cut off leading to: • Severe chest pain • Difficulty swallowing • Obstruction of your esophagus

16. Hiatal Hernias Causes • Exact cause unknown • Your esophagus passes into your stomach through an opening in the diaphragm called the hiatus • Hernias occur when the muscle tissue surrounding this opening becomes weak, and the upper part of the stomach bulges up through the diaphragm into your chest cavity • May be developed after an injury to that area • Born with weakness, or unusually large hiatal opening • Anything that puts intense pressure on you abdomen contributes to a hernia • Persistent or severe coughing or vomiting • Straining while going to the bathroom • Lifting heavy objects

17. Hiatal Hernias Risk Factors • Age 50 or older • Obese • Smoker

18. Hiatal Hernias Diagnosis • Doctor may discover it while trying to determine the cause of heartburn or chest or upper abdominal pain usually found during one of the following procedures: • Barium X-ray • Drink chalky liquid containing barium that coats your upper digestive tract which provides a clear silhouette of your esophagus, stomach and upper part of your small intestine. May help reveal whether the contents of you stomach are backing up into your esophagus • Endoscopy • Pass a thin flexible tube with a fiber-optic light and video camera system down your throat into your esophagus and stomach, checking for inflammation.

19. Hiatal Hernias Complications • Bleeding and anemia • Some large hiatal hernias have lesions in the upper stomach, can bleed and lead to iron deficiency anemia from chronic blood loss • Reduced blood flow to the stomach • GERD (gastroesophageal reflux) • May occur when a hernia slightly displaces the lower esophageal sphincter, a circular band of muscle around the bottom of the esophagus which relaxes to allow food and liquid to flow into your stomach when you swallow • Diaphragm supports and puts pressure on the sphincter to keep it closed when you’re not swallowing, but a hiatal hernia raises the sphincter above the diaphragm reducing pressure on the valve which permits the sphincter muscle to open at the wrong time allowing stomach acid to back up into the esophagus

20. Hiatal Hernias Treatment • Losing weight if you’re overweight • Medications: • Antacids: can neutralize the acidity in your esophagus and provide relief from heartburn (Tums) • H-2 blockers: reduce the amount of acid secreted by your stomach by blocking histamine receptors (Pepcid, Zantac, Axid) • Proton pump inhibitors (PPIs): most effective drug treatment for GERD. They block acid production and allow time for damaged esophageal tissue to heal (Prevacid, Protonix) • Surgery

21. Hiatal Hernias Self-Care • Eat small meals • Avoid problem foods and alcohol • Limit fatty food intake • Sit up after you eat • Don’t exercise immediately after eating • Healthy weight • Stop smoking • Relax

22. Umbilical Hernias • Occurs when part of the intestine protrudes through a weak spot in the abdominal muscles • Common typically harmless condition • Most common in infants • Most close on their own by age 1 though some may take longer to heal

23. Umbilical Hernias SXS • Soft swelling or bulge near the navel • May only notice bulge when baby cries coughs or strains, bulge may disappear when baby is calm or lies on back • In children usually painless, but those that appear in adulthood may cause discomfort

24. Umbilical Hernias Causes • During pregnancy the umbilical cord passes through a small opening in the baby’s abdominal muscles which normally closes before birth. If the muscles don’t meet together in the midline completely this weakness in the abdominal wall may cause umbilical hernia at birth or later on • In adults too much abdominal pressure • Obesity • Heavy lifting • Coughing • Multiple pregnancies

25. Umbilical Hernias Risk Factors • Infants especially premature babies and those with low birth weights • Affects both boys and girls equally • Adults being overweight or having multiple pregnancies may increase risk

26. Umbilical Hernias Diagnosis/Complications • Diagnosed during a physical exam • For children complications rare • Rarely the protruding abdominal tissue becomes trapped and can no longer be pushed back into the abdominal cavity • Adults more likely experience incarceration or obstruction of the intestines • Requires emergency surgery typically

27. Umbilical Hernias Treatment • Most close on their own by age 1, the doctor may even be able to push the bulge back into the abdomen during a physical exam • In children surgery is usually only required: • Large or painful umbilical hernias • Get bigger after age 1 or 2 • Don’t disappear by age 4 • Become trapped or block the intestines • In adults surgery is typically recommended to avoid possible complications especially if the umbilical hernia gets bigger or becomes painful

28. Sources • www.mayoclinic.com • www.emedicinehealth.com • www.medicinenet.com