HerniasHernias

By: Yoshua ArseneaultBy: Yoshua Arseneault

Drew MaynardDrew Maynard

What is it?What is it?

An opening or weakness in the muscular An opening or weakness in the muscular structure of the wall of the abdomen which structure of the wall of the abdomen which causes a bulging of the abdominal wall.causes a bulging of the abdominal wall.

These contents, usually portions of the These contents, usually portions of the intestine or abdominal fatty tissue, are intestine or abdominal fatty tissue, are enclosed in the thin membrane that enclosed in the thin membrane that naturally lines the inside of the cavity.naturally lines the inside of the cavity.

Bulging is more noticeable when the Bulging is more noticeable when the abdominal muscles are tightened which abdominal muscles are tightened which increases the pressure in the abdomen. increases the pressure in the abdomen.

Different types of HerniasDifferent types of Hernias

Inguinal hernia (groin)Inguinal hernia (groin)– Most common location for a herniaMost common location for a hernia

Hiatal hernia Hiatal hernia – Forms at the opening in your diaphragm Forms at the opening in your diaphragm

where your food pipe joins your stomachwhere your food pipe joins your stomach Umbilical hernia (navel)Umbilical hernia (navel)

Inguinal HerniasInguinal Hernias

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

Inguinal HerniasInguinal Hernias

In many people the abdominal wall In many people the abdominal wall weakness that leads to an inguinal weakness that leads to an inguinal hernia occurs at birth when the hernia occurs at birth when the abdominal lining doesn’t close properlyabdominal lining doesn’t close properly

Other inguinal hernias develop as Other inguinal hernias develop as muscles weaken or deteriorate due to muscles weaken or deteriorate due to things such as: aging, strenuous things such as: aging, strenuous physical activity, or coughing that physical activity, or coughing that accompanies smokingaccompanies smoking

Inguinal Hernias SXSInguinal Hernias SXS Some don’t cause any symptoms, and may Some don’t cause any symptoms, and may

not know you have one until your doctor not know you have one until your doctor discovers it during a medical examdiscovers it during a medical exam

Often though can see and feel the bulge Often though can see and feel the bulge Pain or discomfort in your groin especially Pain or discomfort in your groin especially

when bending over, coughing or liftingwhen bending over, coughing or lifting A heavy or dragging sensation in your groinA heavy or dragging sensation in your groin Occasionally in men pain and swelling in the Occasionally in men pain and swelling in the

scrotum around the testicles when the scrotum around the testicles when the protruding intestine descends into the protruding intestine descends into the scrotumscrotum

Inguinal Hernias CausesInguinal Hernias Causes Some have no apparent cause Some have no apparent cause Most occur as a result of increased pressure Most occur as a result of increased pressure

within the abdomen, a pre-existing weak spot in within the abdomen, a pre-existing weak spot in the abdominal wall or a combination of the twothe abdominal wall or a combination of the two

Can happen after an injury or operations in the Can happen after an injury or operations in the abdominal cavityabdominal cavity

In men the weak spot usually occurs along the In men the weak spot usually occurs along the inguinal canal, this is the area where the inguinal canal, this is the area where the spermatic cord, which contains the vas deferens, spermatic cord, which contains the vas deferens, the tube that carries sperm, enters the scrotumthe tube that carries sperm, enters the scrotum

In women the inguinal canal carries a ligament In women the inguinal canal carries a ligament that helps hold the uterus in place and hernias that helps hold the uterus in place and hernias sometimes occur where connective tissue from sometimes occur where connective tissue from the uterus attaches to tissue around pubic bonethe uterus attaches to tissue around pubic bone

Inguinal HerniasInguinal Hernias More Common in MenMore Common in Men

– Men more likely to have an inherent weakness Men more likely to have an inherent weakness along the inguinal canal than women because of along the inguinal canal than women because of the way males develop in the womb.the way males develop in the womb.

– In the male fetus the testicles form within the In the male fetus the testicles form within the abdomen and then move down the inguinal canal abdomen and then move down the inguinal canal into the scrotum, after birth the inguinal canal into the scrotum, after birth the inguinal canal closes almost completely but leaves just enough closes almost completely but leaves just enough room for the spermatic cord to pass throughroom for the spermatic cord to pass through

– Sometimes the canal doesn’t close properly Sometimes the canal doesn’t close properly leaving a weakened area, however in female leaving a weakened area, however in female babies less chance that the inguinal canal wont babies less chance that the inguinal canal wont close after birthclose after birth

Inguinal Hernias Risk Inguinal Hernias Risk FactorsFactors

Being a maleBeing a male Family historyFamily history Medical conditionsMedical conditions Chronic coughChronic cough Chronic constipationChronic constipation Excess weightExcess weight Certain occupationsCertain occupations Premature birthPremature birth Previous herniasPrevious hernias

Inguinal Hernias DiagnosisInguinal Hernias Diagnosis

Physical exam usually all that’s Physical exam usually all that’s needed to diagnose inguinal herniasneeded to diagnose inguinal hernias– Doctor may ask about signs and Doctor may ask about signs and

symptoms and check for a bulge in groin symptoms and check for a bulge in groin areaarea

– May be asked to cough as part of May be asked to cough as part of physical exam since coughing can make physical exam since coughing can make a hernia more easily recognized a hernia more easily recognized

Inguinal Hernias Inguinal Hernias ComplicationsComplications

Most inguinal hernias enlarge over time if they Most inguinal hernias enlarge over time if they aren’t repaired surgicallyaren’t repaired surgically– Large hernias can put pressure on surrounding tissues in Large hernias can put pressure on surrounding tissues in

men may extend into the scrotum causing pain and men may extend into the scrotum causing pain and swellingswelling

Serious complication occurs when a loop of Serious complication occurs when a loop of intestine becomes trapped in the weak point in the intestine becomes trapped in the weak point in the abdominal wallabdominal wall– This may obstruct the bowel leading to severe pain, This may obstruct the bowel leading to severe pain,

nausea, vomiting, and inability to have bowel movement nausea, vomiting, and inability to have bowel movement Can also diminish blood flow to the trapped portion Can also diminish blood flow to the trapped portion

of the intestine, called strangulationof the intestine, called strangulation– May lead to the death of the affected bowel tissuesMay lead to the death of the affected bowel tissues– Is life threatening and requires immediate surgeryIs life threatening and requires immediate surgery

Inguinal Hernias TreatmentInguinal Hernias Treatment If it’s small and isn’t a problem doctor may If it’s small and isn’t a problem doctor may

recommend a watch and wait approachrecommend a watch and wait approach Growing or painful hernias usually require surgeryGrowing or painful hernias usually require surgery Two general types of hernia operationsTwo general types of hernia operations

– Herniorrhaphy: surgeon makes an incision in your groin and Herniorrhaphy: surgeon makes an incision in your groin and pushes the protruding intestine back into your abdomen pushes the protruding intestine back into your abdomen then repairs the weakened or torn muscle by sewing it then repairs the weakened or torn muscle by sewing it togethertogether

– Hernioplasty: surgeon inserts a piece of synthetic mesh to Hernioplasty: surgeon inserts a piece of synthetic mesh to cover the entire inguinal area. Often done laparoscopically cover the entire inguinal area. Often done laparoscopically using several small incisions instead of one large one. A using several small incisions instead of one large one. A fiber optic tube with a tiny camera is inserted into your fiber optic tube with a tiny camera is inserted into your abdomen through one incision and miniature instruments abdomen through one incision and miniature instruments are inserted through the other incisions. Your surgeon than are inserted through the other incisions. Your surgeon than performs the operation using the video camera as a guideperforms the operation using the video camera as a guide

Inguinal Hernias PreventionInguinal Hernias Prevention

Can’t prevent inguinal hernias, but Can’t prevent inguinal hernias, but can take steps to reduce strain on can take steps to reduce strain on your abdominal muscles and tissuesyour abdominal muscles and tissues– Maintain healthy weightMaintain healthy weight– Eat foods high in fiberEat foods high in fiber– Lift heavy objects carefullyLift heavy objects carefully– Don’t smokeDon’t smoke

Hiatal HerniasHiatal Hernias Forms at the opening of Forms at the opening of

the diaphragm where the diaphragm where your esophagus joins your esophagus joins your stomach. Part of the your stomach. Part of the stomach pushes through stomach pushes through this opening causing a this opening causing a hiatal herniahiatal hernia

Most small hiatal hernias Most small hiatal hernias don’t cause problems, don’t cause problems, but large ones can allow but large ones can allow food and acid to back up food and acid to back up into your esophagus into your esophagus leading to heartburn and leading to heartburn and chest painchest pain

Hiatal Hernias SXSHiatal Hernias SXS HeartburnHeartburn Belching Belching Chest pain Chest pain NauseaNausea Usually become worse when you lean forward, Usually become worse when you lean forward,

strain, lift heavy objects or lie downstrain, lift heavy objects or lie down Rare cases part of your stomach that protrudes Rare cases part of your stomach that protrudes

into your chest cavity may become twisted or into your chest cavity may become twisted or have its blood supply cut off leading to:have its blood supply cut off leading to:– Severe chest painSevere chest pain– Difficulty swallowingDifficulty swallowing– Obstruction of your esophagusObstruction of your esophagus

Hiatal Hernias CausesHiatal Hernias Causes Exact cause unknown Exact cause unknown Your esophagus passes into your stomach through Your esophagus passes into your stomach through

an opening in the diaphragm called the hiatusan opening in the diaphragm called the hiatus– Hernias occur when the muscle tissue surrounding this Hernias occur when the muscle tissue surrounding this

opening becomes weak, and the upper part of the opening becomes weak, and the upper part of the stomach bulges up through the diaphragm into your stomach bulges up through the diaphragm into your chest cavitychest cavity

May be developed after an injury to that areaMay be developed after an injury to that area Born with weakness, or unusually large hiatal Born with weakness, or unusually large hiatal

openingopening Anything that puts intense pressure on you Anything that puts intense pressure on you

abdomen contributes to a herniaabdomen contributes to a hernia– Persistent or severe coughing or vomitingPersistent or severe coughing or vomiting– Straining while going to the bathroomStraining while going to the bathroom– Lifting heavy objectsLifting heavy objects

Hiatal Hernias Risk FactorsHiatal Hernias Risk Factors

Age 50 or olderAge 50 or older Obese Obese SmokerSmoker

Hiatal Hernias DiagnosisHiatal Hernias Diagnosis Doctor may discover it while trying to determine Doctor may discover it while trying to determine

the cause of heartburn or chest or upper the cause of heartburn or chest or upper abdominal pain usually found during one of the abdominal pain usually found during one of the following procedures:following procedures:

Barium X-ray Barium X-ray – Drink chalky liquid containing barium that coats your Drink chalky liquid containing barium that coats your

upper digestive tract which provides a clear silhouette of upper digestive tract which provides a clear silhouette of your esophagus, stomach and upper part of your small your esophagus, stomach and upper part of your small intestine. May help reveal whether the contents of you intestine. May help reveal whether the contents of you stomach are backing up into your esophagusstomach are backing up into your esophagus

EndoscopyEndoscopy– Pass a thin flexible tube with a fiber-optic light and video Pass a thin flexible tube with a fiber-optic light and video

camera system down your throat into your esophagus camera system down your throat into your esophagus and stomach, checking for inflammation. and stomach, checking for inflammation.

Hiatal Hernias Hiatal Hernias ComplicationsComplications

Bleeding and anemiaBleeding and anemia– Some large hiatal hernias have lesions in the upper Some large hiatal hernias have lesions in the upper

stomach, can bleed and lead to iron deficiency anemia stomach, can bleed and lead to iron deficiency anemia from chronic blood lossfrom chronic blood loss

Reduced blood flow to the stomachReduced blood flow to the stomach GERD (gastroesophageal reflux)GERD (gastroesophageal reflux)

– May occur when a hernia slightly displaces the lower May occur when a hernia slightly displaces the lower esophageal sphincter, a circular band of muscle around esophageal sphincter, a circular band of muscle around the bottom of the esophagus which relaxes to allow food the bottom of the esophagus which relaxes to allow food and liquid to flow into your stomach when you swallowand liquid to flow into your stomach when you swallow

– Diaphragm supports and puts pressure on the sphincter Diaphragm supports and puts pressure on the sphincter to keep it closed when you’re not swallowing, but a to keep it closed when you’re not swallowing, but a hiatal hernia raises the sphincter above the diaphragm hiatal hernia raises the sphincter above the diaphragm reducing pressure on the valve which permits the reducing pressure on the valve which permits the sphincter muscle to open at the wrong time allowing sphincter muscle to open at the wrong time allowing stomach acid to back up into the esophagusstomach acid to back up into the esophagus

Hiatal Hernias TreatmentHiatal Hernias Treatment Losing weight if you’re overweightLosing weight if you’re overweight Medications: Medications:

– Antacids: can neutralize the acidity in your Antacids: can neutralize the acidity in your esophagus and provide relief from heartburn esophagus and provide relief from heartburn (Tums)(Tums)

– H-2 blockers: reduce the amount of acid H-2 blockers: reduce the amount of acid secreted by your stomach by blocking secreted by your stomach by blocking histamine receptors (Pepcid, Zantac, Axid)histamine receptors (Pepcid, Zantac, Axid)

– Proton pump inhibitors (PPIs): most effective Proton pump inhibitors (PPIs): most effective drug treatment for GERD. They block acid drug treatment for GERD. They block acid production and allow time for damaged production and allow time for damaged esophageal tissue to heal (Prevacid, Protonix)esophageal tissue to heal (Prevacid, Protonix)

SurgerySurgery

Hiatal Hernias Self-CareHiatal Hernias Self-Care

Eat small mealsEat small meals Avoid problem foods and alcoholAvoid problem foods and alcohol Limit fatty food intakeLimit fatty food intake Sit up after you eatSit up after you eat Don’t exercise immediately after Don’t exercise immediately after

eatingeating Healthy weightHealthy weight Stop smokingStop smoking Relax Relax

Umbilical HerniasUmbilical Hernias Occurs when part of Occurs when part of

the intestine the intestine protrudes through a protrudes through a weak spot in the weak spot in the abdominal muscles abdominal muscles

Common typically Common typically harmless conditionharmless condition

Most common in Most common in infantsinfants

Most close on their Most close on their own by age 1 though own by age 1 though some may take some may take longer to heallonger to heal

Umbilical Hernias SXSUmbilical Hernias SXS

Soft swelling or bulge near the navelSoft swelling or bulge near the navel May only notice bulge when baby May only notice bulge when baby

cries coughs or strains, bulge may cries coughs or strains, bulge may disappear when baby is calm or lies disappear when baby is calm or lies on backon back

In children usually painless, but those In children usually painless, but those that appear in adulthood may cause that appear in adulthood may cause discomfortdiscomfort

Umbilical Hernias CausesUmbilical Hernias Causes During pregnancy the umbilical cord passes During pregnancy the umbilical cord passes

through a small opening in the baby’s through a small opening in the baby’s abdominal muscles which normally closes abdominal muscles which normally closes before birth. If the muscles don’t meet before birth. If the muscles don’t meet together in the midline completely this together in the midline completely this weakness in the abdominal wall may cause weakness in the abdominal wall may cause umbilical hernia at birth or later onumbilical hernia at birth or later on

In adults too much abdominal pressureIn adults too much abdominal pressure– ObesityObesity– Heavy liftingHeavy lifting– Coughing Coughing – Multiple pregnanciesMultiple pregnancies

Umbilical Hernias Risk Umbilical Hernias Risk FactorsFactors

Infants especially premature babies Infants especially premature babies and those with low birth weightsand those with low birth weights

Affects both boys and girls equallyAffects both boys and girls equally Adults being overweight or having Adults being overweight or having

multiple pregnancies may increase multiple pregnancies may increase risk risk

Umbilical Hernias Umbilical Hernias Diagnosis/ComplicationsDiagnosis/Complications

Diagnosed during a physical examDiagnosed during a physical exam

For children complications rareFor children complications rare– Rarely the protruding abdominal tissue Rarely the protruding abdominal tissue

becomes trapped and can no longer be becomes trapped and can no longer be pushed back into the abdominal cavitypushed back into the abdominal cavity

Adults more likely experience Adults more likely experience incarceration or obstruction of the incarceration or obstruction of the intestinesintestines– Requires emergency surgery typicallyRequires emergency surgery typically

Umbilical Hernias Treatment Umbilical Hernias Treatment Most close on their own by age 1, the doctor Most close on their own by age 1, the doctor

may even be able to push the bulge back may even be able to push the bulge back into the abdomen during a physical examinto the abdomen during a physical exam

In children surgery is usually only required:In children surgery is usually only required:– Large or painful umbilical herniasLarge or painful umbilical hernias– Get bigger after age 1 or 2Get bigger after age 1 or 2– Don’t disappear by age 4Don’t disappear by age 4– Become trapped or block the intestines Become trapped or block the intestines

In adults surgery is typically recommended In adults surgery is typically recommended to avoid possible complications especially if to avoid possible complications especially if the umbilical hernia gets bigger or becomes the umbilical hernia gets bigger or becomes painfulpainful

SourcesSources

www.mayoclinic.comwww.mayoclinic.com www.emedicinehealth.comwww.emedicinehealth.com www.medicinenet.comwww.medicinenet.com