Herniation: Definition, Pathophysiology and Clinical
Definition
Definition
Hernia is a protrusion of a viscus or part of a viscus through an abnormal opening in the envelope.
Key points
- Abdominal wall hernias are common and cause various symptoms.
- Femoral hernias are more common in women than men, but most inguinal hernia is a hernia in women.
- All femoral hernias require immediate repairs because of the risk of complications.
- Ingunalis hernias can be repaired depends on the symptoms.
Type
Often
- Umbilikal / para-umbilikal.
- Inguinal (director and indirect).
- Femoral.
- Incisional.
Rarely
- Epigastrik.
- Gluteal, lumbar, obturator.
Pathophysiology
- Defective in Binding the abdomen can be congenital) (eg, umbilical hernia, femoral canal) or acquired (eg due to an incision) and bounded by the peritoneum (sac)
- Increased intra-abdominal pressure further and make a weaker defect caused some intra-abdominal contents (eg, omentum, small intestine arch), exit through the openings.
- The contents of the intestine that is trapped inside the bag causing inkarserasi (inability to reduce the contents) and the possibility of strangulation (inhibition of blood flow to areas experiencing inkarserasi).
Clinical picture
- Patient presents with a lump on the site of the hernia.
- Femoral Hernia under and lateral to the pubic tubercle. These hernias usually flattening the lines of the folds of skin on the thighs and 10 times more common in women than men. 50% of the cases is a surgical emergency cases due to terobstruksinya contents of the hernia and 50% of these cases requiring bowel resection halts. Femoral hernias can not be returned to the original (irreducible).
- Inguinal hernia started on the alias and medial to the pubic tubercle lehih wide but can be decreased if enlarged, usually emphasize the lines of the folds of the thigh. Mostly mild and seldom develop complications.
(A) Indirect inguinal hernias can be inserted with pressure by the fingers around the internal inguinal ring, perhaps as narrow and shallow lot younger age in men (3% per year occur with complications).
(B) inguinal hernia director usually has a wide flat, hard to put the emphasis on the fingers and hands more often in men older age (0.3% of cases per year has strangulated).
Incisional hernia bulge, often wide-necked, hard to be controlled by pressure and punctuated by tense rectum. Large incisional hernia and chronic can contain a large number of small intestine and can be irreducible or can not be repaired due to the loss of the right side of stomach contents'.
- True umbilical hernias arise from birth defects and has a symmetrical at the umbilicus due to failure to close.
- Para-umbilical hernia occurs due to defect in the fascia periumbilikalis obtained.
Essential management
- Value for hernias: the severity of symptoms, the risk of complications (type, size of the hernia neck), ease of repair (location, size), likelihood of success (size, number of missing right entrails).
- Value for patients: feasibility of surgery, hernia influence of lifestyle (work, hobbies).
- Improvements to the surgery normally offered to patients with:
a. with the risk of any complications hernia symptoms
b. hernia with obstructive symptoms sebelumnva.
c. hernia with a low risk of complications but with symptoms that interfere with lifestyle, and so forth.
Surgical Principles
- Herniotomi: hernianya sac excision alone for pediatric patients.
- Herniorafi: fix defect-repair with the installation of nets (mesh) is usually performed for inguinal hernia, which is inserted through an open or laparoscopic surgery.
Surgical Complications
- Hemtoma (wound or on the scrotum).
- Acute urinary retention.
- Infection of the wound.
- Chronic pain.
- Pain and swelling of the testicles that cause testicular atrophy.
- Hernia recurrences (about 2%).
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