Hernia
Hernia
Definition : Hernia may be defined as protrusion of a viscus or part of a viscus through an abnormal opening in the walls of its containing cavity.
We have described in article :
Classification of hernia
Causes of hernia
Composition of hernia
what are the groin hernia
Classification of hernia
A). Clinical classification:
- Occult: Not detectable clinically, may cause severe pain.
- Reducible: A swelling which appears and disappears.
- Irreducible: A swelling which cannot be replaced in the abdomen, high risk of complications.
- Obstructed: Bowel in the hernia has good blood supply but bowel is obstructed.
- Strangulated: Painful swelling with vascular compromise, requires urgent surgery.
- Infarcted: When contents of the hernia have become gangrenous, high mortality.
B) According to the anatomical sites:
- Inguinal hernia.
- Femoral hernia.
- Umbilical hernia.
- Para umbilical hernia.
- Epigastric.
- Obturator.
- Incisional.
- Gluteal.
- Lumber.
- Sciatic.
- Pernial hernia.
- Diverticulation.
The causes of hernia.
Aetiology / predisposing factors of hernia :
> Weakness of the abdominal wall:
1) Congenital:
- Presence of congenital sac (indirect inguinal bemis in male)
- Patent canal of Nuck (indirect inguinal hernia in female).
- Failure of transvenalis fascia.
2) Acquired:
- latrogenic surgical incision.
- Muscle weakness following obesity, repented pregnancy, nerve division, muscle wasting.
Continued & repeated raised intra-abdominal pressure :
- Chronic cough e.g. chronic bronchitis, smokers
- Constipation Urinary obstruction.
- Vomiting.
- Ascites.
- Severe muscular effort.
Genetic : High incidence seen in Eskimon (HLA B27)
Collagen metabolic abnormality: Generalized deficiency in collagen particularly smokers.
Others (Great inguinal hernia) :
- Aging
- Smoking
- Failure of posterior inguinal wall or fascia.
- Failure of medial half of transversalis fascia.
Enumerate the composition of hernia.
Composition of hernia : Hernia consists of 3 parts —
The sac : formed by parietal peritoneum.
- Mouth
- Neck
- Body
- Funds
> Coverings : Coverings are derived from the layers of the abdominal wall through which the sac passes.
> Contents :
- Omentum = Omentocele.
- Intestine – Enterocele
- A portion of the bladder (or a diverticulum)
- Ovary with or without the corresponding fallopian tube.
- A Meckel’s diverticuluma Litre’s henia.
- Fluid, as part of ascites or as a residuum thereof.
Groin hernias
- Inguinal hernia : Direct & indirect.
- Femoral hernia.
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