Sunday, January 15, 2006

hernia (inguinal, femoral, or umbilical)

Hernia is a protrusion of an organ or structure from its normal cavity through a congenital or acquired defect. When an inguinal, femoral, or umbilical hernia occurs, a lump or swelling appears on the abdomen underneath the skin. The swelling may be large or small depending on how much of the viscera has protruded.
Congenital defects account for a large portion of hernias. It may appear in infancy or adulthood due to increased intro-abdominal pressure, which can occur during heavy lifting, sneezing, coughing. Hernias that develop in mid-life and old age are due to obesity and the weakening of muscles. Inguinal hernias are the type that occur most commonly. Men are more likely to develop inguinal hernias. Umbilical and femoral hernias are more frequent among women. In the elderly man an inguinal hernia commonly exists with an enlarged prostate. Hernias may be asymptomatic other than the appearance of swelling on the abdomen. The swelling may be painful but disappears when the hernia is reduced. Incarcerated hernias cause severe pain.
A reducible hernia can be returned by manipulation to its own cavity. If it cannot be returned to its own cavity, it is called an irreducible or incarcerated hernia. If the blood supply to the structure within the hernia becomes occluded it is called a strangulated hernia. This leads to gangrene of the trapped tissues, which is a surgical emergency. When a hernia becomes progressively larger in the elderly patient, early surgical intervention is advised since mortality risks are far greater for emergency repair. Reports indicate mortality rates range between 7 percent and 22 percent for emergency surgeries while elective repair carries only a 1.2 percent to 2 percent mortality rate.
Phipps, W. J. Essentials of Medical-Surgical Nursing. St. Louis: C. V. Mosby Co., 1985. Steinberg, F. U. Care of the Geriatric Patient, 6th ed. St. Louis: C. V. Mosby Co., 1983.


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