Scribd Logo
Upload

Welcome to Scribd!

  • 14 views

    Hernia: DR - Kaushik Patel, MPT Assistant Professor SPB Physiotherapy College

    Uploaded by

    Salman Khan
    Hernia is the protrusion of an organ through an abnormal opening in the wall of the cavity that contains it. The most common external hernias are inguinal (73%), femoral (17%), and umbilical (8.5%). Hernias occur due to increased intra-abdominal pressure or weakness in the abdominal wall muscles. Treatment depends on the type of hernia but may include herniorrhaphy to repair the abdominal wall. Physiotherapy focuses on preventing complications, strengthening the abdominal muscles, and advising patients on exercises and lifestyle changes post-surgery.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Hernia: DR - Kaushik Patel, MPT Assistant Professor SPB Physiotherapy College

    Uploaded by

    Salman Khan
    14 views43 pages
    Hernia is the protrusion of an organ through an abnormal opening in the wall of the cavity that contains it. The most common external hernias are inguinal (73%), femoral (17%), and umbilical (8.5%). Hernias occur due to increased intra-abdominal pressure or weakness in the abdominal wall muscles. Treatment depends on the type of hernia but may include herniorrhaphy to repair the abdominal wall. Physiotherapy focuses on preventing complications, strengthening the abdominal muscles, and advising patients on exercises and lifestyle changes post-surgery.

    Original Title

    Hernia.

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Hernia is the protrusion of an organ through an abnormal opening in the wall of the cavity that contains it. The most common external hernias are inguinal (73%), femoral (17%), and umbilical (8.5%). Hernias occur due to increased intra-abdominal pressure or weakness in the abdominal wall muscles. Treatment depends on the type of hernia but may include herniorrhaphy to repair the abdominal wall. Physiotherapy focuses on preventing complications, strengthening the abdominal muscles, and advising patients on exercises and lifestyle changes post-surgery.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    14 views43 pages

    Hernia: DR - Kaushik Patel, MPT Assistant Professor SPB Physiotherapy College

    Uploaded by

    Salman Khan
    Hernia is the protrusion of an organ through an abnormal opening in the wall of the cavity that contains it. The most common external hernias are inguinal (73%), femoral (17%), and umbilical (8.5%). Hernias occur due to increased intra-abdominal pressure or weakness in the abdominal wall muscles. Treatment depends on the type of hernia but may include herniorrhaphy to repair the abdominal wall. Physiotherapy focuses on preventing complications, strengthening the abdominal muscles, and advising patients on exercises and lifestyle changes post-surgery.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 43

    Hernia Dr.

    Kaushik Patel,MPT
    Assistant professor
    SPB physiotherapy college
    Hernia is the protrusion of a part or whole of viscus
    through an abnormal opening in the wall of the cavity
    which contains it.
    • Common external hernia are
    1.Inguinal – about 73%
    2.Femoral – about 17%
    3.Umbilical – about 8.5%
    4.Incisional – its incidence is not included
    Other 1.5 % cases are rare hernia e.g.
    5.Epigastric
    6.Lumbar
    7.Spigelian
    8.Obturator
    9.Gluteal
    Etiology
    A) Any condition which increase intra-abdominal
    pressure
    e.g. - Power full muscular effort or strain by lifting
    heavy weight
    - Whooping cough, chronic cough
    - Obesity,
    - Repeated pregnancy
    - Vomiting, constipation
    B- weakness of the abdominal muscle

    - Congenital weakness
    Incomplete obliteration of umbilical may lead to infantile
    inguinal hernia.

    - Acquired weakness
    Excessive fat in abdomen,
    Repeated pregnancy, surgical incision leads to cutting of
    nerve followed by muscle weakness
    Pathology

    Hernia consists of three part..

    The sac
    The contents of sac
    The covering of sac
    The sac- It is a pouch of peritoneum which comes out
    through the abdominal musculature.
    The sac can be divided in three part
    - The mouth
    - The neck
    - The body
    - The fundus
    The contents of sac – Abdominal viscus
    (depended upon site)
    Fluid – peritoneal exudates

    The covering of sac- Depends upon the layers of


    abdominal through which the sac passes
    Classification

    I. Reducible hernia
    II. Irreducible hernia
    III. Obstructed hernia
    IV. Strangulated hernia
    Reducible hernia – Hernia reduces itself as the patient
    lies down or can be reduced by the patient or by
    surgeon
    One of the 2 most characteristic features of hernia is its
    Reducibility and second feature is Impulses on
    coughing.

    Irreducible hernia - Here the content cannot be


    returned to abdomen because of the adhesion formed
    between sac and content
    Obstructed hernia
    It is irreducible hernia containing intestine which
    obstructed but doesn't interfere blood supply to distal

    Strangulated hernia
    It is irreducible and obstructed hernia ant there is arrest
    of blood supply to the contents
    • An external abdominal hernia is protrusion of
    abdominal viscus through a weak spot in the
    abdominal wall

    Common external hernia are


    • Inguinal hernia
    • Femoral hernia
    • Umbilical hernia
    • Incisional hernia
    Inguinal hernia
    It is the protrusion of part of the contents of the
    abdomen through the inguinal region of the abdominal
    wall.
    It is reducible
    Expansible impulse on cough
    There are two types of inguinal hernia

    1. Indirect inguinal hernia

    2. Direct inguinal hernia


    1. Indirect hernia

    • In indirect hernia the content of abdomen enter the


    deep inguinal canal and traverse the whole canal to
    come out through the superficial inguinal ring, it is
    lateral to the inferior epigastric vessels
    Much common than the direct hernia,
    Can occur at any age but more common in children
    and young adult
    It is more commonly seen on right side. only 1/3 of
    cases are involved bilateral
    Impulses on coughing
    When it is complete it is pyriform shape and when it is
    incomplete it is oval shape
    The hernia has to be reduced by the patient or the
    doctor and it dose not reduced by itself
    There are three types of indirect hernia
    i. BUBONOCELE – hernia is limited to the inguinal
    canal
    ii.FUNICULAR – the contents of hernia can be felt
    separately from the testis and the testis lie below the
    hernia
    iii.COMPLETE OR SCROTAL HERNIA – the hernia
    descends down to the bottom of the scrotum lying in
    front and side of the testis
    Direct inguinal hernia
    Direct inguinal hernias occur medial to the inferior
    epigastric vessels through the posterior wall of the
    inguinal canal
    Female are not affected
    More than ½ the case are bilateral. it is usually caused by
    poor abdominal muscle.
    It is always incomplete and spherical shape
    This hernia is appears as forward bulges
    It is automatically reduces when the patient lies down
    If the impulses is felt on the middle finger it is a direct
    hernia
    Invagination test –

    • When the little finger enters the ring if it goes upward,


    backwards, and out wards it is an indirect hernia
    • If the impulses is felt on the tip of the finger it is an
    indirect hernia
    • When the little finger goes directly backwards, it is
    direct hernia
    • If the impulses is felt on the pulp of the finger it is an
    direct hernia
    Ring occlusion test
    • The hernia must be reduced first

    • A thumb is pressed on the deep inguinal ring then


    asked to cough

    • A direct hernia will show bulge medial to the finger


    but an indirect hernia will not find assess, so no bulge
    Treatment –

    Herniotomy- In this operation the neck of the sac is


    transfixed and ligated and then the hernial sac is excised
    • Incision : ½ inch above and parallel to the medial of
    inguinal ring almost on inguinal canal.

    It is indicated –
    In infants and children in whom there is preformed sac
    In case of young adults with very good inguinal
    musculature
    Hernioraphy –
    It is consist of herniotomy + repair of posterior wall of
    the inguinal canal by opposing the conjoined tendon to
    the inguinal ligament

    Hernioplasty –
    Herniotomy + reinforced repair of the posterior wall of
    the inguinal canal by filling the gap between the
    conjoined tendon and ligament by
    Autogenous or heterogenous material
    Femoral hernia
    • Abdominal contents pass through the femoral ring,
    transverse the femoral canal and comes out through the
    saphenous opening.

    • It is 3rd most common hernia after the inguinal and


    incisional hernia.

    • Common in female elderly and most liable to get


    strangulated
    • You may see a bulge in the upper thigh next to the
    groin.

    • Most femoral hernias cause no symptoms. There may


    be some groin discomfort that is worse when you
    stand, lift heavy objects, or strain.

    • Sometimes, the first symptoms are abdominal pain,


    nausea, and vomiting. This may mean that the intestine
    is blocked, which is an emergency.
    Umbilical hernia

    • This is due to failure of all part of mid gut return to the


    colon during early fetal life. So the abdominal organ
    remain protruded.

    Umbilical hernia in infants and children –


    • This is hernia through a weak umbilical scar,
    • The hernia is usually symptomless and increase in size
    during crying
    • If small, symptomless then conservative treatment.
    • Operation is only justified when the hernia fails to
    disappear after 18 months – Herniorapphy

    Para- umbilical hernia of adult –


    • In the adults the hernia does not protrude through the
    umbilical. But it is protrusion through the linea alba
    just above the umbilicus or occasionally below the
    umbilicus
    • That is why its called para umbilical hernia
    • Women are by far the major victims,
    • Obese patient are mainly involved.
    • Treatment – operation is the treatment of choice
    • MAYO’ S OPERATION
    Incisional hernia
    An incisional hernia is one which occurs through an
    acquired scar in the abdominal wall caused by a
    previous surgical operation or an accidental trauma.
    Etiology

    1. Defect with patient

    - Obese individual
    - Chronic cough
    - Abdominal distension in the early POD
    - Malnutrition
    2- Fault during operation

    - Injury to the motor nerve supplying the area.


    - Improper closer of wound
    - Tube drainage through the laparotomy wound
    - Haemostasis was not perfect
    - Certain incision are more liable to causes incisional
    hernia
    3-Postoperative causes

    - Infection
    - Postoperative cough and distension
    - Postoperative peritonitis due to more chance of
    wound infection.
    - To early removal of sutures
    • Hernia may occur through the small portion of scar at
    lower end
    • Diffuse bulging of whole length of incision
    • Gradually size become increased and irreducible
    • Mostly asymptomatic and broad neck don’t need any
    treatment

    Treatment
    • Conservative treatment – abdominal belt
    • Operative management
    Physiotherapy management –

    • For the undergoing surgery for an inguinal hernia


    pulmonary complications may be a risk when there is a
    chronic chest condition

    • Pre and post operative breathing exercise and chest


    physiotherapy are important

    • DVT is possible complication after herniorraphy and


    so exercise for legs should be given before and after
    surgery
    • These patients likely to have weak abdominal muscles
    which should be strengthen after surgery

    • A progressive scheme of exercise starting with static in


    middle to inner range and following with free active
    exercise should be implemented

    • Care should be taken not to go beyond the ability of the


    patient and exercise in outer range of the abdomen
    should be avoided

    • Patients should be instructed in correct lifting techniques.


    • Patient undergoing surgery for a femoral hernia
    should have similar physiotherapy

    • The risk of pulmonary complications is smaller but


    there may be a greater risk of developing a DVT

    • Correct lifting techniques should be taught so that the


    intra abdominal pressure is not abnormally high during
    lifting
    Patients undergoing for the umbilical and insicional
    hernia surgery physiotherapy is as for abdominal
    surgery

     To prevent pulmonary and circulatory complication.


     Strengthen abdominal muscle
     Teach postural correction
     Scar management
     Advice on back care
     Advice on progression of activities to function
    Thank you…..

    You might also like