HERNIA EXAMINATION

Definition

• Hernia is a protrusion of an organ or part of an organ through a weakened or congenitally defective area in the abdominal wall.

Types

1. Inguinal Hernia

• Inguinal hernias occur in the groin area, where the abdominal wall is weakened.
• Direct inguinal hernias occur through Hesselbach's triangle (a weak area in the posterior wall of the inguinal canal), while indirect inguinal hernias occur through the deep inguinal ring.
• Indirect inguinal hernias are more common in men.

2. Femoral Hernia

• Femoral hernias occur below the inguinal ligament, near the femoral canal.
• Femoral hernias are more common in women and are associated with a higher risk of strangulation.

3. Umbilical Hernia

• Umbilical hernias occur around the belly button (navel) and are more common in infants and children.
• Umbilical hernias are often small and may resolve on their own, but can also be surgically repaired.

4. Incisional Hernia

• Incisional hernias occur through a scar in the abdominal wall from previous surgery.
• Incisional hernias can be small or large and may require surgical repair.

5. Diaphragmatic Hernia

• Diaphragmatic hernias occur through a weakness in the diaphragm, the muscle that separates the chest and abdominal cavities.
• Diaphragmatic hernias can be congenital or acquired and may be associated with respiratory problems.

Causes

• Weakening of the abdominal wall due to age, genetic factors, or previous surgery.
• Increased abdominal pressure due to obesity, straining during bowel movements, or heavy lifting.
• Congenital defects in the abdominal wall.

Clinical Features

• A bulge or lump in the abdominal wall, which may be painful or tender.
• A feeling of discomfort or pressure in the abdomen.
• Straining during bowel movements or heavy lifting may exacerbate the symptoms.
• In advanced cases, the hernia may become incarcerated or strangulated, leading to severe pain, vomiting, and potentially life-threatening complications.

Investigations

• Physical examination: A thorough physical examination, including a digital rectal examination, to assess the size and location of the hernia.
• Imaging studies: X-rays, CT scans, or ultrasound to confirm the diagnosis and rule out other conditions.
• Laboratory tests: Blood work to evaluate liver and kidney function, as well as to rule out other underlying conditions.

Complications

• Incarceration: The hernia becomes trapped and cannot be reduced.
• Strangulation: The blood supply to the herniated tissue is cut off, leading to tissue death and potentially life-threatening complications.
• Adhesions: Fibrotic bands may form between the hernia and surrounding tissues, making it difficult to repair.

Management and Treatment

• Observation: Small, asymptomatic hernias may be monitored without surgical intervention.
• Surgical repair: Hernias that are symptomatic, incarcerated, or strangulated require surgical repair.
• Laparoscopic repair: A minimally invasive surgical technique using small incisions and a camera to visualize the abdominal cavity.
• Open repair: A traditional surgical technique using a larger incision to access the hernia.

Surgical Steps

1 → Incision: A small incision is made in the abdominal wall to access the hernia. 2 → Dissection: The surrounding tissues are gently separated to expose the hernia. 3 → Reduction: The herniated tissue is carefully reduced back into the abdominal cavity. 4 → Repair: The weakened area in the abdominal wall is repaired using sutures or mesh. 5 → Closure: The incision is closed, and the patient is monitored for complications.

Blood Supply and Nerve Supply

• Blood supply: The abdominal wall receives blood from the superior and inferior epigastric arteries.
• Nerve supply: The abdominal wall is innervated by the anterior branches of the intercostal nerves and the iliohypogastric nerve.

Clinical Anatomy

• The abdominal wall is composed of layers of muscle and fascia.
• The rectus abdominis muscle runs vertically in the midline of the abdomen, divided by the linea alba.
• The inguinal canal is a narrow passage in the abdominal wall that allows for the passage of the spermatic cord in males and the round ligament in females.

Homoeopathic Therapeutic Medicines

• Arnica: For pain and inflammation.
• Calcarea carbonica: For weak abdominal muscles and digestive issues.
• Graphites: For skin irritation and inflammation.
• Nux vomica: For digestive issues and abdominal pain.