Case study on inguinal hernia

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This is a case study done by me as a part of my in-service education progamme in my institution...hope this may help all nurses who wants to do a case study.

Transcript of Case study on inguinal hernia

  • OBJECTIVES AT THE END OF THE PRESENTATION THE AUDIENCE WILL BE ABLE TO Attain knowledge regarding the definition, incidence, etiology, signs and symptoms of hernia Understand the surgical correction of inguinal hernia and complications after surgery. Identify patients needs , carry out interventions according to the needs and evaluate patients response to care.
  • DEFINITION An inguinal hernia is a protrusion of abdominal cavity contents through the inguinal canal.
  • INCIDENCE About 25% of males and 2% of females develop inguinal hernias; this is the most common hernia in males and females Indirect inguinal hernias are the most common hernias in both men and women; a right-sided predominance exists.
  • CLASSIFICATION There are two types of inguinal hernia based on their relationship to inferior epigastric vessels DIRECT INGUINAL HERNIA INDIRECT INGUINAL HERNIA
  • DIRECT INGUINAL HERNIA Direct inguinal hernias occur medial to the inferior epigastric vessels when abdominal contents herniate through a weak spot in the fascia of the posterior wall of the inguinal canal, which is formed by the transversalis fascia.
  • INDIRECT INGUINAL HERNIA Indirect inguinal hernias occur when abdominal contents protrude through the deep inguinal ring , lateral to the inferior epigastric vessels.
  • CLINICAL CLASSIFICATIONS Reducible hernia: is one which can be pushed back into the abdomen by putting manual pressure to it. Irreducible hernia: is one which cannot be pushed back into the abdomen by applying manual pressure. Irreducible hernias are further classified into Obstructed hernia-is one in which the lumen of the herniated part of intestine is obstructed but the blood supply to the hernial sac is intact. Incarcerated hernia-is one in which adhesions develop between the wall of hernial sac and the wall of intestine. Strangulated hernia- is one in which the blood supply of the sac is cut off, thus, leading to ischemia. the lumen of the intestine may be patent or not.
  • ETIOLOGY Increased pressure within the abdomen A pre-existing weak spot in the abdominal wall Straining during bowel movements or urination Heavy lifting Ascites Pregnancy Excess weight Chronic coughing or sneezing Peritoneal dialysis
  • SIGNS AND SYMPTOMS A bulge in the area on either side of your pubic bone A burning, gurgling or aching sensation at the bulge Pain or discomfort in the groin, especially when bending over, coughing or lifting A heavy or dragging sensation in groin Weakness or pressure in your groin Occasionally, in men, pain and swelling in the scrotum around the testicles when the protruding intestine descends into the scrotum Signs and symptoms in children Inguinal hernias in newborns and children result from a weakness in the abdominal wall that's present at birth. Sometimes the hernia may be visible only when an infant is crying, coughing or straining during a bowel movement. In an older child, a hernia is likely to be more apparent when the child coughs, strains during a bowel movement or stands for a long period of time.
  • INVESTIGATION A health care provider can confirm that you have a hernia during a physical exam. The growth may increase in size when you cough, bend, lift, or strain. X-ray abdomen/CT Scan in case of strangulated inguinal hernia
  • CONSERVATIVE MANAGEMENT Hernias that or not strangulated or incarcerated can be mechanically reduced. A truss can be placed over the hernia after it has been reduced & left in place to prevent the hernia from recurring.(truss is a firm pad held in place by a belt) The client is taught to apply the truss daily before arising & to inspect the skin underneath for any breakdown.
  • SURGICAL MANAGEMENT Inguinal hernia surgery refers to a surgical operation for the correction of an inguinal hernia. Surgery is not advised in most cases, watchful waiting being the recommended option . In particular, elective surgery is no longer recommended for the treatment of minimally symptomatic hernias, due to the significant risk of chronic pain (Post herniorraphy pain syndrome), and the low risk of incarceration
  • OPEN REPAIR (LICHTENSTEIN) The most commonly performed inguinal hernia repair today is the Lichtenstein repair. A flat mesh is placed on top of the defect It is a "tension-free" repair that does not put tension on muscles It involves the placement of a mesh to strengthen the inguinal region. Patients typically go home within a few hours of surgery, often requiring no medication beyond Paracetamol. Patients are encouraged to walk as soon as possible postoperatively, and they can usually resume most normal activities within a week or two of the operation. Recurrence rate is low,