SURGICAL DISEASES, TRAUMATOLOGY, ORTHOPEDICS, UROLOGY : HERNIA (НЕRNIA) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
There are congenital and acquired hernia. Predisposing points to the emergence of hernia: the weakening of the abdominal wall (senile muscle atrophy, weight loss, obesity, trauma to muscles, healing the wounds of the abdominal wall secondary tension), weakness of muscles and aponeurosis (lack of physical development), incomplete closure of the holes that exist in the embryonic period (inguinal valve, the umbilical ring). Producing points: increased intra-abdominal pressure when the voltage of the abdominal muscles (lifting, not appropriate physical development), strain during bowel movement for constipation, urination (prostate hypertrophy, phimosis).
Pravima hernia: a tumor in a typical location that appears when the voltage disappear when lying down and when pressed, the feeling in the abdominal wall of the hernial ring, transmission cough impulse, leg tumors associated with the abdominal cavity.
Napravila hernia: mprovement tumors in history, the typical localization of the tumor, leg tumors associated with the abdominal cavity, the seal of tumors in natureway.
Types of hernia:
THE FEMORAL HERNIA (НЕRNIA CRURALIS). Symptoms. Often nevprawima hernia. Often the first symptom of a hernia incarceration.
HERNIA OF THE WHITE LINE (НЕRNIA LINEAE ALBAE). Symptoms. Complaints are often completely absent and hernia accidentally found during the inspection. Sometimes pain, discomfort and tightness in the chest when the voltage and after eating, in some cases gastritis symptoms. When feeling limited, soft, nebraskensis or a little painful and often not increasing when utorevenue site over the white line.
THE DIAPHRAGMATIC HERNIA (НЕRNIA DIAPHRAGMATICA). Congenital abnormality of development defect in the sphere passing through the aperture of the bodies, sometimes significant hypoplasia of the diaphragm. Often diaphragmatic hernias occur when damage to the diaphragm (the gap, gunshot wound, incised wound to the chest wall with damage to the diaphragm). Wygodnie the abdominal organs into the chest cavity occurs or wound through the aperture (bag hernia no), or after stretching of scar tissue in the damaged area of the diaphragm. The hernia formation contributes to a positive pressure in the abdominal cavity and negative in the chest.
The symptoms and course. Pain, depending on the tension bryzek and difficulties peristalsis. Difficulties of cardiac activity and respiration (the offset of the heart, limiting excursions of the lungs and diaphragm movement). Dyspeptic symptoms (regurgitation, vomiting) when engaging in Gruziya gate stomach, difficulty in passage of food. During the examination of the thoracic cavity is determined by timpani and the absence of respiratory sounds or heard intestinal peristalsis where there should be a pulmonary sound and pulmonary respiration, displacement of the heart, symptoms of pneumothorax. An accurate diagnosis is made with x-ray inspection, especially during the filling of the stomach and bowel barium.
HERNIA INGUINAL (НЕRNIA INGUINALIS). The symptoms and course. There are direct hernia: exits the abdominal cavity through the internal inguinal fossa, has a direct course, a wide gate, short channel, a semicircular shape, in the scrotum does not fall, the cord lies towards the outside from the bag. Slash hernia: goes through the external inguinal fossa has a slanting direction, descends into the scrotum, the pouch is inside the membranes of the cord. The dimensions are distinguished: primary hernia bag only osupivaja in the depth of the inguinal canal, bulk bag did not come out of the external opening of the inguinal canal, the full bag out of the inguinal canal, PAHO-scrotal hernia - descending into the scrotum and large hernias bag down, pulling the scrotum.
With the introduction of the finger into the inguinal canal after reduction of the hernia is determined by the shape of the hernia gate (oval, triangular). When natureway osupivaja facing the hernia SAC.
HERNIA POSTOPERATIVE (НЕRNIA РОSТОРЕRАТIVА), TRAUMATIC HERNIA (НЕRNIA ТRAUMATICA) is formed by the divergence of the internal seams of the abdominal wall (weak regenerative ability, insufficient seam), after healing of the abdominal wound secondary tension (after intraperitoneal administration of tampons and drains), tearing the muscle and aponeurosis, in violation of the innervation of the muscles.
Symptoms. The protrusion of scars after surgery or injury of the abdominal wall over its entire length or at the site of the scar, when increasing the voltage and state endangered when lying down and pressing. Complaints of pain in movement and tension in abdomen, depending on the stretching of scar tissue, adhesions and tension of the mesentery in Grajewo the bag body. Through the thin scar sometimes easy palpation adjacent organs.
Course and complications. Tensile scar throughout wounds in the absence of hernia gate or wide hernia gate infringement occurs rarely. Partial stretching of the scar, narrow hernia gate infringement often.
THE UMBILICAL HERNIA (НЕRNIA UMBILICALIS). Congenital hypoplasia. Symptoms. Pain, rare when upravenych hernias, intense sometimes when neupravenych. By palpation is a round, sometimes grozdeva swelling in the umbilical region. Thinning of skin can be felt lobules of the gland, if upravenou hernia is defined by a ring (usually narrow, dense).
HERNIA STRANGULATED (НЕRNIA INCORCERATA). Etiology. Fecal infringement: tensile loops will have to face in Grajewo bag, content comes the weakening of peristalsis in the stretched loops, folds, creases, difficult evacuation, stretched loops compress nearby. Elastic infringement: increased intra-abdominal pressure during physical stress (weight lifting, coughing, defecation), pushing voluminous content through the narrow opening. The subsequent reduction stretched while hernial ring. Changes of the peritoneum in the neck of the bag (fibrous overlay, scarring makes it difficult lumbar content and contribute to its infringement.
The pathogenesis. When infringement of a gland disorder comes his blood - necrosis with subsequent inflammation. At the expense of the intestinal loops first venous congestion (compression of the veins), cyanosis, effusion into the lumen of the loop and through the intestinal wall into the hernia SAC (grigia water) passing through the wall of the infection. In place of the compression formed strangulation furrow and necrosis coming from the mucosa. Circulatory disorders in disadvantaged loop gives her mortification, the thrombosis extends to the vessel outlet and especially afferent loop. Developed peritonitis, when the delimitation process cellulitis in the field of hernial SAC with subsequent fecal fistula.
Symptoms. Pain of varying intensity in the area of the hernia, around the abdomen and back. Nepravilnosti spravlyavsheysya previously hernia, reflex phenomena of irritation, nausea, vomiting. When full the infringement of the loop delay of stool and gases, bloating. Further intoxication, anxiety, cold and cyanotic extremities. Local effects: nepravilnosti, the tension of the hernial SAC, the pain feeling, no transfer of the cough impulse and voltage when natureway.
Course and complications. When the infringement of the seal aseptic necrosis of it and the inflammatory process in Grajewo bag. The infringement of the intestine leads to necrosis and its death (shock, poisoning, peritonitis). In the absence of peritonitis is formed abscess with subsequent fecal fistula and possible death from exhaustion. There are: the acute form of infringement of death in 2 to 3 days, chronic - slow growth phenomena, hidden prejudice in his pockets, giving incomplete resetting and parietal infringement.
THE FEMORAL HERNIA (НЕRNIA CRURALIS). Upravenia hernia differencebut from atechnical (by detecting primary tumor in the spine), varicose veins (swollen increases after compression stress and abdomen). Unlike inguinal: swelling under papatowai ligament, not covers (tuberculum pubicum, down on your thigh (side and bottom).
HERNIA OF THE WHITE LINE (НЕRNIA LINEAE ALBAE). Recognition is usually easy, diferenciada from tumors of the abdominal wall (lipoma) and metastatic sites of tumors in the abdominal wall (gastric cancer). To exclude diseases of the stomach. Often patients with gastric symptoms for a long time unsuccessfully treated, while these symptoms depend on the white line hernia.
THE DIAPHRAGMATIC HERNIA (НЕRNIA DIAPHRAGMATICA). Recognition based on the above. Definitely x-ray examination. Often, the symptoms become more pronounced when the hernia incarceration.
HERNIA INGUINAL (НЕRNIA INGUINALIS). Recognition usually is not difficult. Incomplete hernia recognized only by putting one's finger in the inguinal canal. Pravima hernia diferenciada from atechnical, dilatation of the cord, napravila from tumors of the testis, hydrocele.
THE UMBILICAL HERNIA (НЕRNIA UMBILICALIS). Recognition is difficult in ozarelix patients. Diferenciada from inflammatory processes in the umbilicus, cysts. It is necessary to distinguish inflammation hernia from infringement.
HERNIA STRANGULATED (НЕRNIA INCORCERATA). Detection is easy in typical cases of infringement spravlyavsheysya previously hernia. Infringement neupravenych hernias and trapped in the pockets, it is difficult to diagnose. If in doubt, it is better to lean towards infringement. Diferenciada from inflammatory processes (inguinal lymphadenitis inflammation of the epididymis and others).
Prevention of all types of hernias: physical education, selection for admission to work, mechanization lifts weights in children treatment of phimosis, the elderly treatment of hypertrophy of the prostate, constipation, and so on, the Prevention of possible complications is surgical treatment, limiting assumptions of the physical work suffering from hernias (examination when applying for a job) and to avoid heavy physical work during the expansion of the inguinal canal and sluggish groin.
THE FEMORAL HERNIA (НЕRNIA CRURALIS). Operative treatment.
HERNIA OF THE WHITE LINE (НЕRNIA LINEAE ALBAE). Operative treatment.
THE DIAPHRAGMATIC HERNIA (НЕRNIA DIAPHRAGMATICA). Operative treatment.
HERNIA INGUINAL (НЕRNIA INGUINALIS). Operative treatment. Wearing the brace does not cure the hernia does not warrant against infringement, worsens the conditions of surgical treatment and should be strictly limited to cases where surgical treatment is contraindicated.
HERNIA POSTOPERATIVE (НЕRNIA РОSТОРЕRАТIVА), TRAUMATIC HERNIA (НЕRNIA ТRAUMATICA). The operation in the period of six months or a year after healing the wounds of the abdominal wall.
THE UMBILICAL HERNIA (НЕRNIA UMBILICALIS). Operative treatment. Hernia in children under 10 years of surgical treatment are not to be eliminated systematic contraction of the abdominal wall transversely superimposed strips of adhesive tape.
HERNIA STRANGULATED (НЕRNIA INCORCERATA). The urgent surgical treatment. Manual resetting is contraindicated. Temporary measures (before admission to hospital): supine position with elevated pelvis, ice on the area of the hernia or a warm bath. In the postoperative period: a blood transfusion, sulfonamides, penicillin, the infusion of large amounts of fluids (5% glucose solution, saline solution), the heart, is symptomatic. The postoperative pulmonary complications.