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Hernias
By: Yoshua Arseneault
Drew Maynard
What is it?
An opening or weakness in the muscular
structure of the wall of the abdomen which
causes a bulging of the abdominal wall.
 These contents, usually portions of the intestine
or abdominal fatty tissue, are enclosed in the
thin membrane that naturally lines the inside of
the cavity.
 Bulging is more noticeable when the abdominal
muscles are tightened which increases the
pressure in the abdomen.

Different types of Hernias

Inguinal hernia (groin)
– Most common location for a hernia

Hiatal hernia
– Forms at the opening in your diaphragm
where your food pipe joins your stomach

Umbilical hernia (navel)
Inguinal Hernias

Occurs when soft tissue
(usually part of the
intestine) protrudes
through a weak point or
tear in your lower
abdominal wall. Can be
especially painful when
you cough bend over or
lift a heavy object.
Inguinal Hernias
In many people the abdominal wall
weakness that leads to an inguinal hernia
occurs at birth when the abdominal lining
doesn’t close properly
 Other inguinal hernias develop as muscles
weaken or deteriorate due to things such
as: aging, strenuous physical activity, or
coughing that accompanies smoking

Inguinal Hernias SXS
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Some don’t cause any symptoms, and may not
know you have one until your doctor discovers it
during a medical exam
Often though can see and feel the bulge
Pain or discomfort in your groin especially when
bending over, coughing or lifting
A heavy or dragging sensation in your groin
Occasionally in men pain and swelling in the
scrotum around the testicles when the
protruding intestine descends into the scrotum
Inguinal Hernias Causes
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Some have no apparent cause
Most occur as a result of increased pressure within the
abdomen, a pre-existing weak spot in the abdominal wall
or a combination of the two
Can happen after an injury or operations in the
abdominal cavity
In men the weak spot usually occurs along the inguinal
canal, this is the area where the spermatic cord, which
contains the vas deferens, the tube that carries sperm,
enters the scrotum
In women the inguinal canal carries a ligament that
helps hold the uterus in place and hernias sometimes
occur where connective tissue from the uterus attaches
to tissue around pubic bone
Inguinal Hernias

More Common in Men
– Men more likely to have an inherent weakness along
the inguinal canal than women because of the way
males develop in the womb.
– In the male fetus the testicles form within the
abdomen and then move down the inguinal canal into
the scrotum, after birth the inguinal canal closes
almost completely but leaves just enough room for
the spermatic cord to pass through
– Sometimes the canal doesn’t close properly leaving a
weakened area, however in female babies less chance
that the inguinal canal wont close after birth
Inguinal Hernias Risk Factors
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Being a male
Family history
Medical conditions
Chronic cough
Chronic constipation
Excess weight
Certain occupations
Premature birth
Previous hernias
Inguinal Hernias Diagnosis

Physical exam usually all that’s needed to
diagnose inguinal hernias
– Doctor may ask about signs and symptoms
and check for a bulge in groin area
– May be asked to cough as part of physical
exam since coughing can make a hernia more
easily recognized
Inguinal Hernias Complications

Most inguinal hernias enlarge over time if they aren’t
repaired surgically
– Large hernias can put pressure on surrounding tissues in men
may extend into the scrotum causing pain and swelling

Serious complication occurs when a loop of intestine
becomes trapped in the weak point in the abdominal
wall
– This may obstruct the bowel leading to severe pain, nausea,
vomiting, and inability to have bowel movement

Can also diminish blood flow to the trapped portion of
the intestine, called strangulation
– May lead to the death of the affected bowel tissues
– Is life threatening and requires immediate surgery
Inguinal Hernias Treatment
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If it’s small and isn’t a problem doctor may recommend a
watch and wait approach
Growing or painful hernias usually require surgery
Two general types of hernia operations
– Herniorrhaphy: surgeon makes an incision in your groin and
pushes the protruding intestine back into your abdomen then
repairs the weakened or torn muscle by sewing it together
– Hernioplasty: surgeon inserts a piece of synthetic mesh to cover
the entire inguinal area. Often done laparoscopically using
several small incisions instead of one large one. A fiber optic
tube with a tiny camera is inserted into your abdomen through
one incision and miniature instruments are inserted through the
other incisions. Your surgeon than performs the operation using
the video camera as a guide
Inguinal Hernias Prevention

Can’t prevent inguinal hernias, but can
take steps to reduce strain on your
abdominal muscles and tissues
– Maintain healthy weight
– Eat foods high in fiber
– Lift heavy objects carefully
– Don’t smoke
Hiatal Hernias
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Forms at the opening of the
diaphragm where your
esophagus joins your
stomach. Part of the
stomach pushes through this
opening causing a hiatal
hernia
Most small hiatal hernias
don’t cause problems, but
large ones can allow food
and acid to back up into
your esophagus leading to
heartburn and chest pain
Hiatal Hernias SXS
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Heartburn
Belching
Chest pain
Nausea
Usually become worse when you lean forward, strain, lift
heavy objects or lie down
Rare cases part of your stomach that protrudes into your
chest cavity may become twisted or have its blood
supply cut off leading to:
– Severe chest pain
– Difficulty swallowing
– Obstruction of your esophagus
Hiatal Hernias Causes
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Exact cause unknown
Your esophagus passes into your stomach through an
opening in the diaphragm called the hiatus
– Hernias occur when the muscle tissue surrounding this opening
becomes weak, and the upper part of the stomach bulges up
through the diaphragm into your chest cavity
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May be developed after an injury to that area
Born with weakness, or unusually large hiatal opening
Anything that puts intense pressure on you abdomen
contributes to a hernia
– Persistent or severe coughing or vomiting
– Straining while going to the bathroom
– Lifting heavy objects
Hiatal Hernias Risk Factors
Age 50 or older
 Obese
 Smoker
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Hiatal Hernias Diagnosis
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Doctor may discover it while trying to determine the
cause of heartburn or chest or upper abdominal pain
usually found during one of the following procedures:
Barium X-ray
– Drink chalky liquid containing barium that coats your upper
digestive tract which provides a clear silhouette of your
esophagus, stomach and upper part of your small intestine. May
help reveal whether the contents of you stomach are backing up
into your esophagus
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Endoscopy
– Pass a thin flexible tube with a fiber-optic light and video camera
system down your throat into your esophagus and stomach,
checking for inflammation.
Hiatal Hernias Complications
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Bleeding and anemia
– Some large hiatal hernias have lesions in the upper stomach,
can bleed and lead to iron deficiency anemia from chronic blood
loss
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Reduced blood flow to the stomach
GERD (gastroesophageal reflux)
– May occur when a hernia slightly displaces the lower esophageal
sphincter, a circular band of muscle around the bottom of the
esophagus which relaxes to allow food and liquid to flow into
your stomach when you swallow
– Diaphragm supports and puts pressure on the sphincter to keep
it closed when you’re not swallowing, but a hiatal hernia raises
the sphincter above the diaphragm reducing pressure on the
valve which permits the sphincter muscle to open at the wrong
time allowing stomach acid to back up into the esophagus
Hiatal Hernias Treatment
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Losing weight if you’re overweight
Medications:
– Antacids: can neutralize the acidity in your esophagus
and provide relief from heartburn (Tums)
– H-2 blockers: reduce the amount of acid secreted by
your stomach by blocking histamine receptors
(Pepcid, Zantac, Axid)
– Proton pump inhibitors (PPIs): most effective drug
treatment for GERD. They block acid production and
allow time for damaged esophageal tissue to heal
(Prevacid, Protonix)
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Surgery
Hiatal Hernias Self-Care
Eat small meals
 Avoid problem foods and alcohol
 Limit fatty food intake
 Sit up after you eat
 Don’t exercise immediately after eating
 Healthy weight
 Stop smoking
 Relax
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Umbilical Hernias
Occurs when part of
the intestine protrudes
through a weak spot in
the abdominal muscles
 Common typically
harmless condition
 Most common in
infants
 Most close on their
own by age 1 though
some may take longer
to heal
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Umbilical Hernias SXS
Soft swelling or bulge near the navel
 May only notice bulge when baby cries
coughs or strains, bulge may disappear
when baby is calm or lies on back
 In children usually painless, but those that
appear in adulthood may cause discomfort
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Umbilical Hernias Causes
During pregnancy the umbilical cord passes
through a small opening in the baby’s abdominal
muscles which normally closes before birth. If
the muscles don’t meet together in the midline
completely this weakness in the abdominal wall
may cause umbilical hernia at birth or later on
 In adults too much abdominal pressure
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Obesity
Heavy lifting
Coughing
Multiple pregnancies
Umbilical Hernias Risk Factors
Infants especially premature babies and
those with low birth weights
 Affects both boys and girls equally
 Adults being overweight or having multiple
pregnancies may increase risk
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Umbilical Hernias
Diagnosis/Complications
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Diagnosed during a physical exam
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For children complications rare
– Rarely the protruding abdominal tissue
becomes trapped and can no longer be
pushed back into the abdominal cavity
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Adults more likely experience incarceration
or obstruction of the intestines
– Requires emergency surgery typically
Umbilical Hernias Treatment
Most close on their own by age 1, the doctor may
even be able to push the bulge back into the
abdomen during a physical exam
 In children surgery is usually only required:
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Large or painful umbilical hernias
Get bigger after age 1 or 2
Don’t disappear by age 4
Become trapped or block the intestines
In adults surgery is typically recommended to
avoid possible complications especially if the
umbilical hernia gets bigger or becomes painful
Sources
www.mayoclinic.com
 www.emedicinehealth.com
 www.medicinenet.com
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