Hernias

Question 1

What is a hernia?

Answer 1

Refers to an organ or part of an organ that protrudes outside the walls of its usual cavity to weakened abdominal walls and intraabdominal pressures.

Question 2

Name the different places you can get hernias.

Answer 2

• groin hernias (inguinal, femoral, obturator)
• abdominal wall hernias (umbilical, epigastric, spigelian, incisional)
• hiatus hernia

Question 3

What are the different types of hernias?

Answer 3

1) Reducible- contents of the hernia can be pushed back into its original position. These hernias can either be left alone or repaired electively.
2) Irreducible or Incarcerated- the contents of the hernia are stuck and cannot be pushed back into their original position. Acutely incarcerated hernias should be repaired urgently. Other hernias can gradually become adherent to the surrounding tissues over time without causing any constriction of the contents. Chronically incarcerated hernias are usually repaired electively unless they are very painful or at high risk of obstruction or strangulation.
3) Obstructed- the contents of a hernia containing bowel are compressed to the extent that the bowel lumen is no longer patent, leading to obstruction. These hernias usually require emergency surgery unless they can be reduced very quickly.
4) Strangulated- compression of the contents of a hernia prevents blood flow to the tissues causing ischemia which may lead to infarction and necrosis. These hernias most serious and require emergency surgery asap.

Question 4

What are the causes of Hernias?

Answer 4

Generally speaking, hernias are caused by increased intra-abdominal pressure, weak or damaged tissues, or a combination of both.

1) Increased intra-abdominal pressure may be due to:

• Chronic cough: COPD, long-term smoking, bronchiectasis, cystic fibrosis
• Abdominal distension: pregnancy, ascites, peritoneal dialysis, obesity (ventral hernias)
• Straining: chronic constipation, prostatism, heavy lifting during work or exercise
• Kyphoscoliosis

2) Weakened tissues may result from:

• Congenital defects: patent processus vaginalis, patent umbilical ring
• Collagen disorders: Ehlers-Danlos syndrome, vitamin C deficiency, family history of hernias
• Trauma: including surgery
• Ageing
  Chronic malnutrition
• Long-term corticosteroid use