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Thursday, October 16, 2014

HERNIA


Agak lama jugak saya tidak menulis dan berbincang mengenai penyakit didalam ruang belog ini. Kali ini saya ingin berbincang dan memaparkan sajenis penyakit yang menyerang terutamanya kaum adam, iaitu  Hernia - inguinal. ( us.wow.com/wiki/hernia ) Saperti yang dikatakan sabelum ini, saya bukanlah "expert" atau pakar perubatan untuk berkongsi pendapat dalam ruangan ini. Saya hanya mencedok dari internet dan buat posting kedalam belog saya. Penyakit yang selalu saya paparkan dalam belog saya adalah berkaitan dengan penyakit yang saya  sendiri alami.

Tujuan memuatnaik dan  mengetengahkan paparan kedalam belog adalah untuk merekodkan semua penyakit yang boleh dijadikan pedoman atau rujukan kepada jenerasi saya mengenai penyakit-penyakit yang telah saya alami. Rekod-rekod saperti ini perlu dibuat rujukan bukan saja ianya memberi menfaat kepada generasi saya yang akan datang tetapi juga kepada sesiapa jua yang  berminat mengenainya. Diantara penyakit yang telah dibincangkan sebelum ini ialah: 

COXCY DYNIA, 
PROSTATE DISORDER
PERFECTIONIST ( Sajenis penyakit saikologi )

INGUINAL HERNIA.

A hernia is the protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it from within.[1][2] There are different kinds of hernias, each requiring a specific management or treatment.

Signs and symptoms

Frontal view of an inguinal hernia (right).
By far the most common hernias develop in the abdomen, when a weakness in the abdominal wall evolves into a localized hole, or "defect", through which adipose tissue, or abdominal organs covered with peritoneum, may protrude. Another common hernia involves the spinal discs and causes sciatica. A hiatal hernia occurs when the stomach protrudes into the mediastinum through the esophageal opening in the diaphragm.
Hernias may or may not present with either pain at the site, a visible or palpable lump, or in some cases more vague symptoms resulting from pressure on an organ which has become "stuck" in the hernia, sometimes leading to organ dysfunction. Fatty tissue usually enters a hernia first, but it may be followed or accompanied by an organ.
Hernias are not tears in the tissue but are openings in the adipose tissue. It is possible for a hernia to come and go, but in most cases a pain will persist.
Symptoms and signs vary depending on the type of hernia. Symptoms may or may not be present in some inguinal hernias. In the case of reducible hernias, a bulge in the groin or in another abdominal area can often be seen and felt. When standing, such a bulge becomes more obvious. Besides the bulge, other symptoms include pain in the groin that may also include a heavy or dragging sensation, and in men, there is sometimes pain and swelling in the scrotum around the testicular area.[3]
Irreducible abdominal hernias or incarcerated hernias may be painful, but their most relevant symptom is that they cannot return to the abdominal cavity when pushed in. They may be chronic, although painless, and can lead to strangulation (loss of blood supply) and/or obstruction (kinking of intestine). Strangulated hernias are always painful and pain is followed by tenderness. Nausea, vomiting, or fevermay occur in these cases due to bowel obstruction. Also, the hernia bulge in this case may turn red, purple or dark and pink.
In the diagnosis of abdominal hernias, imaging is the principal means of detecting internal diaphragmatic and other nonpalpable or unsuspected hernias. Multidetector CT (MDCT) can show with precision the anatomic site of the hernia sac, the contents of the sac, and any complications. MDCT also offers clear detail of the abdominal wall allowing wall hernias to be identified accurately.[4]

Causes

Causes of hiatal hernia vary depending on each individual. Among the multiple causes, however, are the mechanical causes which include: improper heavy weight lifting, hard coughing bouts, sharp blows to the abdomen, and incorrect posture.[5]
Furthermore, conditions that increase the pressure of the abdominal cavity may also cause hernias or worsen the existing ones. Some examples would be: obesity, straining during a bowel movement or urination (constipation, enlarged prostate), chronic lung disease, and also, fluid in the abdominal cavity (ascites).[6]
Also, if muscles are weakened due to poor nutrition, smoking, and overexertion, hernias are more likely to occur.
The physiological school of thought contends that in the case of inguinal hernia, the above-mentioned are only an anatomical symptom of the underlying physiological cause. They contend that the risk of hernia is due to a physiological difference between patients who suffer hernia and those who do not, namely the presence of aponeurotic extensions from the transversus abdominis aponeurotic arch.[7]

Diagnosis

Inguinal

Main article: inguinal hernia
An incarcerated inguinal hernia as seen on CT
Diagram of an indirect, scrotalinguinal hernia (median view from the left).
By far the most common hernias (up to 75% of all abdominal hernias) are the so-called inguinal hernias. Inguinal hernias are further divided into the more common indirect inguinal hernia(2/3, depicted here), in which the inguinal canal is entered via a congenital weakness at its entrance (the internal inguinal ring), and the direct inguinal hernia type (1/3), where the hernia contents push through a weak spot in the back wall of the inguinal canal. Inguinal hernias are the most common type of hernia in both men and women. In some selected cases, they may require surgery.

Femoral

Main article: femoral hernia
Femoral hernias occur just below the inguinal ligament, when abdominal contents pass into the weak area at the posterior wall of the femoral canal. They can be hard to distinguish from the inguinal type (especially when ascending cephalad): however, they generally appear more rounded, and, in contrast to inguinal hernias, there is a strong female preponderance in femoral hernias. The incidence of strangulation in femoral hernias is high. Repair techniques are similar for femoral and inguinal hernia.

Umbilical

Main article: Umbilical hernia
They involve protrusion of intraabdominal contents through a weakness at the site of passage of the umbilical cord through the abdominal wall. Umbilical hernias in adults are largely acquired, and are more frequent in obese or pregnant women. Abnormal decussation of fibers at the linea alba may contribute.

Incisional

Main article: incisional hernia
An incisional hernia occurs when the defect is the result of an incompletely healed surgical wound. When these occur in medianlaparotomy incisions in the linea alba, they are termed ventral hernias. These can be the most frustrating and difficult to treat, as the repair utilizes already attenuated tissue.

Diaphragmatic

Main article: diaphragmatic hernia
Diagram of a hiatus hernia(coronal section, viewed from the front).
Higher in the abdomen, an (internal) "diaphragmatic hernia" results when part of the stomach or intestine protrudes into the chest cavity through a defect in the diaphragm.
A hiatus hernia is a particular variant of this type, in which the normal passageway through which the esophagus meets the stomach (esophageal hiatus) serves as a functional "defect", allowing part of the stomach to (periodically) "herniate" into the chest. Hiatus hernias may be either "sliding", in which the gastroesophageal junction itself slides through the defect into the chest, or non-sliding (also known as para-esophageal), in which case the junction remains fixed while another portion of the stomach moves up through the defect. Non-sliding or para-esophageal hernias can be dangerous as they may allow the stomach to rotate and obstruct. Repair is usually advised.
A congenital diaphragmatic hernia is a distinct problem, occurring in up to 1 in 2000 births, and requiring pediatric surgery. Intestinal organs may herniate through several parts of the diaphragm, posterolateral (in Bochdalek's triangle, resulting in Bochdalek's hernia), or anteromedial-retrosternal (in the cleft of Larrey/Morgagni's foramen, resulting in Morgagni-Larrey hernia, or Morgagni's hernia).

Other hernias

Since many organs or parts of organs can herniate through many orifices, it is very difficult to give an exhaustive list of hernias, with all synonyms and eponyms. The above article deals mostly with "visceral hernias", where the herniating tissue arises within the abdominal cavity. Other hernia types and unusual types of visceral hernias are listed below, in alphabetical order:
  • Amyand's hernia: containing the appendix vermiformis within the hernia sac
  • Cooper's hernia: a femoral hernia with two sacs, the first being in the femoral canal, and the second passing through a defect in the superficial fascia and appearing almost immediately beneath the skin.
  • Epigastric hernia: a hernia through the linea alba above the umbilicus.
  • Hiatal hernia: a hernia due to "short oesophagus" — insufficient elongation — stomach is displaced into the thorax
  • Littre's hernia: a hernia involving a Meckel's diverticulum. It is named after the French anatomist Alexis Littré (1658–1726).
  • Lumbar hernia (Bleichner's Hernia): a hernia in the lumbar region (not to be confused with a lumbar disc hernia), contains the following entities:
    • Petit's hernia: a hernia through Petit's triangle (inferior lumbar triangle). It is named after French surgeon Jean Louis Petit (1674–1750).
    • Grynfeltt's hernia: a hernia through Grynfeltt-Lesshaft triangle (superior lumbar triangle). It is named after physician Joseph Grynfeltt (1840–1913).
  • Maydl's hernia: two adjacent loops of small intestine are within a hernial sac with a tight neck. The intervening portion of bowel within the abdomen is deprived of its blood supply and eventually becomes necrotic.
  • Morgagni hernia: a type of hernia where abdominal contents pass into the thorax through a weakness in the diaphragm
  • Obturator hernia: hernia through obturator canal
  • Pantaloon hernia (Saddle Bag hernia): a combined direct and indirect hernia, when the hernial sac protrudes on either side of theinferior epigastric vessels
  • Paraesophageal hernia
  • Paraumbilical hernia: a type of umbilical hernia occurring in adults
  • Perineal hernia: a perineal hernia protrudes through the muscles and fascia of the perineal floor. It may be primary but usually is acquired following perineal prostatectomy, abdominoperineal resection of the rectum, or pelvic exenteration.
  • Properitoneal hernia: rare hernia located directly above the peritoneum, for example, when part of an inguinal hernia projects from thedeep inguinal ring to the preperitoneal space.
  • Richter's hernia: a hernia involving only one sidewall of the bowel, which can result in bowel strangulation leading to perforation through ischaemia without causing bowel obstruction or any of its warning signs. It is named after German surgeon August Gottlieb Richter (1742–1812).
  • Sliding hernia: occurs when an organ drags along part of the peritoneum, or, in other words, the organ is part of the hernia sac. Thecolon and the urinary bladder are often involved. The term also frequently refers to sliding hernias of the stomach.
  • Sciatic hernia: this hernia in the greater sciatic foramen most commonly presents as an uncomfortable mass in the gluteal area. Bowel obstruction may also occur. This type of hernia is only a rare cause of sciatic neuralgia.
  • Spigelian hernia, also known as spontaneous lateral ventral hernia
  • Sports hernia: a hernia characterized by chronic groin pain in athletes and a dilated superficial inguinal ring.
  • Velpeau hernia: a hernia in the groin in front of the femoral blood vessels

Characteristics

Hernias can be classified according to their anatomical location:
Examples include:
Each of the above hernias may be characterized by several aspects:
  • congenital or acquired: congenital hernias occur prenatally or in the first year(s) of life, and are caused by a congenital defect, whereas acquired hernias develop later on in life. However, this may be on the basis of a locus minoris resistantiae (Lat. place of least resistance) that is congenital, but only becomes symptomatic later in life, when degeneration and increased stress (for example, increased abdominal pressure from coughing in COPD) provoke the hernia.
  • complete or incomplete: for example, the stomach may partially or completely herniate into the chest.
  • internal or external: external ones herniate to the outside world, whereas internal hernias protrude from their normal compartment to another (for example, mesenteric hernias).
  • intraparietal hernia: hernia that does not reach all the way to the subcutis, but only to the musculoaponeurotic layer. An example is aSpigelian hernia. Intraparietal hernias may produce less obvious bulging, and may be less easily detected on clinical examination.
  • bilateral: in this case, simultaneous repair may be considered, sometimes even with a giant prosthetic reinforcement.
  • irreducible: the hernial contents cannot be returned to their normal site with simple manipulation.
If irreducible, hernias can develop several complications (hence, they can be complicated or uncomplicated):
  • strangulation: pressure on the hernial contents may compromise blood supply (especially veins, with their low pressure, are sensitive, and venous congestion often results) and cause ischemia, and later necrosis and gangrene, which may become fatal.
  • obstruction: for example, when a part of the bowel herniates, bowel contents can no longer pass the obstruction. This results in cramps, and later on vomiting, ileus, absence of flatus and absence of defecation.
  • dysfunction: another complication arises when the herniated organ itself, or surrounding organs, start to malfunction (for example, sliding hernia of the stomach causing heartburn, lumbar disc hernia causing sciatic nerve pain, etc.).

Treatment

Main articles: Hernia repair and Inguinal hernia surgery
Hernia repair being performed aboard the amphibious assault ship USS Bataan.
Surgery is usually recommended for most types of hernias to prevent complications like obstruction of the bowel or strangulation of the tissue, although umbilical hernias and hiatus hernias are usually left to heal on their own, or are treated with medication, respectively.[9] Most abdominal hernias can be surgically repaired, but surgery often has complications, such as chronic groin pain. Time needed for recovery after treatment is greatly reduced if hernias are operated on laparoscopically, the minimally invasive operation most commonly used today.[10] Uncomplicated hernias are principally repaired by pushing back, or "reducing", the herniated tissue, and then mending the weakness in muscle tissue (an operation called herniorrhaphy). If complications have occurred, the surgeon will check the viability of the herniated organ, and resect it if necessary.
Muscle reinforcement techniques often involve synthetic materials (a mesh prosthesis). The mesh is placed either over the defect (anterior repair) or under the defect (posterior repair). At times staples are used to keep the mesh in place. These mesh repair methods are often called "tension free" repairs because, unlike some suture methods (e.g. Shouldice), muscle is not pulled together under tension. However, this widely used terminology is misleading, as there also exists many tension-free suture methods that do not use mesh (e.g. Desarda, Guarnieri, Lipton-Estrin...).
Evidence suggests that tension-free methods (with or without mesh) often have lower percentage of recurrences and the fastest recovery period compared to tension suture methods. However, among other possible complications, prosthetic mesh usage seems to have a higher incidence of chronic pain and, sometimes, infection.[11]
One study attempted to identify the factors related to mesh infections and found that compromised immune systems (such as diabetes) was a factor.[12] Mesh has also become the subject of recalls and class action lawsuits.[13]
Laparoscopic surgery is also referred to as "minimally invasive" surgery, which requires one or more small incisions for the camera and instruments to be inserted, as opposed to traditional "open" or "microscopic" surgery, which requires an incision large enough for the surgeon's hands to be inserted into the patient. The term microscopic surgery refers to the magnifying devices used during open surgery.
Many patients are managed through day surgery centers, and are able to return to work within a week or two, while intense activities are prohibited for a longer period. Patients who have their hernias repaired with mesh often recover in a number of days, though pain can last longer, and often forever. Surgical complications have been estimated to be more than 20 percent. They include chronic pain, surgical site infections, nerve and blood vessel injuries, injury to nearby organs, and hernia recurrence.
Due to surgical risks, mainly chronic pain risk, the use of external devices to maintain reduction of the hernia without repairing the underlying defect (such as hernia trusses, trunks, belts, etc.) are often used. In particular, we can mention uncomplicated incisional hernias that arise shortly after the operation (should only be operated after a few months), or inoperable patients. There have been known cases where hiatal and esophageal hernias have shown signs of improvements after the patient stopped producing stress on the affected area by fasting or parenteral nutrition.It is essential that the hernia not be further irritated by carrying out strenuous labour.

Complications

Complications may arise post-operation, including rejection of the mesh that is used to repair the hernia. In the event of a mesh rejection, the mesh will very likely need to be removed. Mesh rejection can be detected by obvious, sometimes localised swelling and pain around the mesh area. Continuous discharge from the scar is likely for a while after the mesh has been removed.
A surgically treated hernia can lead to complications, while an untreated hernia may be complicated by:

Hernia





Hernia Overview

A hernia occurs when the contents of a body cavity bulge out of the area where they are normally contained. These contents, usually portions of intestine or abdominal fatty tissue, are enclosed in the thin membrane that naturally lines the inside of the cavity. Hernias by themselves may be asymptomatic (produce no symptoms) or cause slight to severe pain. Nearly all have a potential risk of having their blood supply cut off (becoming strangulated). When the content of the hernia bulges out, the opening it bulges out through can apply enough pressure that blood vessels in the hernia are constricted and therefore the blood supply is cut off. If the blood supply is cut off at the hernia opening in the abdominal wall, it becomes a medical and surgical emergency as the tissue needs oxygen, which is transported by the blood supply.
Different types of abdominal wall hernias include the following:
  • Inguinal (groin) hernia: Making up 75% of all abdominal wall hernias and occurring up to 25 times more often in men than women, these hernias are divided into two different types, direct and indirect. Both occur in the groin area where the skin of the thigh joins the torso (the inguinal crease), but they have slightly different origins. Both of these types of hernias can similarly appear as a bulge in the inguinal area. Distinguishing between the direct and indirect hernia, however, is important as a clinical diagnosis.
    • Indirect inguinal hernia: An indirect hernia follows the pathway that the testicles made during fetal development, descending from the abdomen into the scrotum. This pathway normally closes before birth but may remain a possible site for a hernia in later life. Sometimes the hernia sac may protrude into the scrotum. An indirect inguinal hernia may occur at any age.
    • Direct inguinal hernia: The direct inguinal hernia occurs slightly to the inside of the site of the indirect hernia, in an area where the abdominal wall is naturally slightly thinner. It rarely will protrude into the scrotum. Unlike the indirect hernia, which can occur at any age, the direct hernia tends to occur in the middle-aged and elderly because their abdominal walls weaken as they age.
  • Femoral hernia: The femoral canal is the path through which the femoral artery, vein, and nerve leave the abdominal cavity to enter the thigh. Although normally a tight space, sometimes it becomes large enough to allow abdominal contents (usually intestine) to protrude into the canal. A femoral hernia causes a bulge just below the inguinal crease in roughly the mid-thigh area. Usually occurring in women, femoral hernias are particularly at risk of becoming irreducible (not able to be pushed back into place) and strangulated. Not all hernias that are irreducible are strangulated (have their blood supply cut off), but all hernias that are irreducible need to be evaluated by a health care professional.
  • Umbilical hernia: These common hernias (10% to 30%) are often noted at birth as a protrusion at the belly button (the umbilicus). This is caused when an opening in the abdominal wall, which normally closes before birth, doesn't close completely. If small (less than half an inch), this type of hernia usually closes gradually by age 2. Larger hernias and those that do not close by themselves usually require surgery at age 2 to 4 years. Even if the area is closed at birth, umbilical hernias can appear later in life because this spot may remain a weaker place in the abdominal wall. Umbilical hernias can appear later in life or in women who are pregnant or who have given birth (due to the added stress on the area).
  • Incisional hernia: Abdominal surgery causes a flaw in the abdominal wall. This flaw can create an area of weakness through which a hernia may develop. This occurs after 2% to 10% of all abdominal surgeries, although some people are more at risk. Even after surgical repair, incisional hernias may return.
  • Spigelian hernia: This rare hernia occurs along the edge of the rectus abdominus muscle through the spigelian fascia, which is several inches lateral to the middle of the abdomen.
  • Obturator hernia: This extremely rare abdominal hernia develops mostly in women. This hernia protrudes from the pelvic cavity through an opening in the pelvic bone (obturator foramen). This will not show any bulge but can act like a bowel obstruction and cause nausea and vomiting. Because of the lack of visible bulging, this hernia is very difficult to diagnose.
  • Epigastric hernia: Occurring between the navel and the lower part of the rib cage in the midline of the abdomen, epigastric hernias are composed usually of fatty tissue and rarely contain intestine. Formed in an area of relative weakness of the abdominal wall, these hernias are often painless and unable to be pushed back into the abdomen when first discovered.
  • Hernia Symptoms can include:
    • Bulge or swelling
    • Pain
    • Nausea and/or Vomiting
    • Constipation
    • Urinary Symptoms
    • Other Symptoms

    • What is Hernia?

      We know that all the tissues of our body are contained in their respective organs. Now, an organ might be malformed and protrude or bulges out of their constituent tissue. Hernia occurs when the part of the body tissue, which holds the organ loses its firmness and tend to loosen thus causing the organ to protrude out of the weakened tissue.
      Hernia can occur in any part in our body;  however, the tissues of the abdomen are more vulnerable to it.

      What does Hernia do?

      Hernia is very painful and the movement of the part where it occurs is definitely going to be effected and lose agility. Once a person gets hernia, it is difficult to cure it. They are like the vicious circles that keep repeating at some point or the other. However, depending on the nature of the organ, there could be some temporary cure but no permanent relief. It could be dangerous to neglect hernia, might even be fatal.
      When the hernia within the bowels, gets twisted and may collapse, the blood circulation stops at that region, resulting in the death of the tissue. This is a serious situation and the person must undergo an operation immediately.

      Commonly known Hernia

      Although, there are several forms of hernia still, all of them do not frequently occur. The most commonly occurring ones are listed below:
      The Abdominal Wall Hernia is a well-known disease that occurs in at least 1 percent of the population. It is otherwise known as Epigastria or Ventral Hernia. The Umblical and Inguinal Hernias also fall under the Abdominal Wall Hernial category.
      Hernia
      Hernia Forms
      Next is the Indirect Inguinal Hernia, which is exclusive to men. This hernia gets its roots from the childhood itself. The intestinal canal, which passes through that of the testis, undergoes a loop and entering the scrotum. This results in abnormal growth of the scrotum.
      The Direct Inguinal Hernia affects both men and women. The intestine forms a loop in the interiors of the groin, causing it to bulge.
      The Femoral Hernia could be seen in both, men and women although most commonly women are vulnerable to it. This hernia affects the blood vessels in the thigh, where the loop enters the blood vessel canal. This will create a swelling in the groin and the inner part of the thigh.
      Umblical Hernia is another common hernia, where the loop of the intestine bulges out of the abdomen tissues, but stays below the skin. This is found in both men and women.
      The Hiatal Hernia occurs when the stomach loop comes out and grows upright, entering the lungs (through the diaphragm) and can affect both men and women.
      Another common form of hernia is the Incisional Hernia. This is an example of the recurring hernia that was mentioned earlier. After the surgery, when the tissue (operated tissue) suffers from excessive strain while lifting heavy loads or severe coughing, there is an excessive stress on the incisional tissue.
      Commonly known hernia forms
      Commonly known hernia forms

      Why does it Happen?

      A few Hernias might be present right from the childhood, although many are seen only after sometime. It happens due to the excessive pressure in the openings in the abdominal region. Hernia is a hereditary disease and even common coughs or strains during exercises and lifting weights, accumulation of foods in the abdominal canal or sometimes obesity might cause hernia. Sometimes chronic lung disease is known to be the main cause of hernia.

      Hernia Symptoms (Symptoms of Hernia)

      There might be many hernia symptoms, based on the type and the tissue affected. Mostly all the Hernia start off, as an unnoticeable breakthroughs of the tissues. They just appear as small chunks under the skin, which might be as small as a marble. The starting of Hernia is generally painless. But with time, the size increases as the pressure on the internal walls increases and it turns out to be pretty painful.
      To begin with, Hernia can be controlled, by just carefully treating the bulging parts and pushing them inside. This kind is called Reducible Hernia, but the ones, which cannot be controlled even after surgery, are called Irreducible or Incarcerated Hernia.

      Treatment of Hernia

      To control the growth of the tissues, one can use supports and binds for temporary relief. For a better solution, a surgery can be done on the affected muscles. This surgery is called as Herniorrhaphy. If the region affected is big, then some artificial material can be used to replace or sew the region. And necessary care has to be taken to avoid any infections after the treatment. In addition, the affected person should be very careful about the surgery and question the doctor about any doubts regarding the side effects of the surgery.

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