Hernia - Causes, Symptoms and Treatment .MF .
Hernia - protrusion of the viscera with the parietal layer of a peritoneum through a defect in the muscle layer of the abdominal wall under the skin.Distinguish femoral hernia, hernia the white line hernia inguinal, umbilical hernia, hernia postoperative, strangulated hernia.Femoral hernia is more common in women.Hernial ring is femoral canal, the insides out inwards from the hip joints.
There are many types of hernias.Almost all the show point to the place of hernia output (eg, inguinal hernia), some - in the name of the scientist who first described them (for example, hernia Richter).The most famous types are:
- inguinal hernia, in which the hernial sac is located in the inguinal canal;
- thigh - hernial sac is located along the large vessels on the inner side of the thigh at the site of the outcome of these vessels from the abdomen;
- Umbilical - hernial sac comes either through the umbilical ring or exit through the site of placental vessels;
- diaphragmatic - hernial sac comes through a hole i
- -posledstvie ventral abdominal wall injury if the muscle layers is not reconstructed.
hernia sometimes located inside the abdominal cavity, if the hernial sac goes, for example, through the sciatic foramen;These hernias occur infrequently, and some do not matter.
intra-abdominal hernias arise as a result of penetration of the internal organs in various pockets of the peritoneum: about blind or sigmoid colon, the packing bag near Treitz ligament.Hernias of this type appear only during complications, infringement occurs when a partial or complete intestinal obstruction, which leads the sick on the operating table.During laparotomy finding infringement of the internal hernia.The disease is very rare.
hernia is either congenital or acquired.Congenital appears due to vulnerabilities or potential hernial ring, existing from birth.Some hernias can be corrected, others can not.A large number of irreducible hernia violated and cause symptoms similar to symptoms of intestinal obstruction.The hernial sac may be small or large intestine, urinary bladder, fold of peritoneum or ovary.
Signs and over.
noted protrusion in an area where there was a hernia, palpation oboznalsya hernial, when you cough - that is, the finger that put the ball in the hernial feels a push in the internal organs when coughing.Very common complication is infringement.There is also an inflammation of the hernia sac and cellulitis.With extensive ruptures can occur ileus in the hernial sac.
The most dangerous complication is considered infringement, in which due to the pressure in the hernial ring is a disturbance of blood circulation in the organs, which fell into the hernial sac, with their probable necrosis.If such patients svoevremennon not operate, it may obrazovatsya peritonitis, cellulitis hernia sac, acute intestinal obstruction.
The cause of hernia is considered a weakness of the cavity wall, where herniated penetrate, leading the appearance of the wall defect.This is facilitated by factors such as increased intracavitary pressure (for example, intra-abdominal at constant coughing, weight lifting) and congenital defects in the walls of the cavities or not zarubtsevanie congenital holes.
hernia hernia diagnosis is as follows:
Complaints patient: it may be complaints about the presence of occurrence of protrusions in a particular area have fallen ill, which occurs during exercise.In addition, it can be observed small blunt temporary pain in the bulge region.If the pain in the bulge area, which no longer disappear from the patient, constant, this indicates irreducible hernia.
Instrumental methods of examination: these include a method such as transillumination, is used to the differences scrotal hernia from dropsy.It includes an examination region via scrotal luminous element.
Physical methods of examination: doctor after examining the protrusion touches it, determines its density, reduce a whether it is in the cavity, and also notes the status of the natural channels and holes (not expanded if they, for example, the introduction of the fingertip in the inguinal canal, there is not increasedDoes he)
Yet another method of examination - is ultrasound.
Inguinal hernias account for between 80 and 90 per cent other types of hernias.Among cases with inguinal hernias are men between 90 and 97 percent, and women from 3 to 10 percent.More frequent occurrence of inguinal hernias in men is associated with the peculiarities of the anatomical structure and the inguinal region in men.Inguinal hernias are both so acquired and congenital.
Congenital inguinal hernia.
If the vaginal portion of the peritoneum is completely unhealed, its cavity without difficulty in communication with the cavity of the abdominal part.Later formed congenital inguinal hernia, where the processus vaginalis is a hernia sac.Congenital inguinal hernias account for the principal amount of hernias in children.Still in adults appear congenital inguinal hernia.
Acquired inguinal hernia.
Distinguish external oblique inguinal hernia and internal inguinal hernia.Oblique inguinal hernia goes through the external inguinal fossa;straight - dumped the medial inguinal fossa.In the initial stage of development of oblique inguinal hernia vypyachevanie unnoticed.When the voltage or coughing patient is denoted by an oval-shaped swelling, which disappears quickly after only ill ceases to strain at the bottom of the channel form of hernia sac comes to the external opening of the inguinal canal.When the cord form the hernia passes through the external opening of the inguinal canal and located at different heights of the spermatic cord.When inguinal-scrotal hernia opuskaetsyav form the scrotum, increasing it.Only in the early stages of the disease oblique inguinal hernia has an oblique direction.As growth hernia inner opening of the inguinal canal is expanded in the medial direction, pushing the epigastric vessels medially.
When continuously existing inguinal-scrotal hernias inguinal canal acquires a forward direction, and the upper opening of it is almost flush with the inner hole of the so-called oblique hernia rectified with speed.
For large hernia scrotum greatly increases in size, the penis is hidden under the skin, the contents of the hernia are not individually reduce a into the peritoneum.When you reposition heard rumbling in the stomach.
Direct inguinal hernia passes from the abdominal cavity through the medial hole, sticking a transverse back wall of the inguinal canal.Coming through the external opening of the inguinal canal, scrotum razrostaetsya at the root of occlusive disease in a circular formation.Very often a direct inguinal hernia is bilateral.
Define a special group of in-wall inguinal hernias.Under these hernias hernial sac located between the different layers of the abdominal wall.
Separate preperitoneal hernia is when the hernial sac lies between the peritoneum and the transverse fascia, intermuscular hernia, when the hernial sac is located between layers of muscle and aponeurosis;surface hernia, when the hernial sac located behind the superficial inguinal ring between the aponeurosis of the external oblique abdominal muscles and superficial fascia.
Clinic and diagnosis: to identify the formed inguinal hernia is not difficult.The classic symptom is history: the sudden appearance of a hernia at the time of physical effort or the gradual development of herniation, bulging appearance of the abdominal wall at a voltage in the vertical position of the body of the sick and the reduction of a hernia in the horizontal position of the patient.Sick bothers pain in the hernia, abdominal pain, feeling of discomfort when walking, dyspeptic symptoms, while sliding hernia of the bladder appear dizuricheskie manifestations.
diagnosis of inguinal hernia is as follows:
Survey sick in a vertical position gives an idea of the asymmetry of the inguinal regions.If there is a bulging of the abdominal wall, you can determine the size and shape of the hernia.When the feeling determine surface texture hernial protrusion, intestinal rumbling, percussion - percussion sound.Finger examination of the external opening of the inguinal canal is performed in the horizontal position of the patient after reposition the contents of the hernia sac.Dr. forefinger invaginiruya the skin of the scrotum, enters the surface opening of the inguinal canal, which is located inside and slightly higher from the pubic tubercle.A survey of inguinal hernias in women is based on inspection and palpation, since the introduction of the finger into the external opening of the inguinal canal is impossible.
Women inguinal hernia distinguish a cyst round ligament of the uterus, which takes place in the inguinal canal.
cyst round ligament of the uterus, unlike a hernia does not change its size with the horizontal position of the patient, percussion sound on it is always dull, and may be over the tympanic hernia.
Featuring inguinal hernia need from hydrocele and spermatic cord, inguinal ectopic testis femoral hernia.
Dystrophic violations in the lumbosacral spine are most pronounced between the ages of twenty to fifty years and are one of the most frequent causes of temporary disability and often - disability of the patient.Up to fifty percent of all surgical interventions in hospitals neurosurgical profile held on the disc pathology at the lumbosacral level.
herniated disc is the most common and most difficult detection of osteochondrosis.This forms the pain radicular syndrome, which may be accompanied by paresis or paralysis of the lower limbs, sensory disorders, pelvic organs.Nineteen percent of patients with herniated intervertebral discs require surgical treatment.
disease occurs as a result of rupture of the intervertebral disc.Emerging with a hernia, standing back and to the side, pressing on the nerve root at the point of exit from the spinal canal and provoke inflammation accompanied by edema.This explains why the pain and loss of sensation appear only one day after the onset of the disease.A pinched nerve root sends to the brain pain impulses that are perceived by the sick as if they come from the legs.Some nerve, located off-site hernia pressure almost ceases to function, which leads to a decrease in sensitivity and Hassle appearance of weakness in the leg.
Almost all cases the main complaint is pain.Very often, the pain occurs in young adulthood after moderate physical exertion, awkward position in the workplace or in bed.The disease often occurs at an inclination while turning away, often in combination with the heavy lifting.Characterized by sudden and not very strong strong pain in the lumbar region.Then, during the day there is pain and weakness in one leg, sometimes with loss of sensitivity to pain appears inside of the foot and the lower part of the tibia or on the outer side of the foot and the inside of the shin.When movements, coughing, sneezing or straining, back pain and leg amplified and often become so intense that the sick need bedrest.
Some of improvement can be achieved in the supine position, lifted legs or placing them on a pillow.
There are two stages of the disease.
At the first stage there is pain in the lumbar region, which indicates the beginning of the degenerative process.Under the influence of degenerative changes in the vertebral-motor segment is broken quite a complicated structure of the fibrous ring, are formed in the radial cracks, which reduces its strength.The nucleus pulposus protrudes, blood circulation in this zone, there is a local tissue edema, adhesions, hypoxia roots of the spinal cord.There is pain, leading to pathological miofixation zone due to tension in the muscles and because of this there is a compensatory curvature of the overlying spine.Later prolonged pathological impulses leads to dystrophic violations joint and ligament apparatus.
At the second stage the nature of pain varies.There is a compression radicular syndrome, which is caused by mechanical compression and stretching the spine.This gives rise to the spine swelling, broken its blood supply.In direct contact with a herniated disc spine, chemical stimulation causes a strong pain.Often the appearance of radicular pain in the lumbosacral area pain diminish or disappear.Apparently, this is due to a decrease in vnutridiskovogo pressure due to rupture of the fibrous ring.
Very often observed vegetative narushneniya as hypothermia, skin, their pastosity, broken
sweating, increased skin dryness.
Quite often, patients take a forced situation.Compensatory posture, reducing the degree of pressure and tension spine manifested scoliosis, lumbar lordosis seal, limiting flexion and extension of the body, long back muscle strain.Occasionally ill can not straighten his leg because of the pain.Motor change in the form of paresis or paralysis are rare, they are more typical for severe cases.May include the trophic disorders in the form of "weight loss" due to muscle atrophy.
Symptoms of inguinal hernia.Patients complain of pain and the presence of a small tumor in the groin crease.On examination, it marked protrusion (hazelnut) oval.Flexing is not shifted to the side, to the touch - soft consistency.
Hernia white line appears between the tendon fibers forming the white line of the abdomen.
Symptoms of hernia the white line.Patients complain of pain, resembling the nature of the pain of stomach ulcers and other gastrointestinal diseases.On examination, sometimes determined by a small protrusion in the white line that appears in the main straining.
inguinal hernia appears in the inguinal canal.If the hernial protrusion begins in the internal inguinal ring, and further extends through the channel parallel to the spermatic cord, and then goes under the skin through the external inguinal ring, then this is called oblique hernia.If the hernial protrusion begins in the rear wall at the external inguinal ring, the hernia is called a straight line.
Symptoms of inguinal hernia.Oblique inguinal hernia sac attains a large size, a hernia in the form of an oval bulge down into the scrotum in men or sexual lip in women.With the direct inguinal hernia hernial protrusion has the form of half of the world, it is located closer to the pubic articulation.
umbilical hernia appears in the umbilical ring.When the feeling finger clearly feels the edge of the umbilical ring and the hernial protrusion;easy to reduce a into the abdominal cavity.
symptoms of umbilical hernia.Pain, nausea.
postoperative hernia appears in a place dispersed edges postoperative suture.
Symptoms of postoperative hernia.Pain, nausea, vomiting, and sometimes constipation.
strangulated hernia occurs in cases when under the influence of a strong and quick contraction of the abdominal muscles and increase intra-abdominal pressure occur compression of the hernial ring and infringement of hernia sac - bowel loops or omentum (the latter in case of hernia the white line).In the place of infringement is a violation of blood circulation in the tissues, which leads to their necrosis and peritonitis.
Symptoms of strangulated hernia.A hernia does not reduce a, there are severe pain in the bulge in the lower abdomen.If the infringement intestine is delayed stool and gas, bloating, and vomiting.Traditional methods hernia.Treatment operative.
At this time, there is only one type of hernia -operativny.Exceptional effective method is operational.Surgery is best done during the cold time of the year, without waiting for complications or infringement.Attempts to reposition hernial protrusion when infringement is not possible because of the risk to straighten the body with changes in blood circulation in the abdominal cavity.