The Hernia definition says that “It occurs when an organ or a tissue protrudes or bulges out through a weakening of a muscle wall that encloses the abdominal cavity. The sac that bulges out through the weak portion might contain a piece of intestine or a fatty lining of the colon if a hernia occurs in the abdominal wall or the groin. If a hernia via the diaphragm, the muscle that separates the chest part from the abdomen then the part of the stomach might also be involved.
The abdominal wall is composed of layers of different types of muscles and tissues. Weak spots might also develop in these layers to allow the contents of the abdominal cavity to protrude or herniate. The most common abdominal hernias are developed in the groin or hernia groin (inguinal hernias), the diaphragm (hiatal hernias), and hernia belly button or hernia stomach (umbilicus). Hernias might be present at birth (congenital), or they might develop at any time after (acquired).
TYPES OF HERNIA:-
- Inguinal hernias:- The most common type of the abdominal hernias. The inguinal canal is an opening that permits the spermatic cord and the testicle to descend from the abdomen to the scrotum as the fetus develops and matures. After the testicle descends, the opening of the canal is supposed to close tightly, but in some cases, the muscles that attach to the pelvis left behind a weakened area. If some stress is placed on that area, the weakened tissues allow the portion of small bowel to slide through the opening, causing pain and a bulge.
- Femoral hernia:- Occur via the opening in the floor of the abdomen where there is some space for the femoral artery and the vein to pass from the abdomen to the upper leg.
- Obturator hernias:- They are the least common hernia of the pelvic floor. These are most commonly found in the women who had multiple pregnancies or the one who has lost weight. It occurs via the obturator canal which is another connection of the abdominal cavity to the leg and contains the obturator artery, vein, and the nerve.
The test for the diagnosis include:
- X-ray of the upper digestive system:- X-rays are taken after a person drink a chalky liquid that coats the inside lining of the digestive tract. This coating allows the doctor to see a silhouette of the esophagus, stomach, and the upper intestine.
- Upper endoscopy:- The doctor inserts a thin and flexible tube equipped with a light and a camera (endoscope) down the throat, to examine the inside of the esophagus and the stomach and check for the inflammation.
- Esophageal manometry:- This test measures the rhythmic muscle contractions in the esophagus when a person swallows. It also measures the coordination and the force exerted by the muscles of the esophagus.
They are used if the patient contains a strangulated hernia. The broad-spectrum antibiotics, mainly ampicillin and gentamicin, should be given in such cases of gastroschisis and to the patients with large omphalocele.
- Cefoxitin:- Multiple regimens that include bowel perforation or the ischemic bowel can be used. Cefoxitin provides the coverage for both aerobic as well as anaerobic gram-negative bacteria.
- Gentamicin:- It is an aminoglycoside antibiotic which is used for the gram-negative bacterial coverage. It is mainly used in combination with an agent, effective against gram-positive organisms and that covers the anaerobes. The drug is used in combination with ampicillin for the prophylaxis in patients with open surgeries.
- Ampicillin:- It is used in combination with gentamicin for the prophylaxis in patients with open surgeries. It interferes with the synthesis of the bacterial cell wall during the active replication, leading to a bactericidal activity against the susceptible organisms.
- Lidocaine and epinephrine:- Lidocaine is a local anesthetic used in around 0.5-1% concentration in combination with bupivacaine in a 50:50 mixture. This agent helps inhibit the depolarization of type C sensory neurons by blocking down the sodium channels. Epinephrine help prolongs the duration of the anesthetic effects of lidocaine by causing vasoconstriction of the blood vessels which surrounds the nerve axons.
- Bupivacaine:- Bupivacaine in 0.25% concentration is used in combination with lidocaine and epinephrine. It decreases the permeability of sodium ions in the neuronal membranes. This results in the blockage of depolarization, thus blocking the transmission of the nerve impulses.
- Propofol:- It is a phenolic compound unlike other types of anticonvulsants. It contains general anesthetic properties when it is administered intravenously. Propofol produces rapid hypnosis, mainly within 40 seconds. The effects are then reversed within 30 minutes following with the discontinuation of the infusion. Propofol also shows anticonvulsant properties.
- Thiopental:- It is a short-acting barbiturate, sedative or hypnotic with the rapid onset and duration of action of around 5-20 minutes. Like methohexital, it is used as an induction agent for intubation.
- Lorazepam:- It is a sedative-hypnotic consisting of benzodiazepine, having a rapid onset of action and a relatively long half-life. By increasing the activity of the gamma-aminobutyric acid (GABA), which is a major inhibitory neurotransmitter, it might depress the levels of the central nervous system (CNS), including the limbic system and the reticular formations.
- Midazolam:- It is a sedative-hypnotic type of the benzodiazepine class that provides the initial sedation as well as amnesia.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
These agents contain analgesic, anti-inflammatory, and antipyretic activity. Their mode of action is not known but they might inhibit the cyclooxygenase (COX) activity and prevent prostaglandin synthesis. Other mechanisms also occur such as the inhibition of leukotriene synthesis, lysosomal enzyme release, the lipoxygenase activity, neutrophil aggregation, and certain cell membrane functions.
- Diclofenac:- It inhibits the prostaglandin synthesis by enhancing the COX activity, which, decreases the formation of the prostaglandin precursors.
- Ibuprofen:- It is the drug of choice for the patients with mild to moderate pain. It helps inhibit the inflammatory reactions and the pain by lowering the prostaglandin synthesis.
- Sulindac:- It decreases the activity of the COX and, in turn, it inhibits the prostaglandin synthesis. This causes the lowering the formation of the inflammatory mediators.
- Naproxen:- It is used for relief of mild to moderate type of pain. It inhibits the inflammatory reactions and the pain by lowering the activity of the enzyme COX.
- Meloxicam:- It decreases the COX activity and, this, in turn, inhibits the prostaglandin synthesis. These effects decrease the formation of the inflammatory mediators.
- Ketoprofen:- It is used for the relief of mild to moderate pain and the inflammation.
- Flurbiprofen:- It inhibits the COX, thus inhibiting the prostaglandin biosynthesis. These effects result in the analgesic, antipyretic, and the anti-inflammatory activities.
- Acetaminophen and Codeine:- This combination of the drugs is indicated and used for mild to moderate pain.
- Acetaminophen:- It is the drug of choice for the treatment of the pain in patients with hypersensitivity to aspirin or NSAIDs, as well as in patients with the upper GI disease or who intake oral anticoagulants.
- Hydrocodone Bitartrate and Acetaminophen:- This combination of the drugs is indicated and used for the relief of the moderately severe to severe pain.
- Tramadol:- It is an analgesic drug that acts over the monoaminergic and the opioid mechanisms. Its monoaminergic effect is similar to the tricyclic antidepressants. Tolerance and dependence are uncommon.