Description hernia
Hernia or hernia is vakovité vychlípení peritoneum(peritoneum), which is a double membrane that lines the abdominal cavity and covers also organs in the abdominal cavity saved. Vakovité vychlípení contains part or parts of organs of the abdominal cavity. The basic difference between a hernia and prolapse is a continuous lining of the peritoneum, which is the authority for the herniation.
Hernia occurs in areas of the abdominal wall where the wall is weakened (mostly). On one side of the weakened abdominal wall, and on the other hand, applies increased intra-abdominal pressure, which pushes the future content of the hernia to vakovitého vychlípení. Increased intra-abdominal pressure occurs in a variety of conditions: very often it is the physical exertion of man, as well as chronic cough.
Regarding the weakening of the abdominal wall, so that the weakened mostly because of the anatomical arrangement, which is advantageous in that the hernia has exceptions typical localization. To explain what anatomical arrangement in relation to the hernia means an example, the slots between the muscles, which stiffens the abdominal wall. The reason for the weakening of the wall but can be congenital malformation or postoperative scars where the hernia may also develop.
For an accurate description of hernia doctors use several terms. For each hernias are three basic parts: a hernia gate, hernia sac and finally hernia contents.
Hernia gate, a channel or ring that establishes communication between the abdominal cavity and kýlním bag. Hernia sac is formed by the peritoneum. The contents of the hernia generally consists of moving organs of the abdominal cavity.
Often it is called gut hanging apparatus. Omentum, then Kyle says epiplokéla, other times it loops of small intestine, then of course we are talking about enterocele. In kýlním bag contents can be stored freely, then called free hernia (hernia Libero) or may coalesce with the wall (hernia accreta).
Signs and symptoms of hernia
Leaning inguinal hernia Direct inguinal hernia Femoral hernia obturatorious hernia Umbilical herniahernia scar Nadbřišková hernia Internal hernia
The hernia manifests itself primarily palpation or eyes, as well as pain. The main risk for the patient is that the hernia may uskřinout.
The entrapment can occur in different ways: entrapment elastic, which often occurs when straight hernia. The mechanism consists of elastic strangulation hernia formation dynamics. Hernia is due to increased intraabdominal press formed, but after what intraabdominal pressure decreases, the loop of the small intestine (most often), the throttling due to the reduction circuit hernial gates.
Faint or incarceration obstipační mechanism occurs over time. A hernia is a relatively broad goal, of course, intestinal loops begin to fulfill the intestinal contents and gases, which in turn increases the inlet and outlet of the bowel loop until Hernia goal is not big enough.
Now we meet a condition that occurs after hernia incarceration. It leads to intestinal obstructionand begin to develop so-called. Strangulation ileus. Ileus is a condition which does not process the intestinal contents, which are accumulated and expands the digestive tube (often up to enormous dimensions).
Kyle is also the conclusion of the afferent vessels, which can ultimately cause necrosis of the bowel. The accumulation of intestinal contents vigorously propagate bacteria that produce toxic products for humans and that impaired intestinal wall through and flood the entire body. Another consequence of the metabolic and ionic disruption.
Untreated ileus death. The intestine may perforate and flood the abdominal cavity its content, causing massive peritonitis, which again is a life-threatening condition.
Intestinal loops need not only uskřinout hernia goal, but Kyle can rotate around its long axis. This condition is called volvulus in hernia. Clinically volvulus effect as ileus.
Hernias can be divided into several clinical forms depending on where you created (in connection with the anatomical localization).
Leaning inguinal hernia
The hernia follows the path through which a testicle during prenatal life. The testicle is located in the kidneys, where it descends anatomical its way into the scrotum at the end of prenatal life.Descended testicles are one of the signs of full-term male fetus.
If the testicle does not descend, we talk about. Cryptorchidism, which may itself be adjusted. If not, you need surgical removal, as undescended testicle at a high risk of developing malignant tumor.
For the formation of a hernia it is important to preserve (persistence) processus vaginalis, which can be imagined as a tunnel which passes testicle. They can be two basic situations, namely that it is processus vaginalis preserved in its entire length, then the whole itself processus vaginalis is itself kýlním bag and its contents, including the testis kýlním content – the whole situation is called a hernia vaginalis testicularis.
If the processus vaginalis retained only a small part, then penetrates hernia around the spermatic cord and tunica vaginalis testis (testicle package) does not communicate, we talk about the game vaginalis funicularis. Clinically, this hernia manifests itself as a small bump in the outer part of the inguinal canal (canalis inguinalis). Later hernia can descend to the scrotum – scrotalis hernia.
In women, the situation is more complicated, because they are not formed testis nor processus vaginalis. Hernia may descend along the characteristic structures – along ligament rotundum up to the great pubic lip – the situation is called a hernia labialis.
Direct inguinal hernia
This species is much rarer than oblique hernia. Hernia penetrates the gap between the muscles (oblique abdominal muscles) before pushing a transverse fascia until it gets to the outer mouth of the inguinal canal. This hernia is never congenital (unlike previous). We can usually find it in men older than 40 years.
femoral hernia
Femoral hernia begins below the inguinal ligament toward navnitř from the femoral vein. Undergoes a characteristic structure – canalis femoralis. This hernia, unlike previous predominantly occurs in women of advanced age. Usually of small dimensions, often strangulated.
obturatorious hernia
Obturatorious hernia penetrates the channel in the muscle (musculus obturator, which attracts thigh toward the midline – but these muscles is more). Under the skin gets back in typical localization – fossa ovalis. Hernia content is the intestine.
Affected are again more women.
Umbilical hernia
This species is necessary to distinguish from umbilical hernia, from which it differs from the above that arises after childbirth. In children, it arises as enterocele (see above). In adults, this option is presented epiplokélou (see above), which occurs exclusively in women due to expansion and bowing umbilical scar due to repeated pregnancy or obesity
Hernia scar
Incisional hernia occurs frequently in operations in the abdominal cavity. Usually they appear only as bulging scars, but it can occur right hernia.
Nadbřišková hernia
This hernia penetrates the shroud of both direct abdominal muscle (aponeurosis musculi recti abdominis).
With this hernia man may be born, but often occurs as a result of separation of the abdominal muscles after repeated pregnancies.
internal hernia
These form a separate group of hernias that bulge inside the abdominal cavity, and projections into the peritoneum (the so-called. Peritoneal recession). Externally, these hernias are not at all obvious.Again, divided by anatomical site (recesus each has its own name, according to him, is known as well as possible hernia in it).
Hernia mesocolica Treitz hernia or are formed in the processus duodenojejunalis (front part of the small intestine). The actual hernia sac lies behind the peritoneum wall to the left of the spine. It contains the small intestine, which may rarely uskřinout. Otherwise, the patient does not cause trouble.
Hernia bursae omentalis is another example of an internal hernia. Created by inserting a small or large intestine into the bursa omentalis (the space behind the stomach – very simply put).
The last example is diaphragmatic hernia, which may be congenital and acquired throughout life.Risk of hernias is that it may oppress the lungs, which are improperly developed.
treatment of hernia
A hernia is treated by surgery. The surgeon returns the abdominal organs into the abdominal cavity, fixes them and reponuje peritoneum.
complication of hernia
The most serious complication is ileus, which was described above.
Other names: hernia, bar, inguinal hernia, femoral hernia, obturatorious hernia, umbilical hernia, hernia scar, nadbřišková hernia, internal hernias
