An abdominal hernia manifests itself by protrusion of a whole internal organ or its individual part through a gate into the subcutaneous region of the anterior body wall or into a formed pocket. In half the cases, the organs exit the abdominal cavity simultaneously with the parietal peritoneum covering the subcutaneous space from the inside. A characteristic manifestation of a hernia is a symptom of a coughing push.
To identify the connection of the arising urges with the disease, they put a hand to the protrusion and trace its behavior when coughing. Usually, a jerk is felt, which indicates a message of an abnormal formation with a peritoneum, the absence of such indicates a restraint of the hernia. Protrusion of organs occurs through a hernial gate. The parietal peritoneum with a part of the intestines, nerve endings, and tendons captured during exit is a hernial sac.
Peritoneal function
The fixing frame for vital organs helps in the process of homeostasis, fluid exchange, supports intra-abdominal pressure:
- performs a resorptive function, namely, it absorbs protein breakdown products, tissue necrosis, exudates, bacteria;
- serous cover in certain parts of the small and duodenum is able to secrete fibrin and fluid;
- a large omentum, which serves as a kind of barrier to infection of the inflammatory focus, gives mechanical protection to immunity of a cellular and humoral nature.
Abdominal line hernia and its complications
If an incompetent suture is made during surgery, the patient does not fully comply with the doctor’s instructions, then a recurrent hernia occurs, the gate for which is a thin scar site. Not operated hernia has the following complications:
- if the organs contained in the hernial sac are infringed, then their necrosis gradually occurs, which is dangerous by the occurrence of inflammation and is fatal;
- if part of the intestine is involved in the protrusion, then the passage of food masses and contents is difficult;
- to the appearance of peritonitis also leads to regional pinching of the lateral wall of the intestine, which leads to the necrosis of the captured area;
- purulent process develops (phlegmon);
- the hernia of the white line increases to enormous size, this leads to the case when, after its removal, the organs contained in the bag do not fit into the abdominal cavity.
Stages of peritonitis from the duration of the disease
In an acute inflammatory process in the abdomen , an ambulance is urgently called, procrastination is dangerous to human life. Peritonitis differs complete or affecting a specific area. Inflammation is caused by various aerobic and anaerobic species of bacteria that have fallen into the abdominal cavity. The method of determination according to the theory of L. S. Simonyan, depending on the pathological changes and the duration of the disease, distinguishes the stages of peritonitis:
- the reactive period lasts during the first day and is manifested by maximum symptoms;
- the transition to the toxic stage is carried out over a period of 24 to 72 hours, characterized by the appearance of messengers of intoxication and poisoning of the body;
- a deep, in most cases, an irreversible form develops after three days, the course of the disease with sharp manifestations of the local inflammatory process.
Classification of the disease by the nature of the infection
Primary peritonitis is rare, it accounts for about 1% of inflammatory phenomena. Infection occurs after microbes enter the peritoneum by the internal route, by the hematogenous, lymphogenous method or from the female reproductive organs through the fallopian tubes.
Diaphragmatic hernia causes secondary peritonitis after surgery or due to complications of injured peritoneal tissues. The following causes of infection are distinguished:
- infection from the inflammatory process;
- perforated path;
- microbial contamination due to injury;
- postoperative complication.
Varieties of peritonitis depending on other factors
The division into the acute and chronic stage comes from the symptoms and the clinical picture of the disease. The determination technique, depending on the exudate, allows you to identify the fibrinous, serous, purulent, fibrinous-purulent, hemorrhagic nature of the inflammation.
The etiological division of forms of peritonitis is caused by many varieties of microflora and bacteria that cause inflammation. The main pathogenic microbes to date are recognized as staphylococci, streptococci, anaerobes, protea, enterococci, Escherichia coli. The bacterial army includes pneumococci, gonococci, hemolytic streptococcus and other species.
In the etiological groups, a non-bacterial aseptic case of the disease is separately isolated, when the hernia of the diaphragm is complicated due to the penetration of urine, blood, bile or gastric juice into the peritoneal cavity. This is a dangerous picture, and peritonitis in a matter of hours turns into an infectious one, since the walls become permeable to bacteria very soon after the onset of inflammation.
Metabolic disorders
Violation of the water-electrolyte ratio in the body and protein balance is considered as an aggravating sign of an external hernia of the abdomen. The output of proteins is accelerated due to hypermetabolism, the loss of important building material is carried out with urine, vomit, exudate. Pronounced hypoproteinomy and a decrease in the amount of protein occur with extensive severe peritonitis.
Together with body fluids, potassium is released, it leaves the intercellular space, because of this, hypokalemia occurs in patients. After the development of the inflammatory process, the picture can radically change, since the excretion of fluid by the kidneys decreases, the death of a sufficient number of cells is noted. As a result of changes, hyperkalemia develops.
In two thirds of patients, alkalosis develops in the blood, sometimes a shift in the direction of acidosis arising as a result of circulatory disorders, disorganization of metabolic processes and hypoxia is detected in the tissues, these processes are interrupted by hernia removal.
In the stage of the terminal period with developing oliguria, the hematopoietic system begins to work on the production of acidic metabolic products, such as magnesium, nitrogen, potassium, phosphorus. There is a shift in blood counts towards respiratory and metabolic acidosis. Tests for acute peritonitis change quickly, so constant monitoring of blood, urine and other body fluids is recommended.
Symptoms of peritonitis
There are a number of standard signs by which it is known how to determine a hernia and inflammation of the peritoneum:
- severe unbearable pain in the peritoneum;
- heat;
- the stomach swells, becomes hard;
- a feeling of weakness throughout the body;
- vomiting and nausea;
- violation of the gastrointestinal tract, constipation, flatulence.
Cough Syndrome
It manifests itself in acute and chronic diseases of the abdominal cavity. Diagnosis of coughing was proposed by G. G. Karavanov and described in detail by I. M. Siomash. Many surgery clinics have adopted this symptom to preliminarily determine the sign of an inflamed abdomen.
Method of use
The fingers are slightly bent in the direction of the palm and the knuckles are slightly pressed on the study area. For some time after this action, nothing is done to ease the pain of pressure. After this, the patient is checked for a symptom of a cough push. He is offered to reproduce a cough, if after the procedure there is pain in the pressure area, then this indicates an inflammatory process inside the peritoneum.
Principle of operation
A sharp reduction in coughing spasms of the peritoneal wall and diaphragm transfers a push to the surface of the liver and lower organs. The filled intestine is also exposed, which transmits a downward movement. A sensation of pain appears when, when moving, one or another diseased organ encounters a region pressed by the hand. If the inflammatory process affects the peritoneum, then the pain sensation manifests itself from shaking of the inner layer, while the intra-abdominal pressure rises.
The author of the study, A. S. Cheremskaya, describes the effect of cough syndrome in relation to appendicitis. When coughing a patient in case of inflammation of the appendix, pain in the ileal region is constantly felt . The effect of this effect is somewhat different from cough with peritonitis and hernia.
Syndrome of diffuse acute peritonitis and the chronic stage of the disease cause different sensations during coughing. An older appendix reacts with intermittent breathing, as if the patient is trying to hold back the pain. The acute stage is characterized by unbearable pain. The symptom of a cough push differently reveals the stage of peritonitis.
In addition to peritonitis, hernia and appendicitis, this symptom manifests itself in acute and chronic diseases of other abdominal organs. Pain from cough stress appears in the case of gallbladder inflammation, stomach ulcers, bowel obstruction, etc. Thus, the symptom of a cough push differs from other studies in that it allows you to identify a large number of diseases at the initial stage.
Hernia and its varieties
Human protrusions can be acquired and congenital. The second option happens in newborn babies. This violation occurs due to an abnormally formed peritoneum in the fetal development. Acquired protrusions of the internal organs appear in the process of a patient's life and are divided into three types:
- with weakened muscles of the abdominal wall;
- due to significant sports or workload;
- post-traumatic, arising from a violation of the integrity of the peritoneum, if a previous operation takes place; the laser has an advantage over conventional surgical instruments in this case.
Internal hernias are located in the chest cavity or in the abdomen. External protrusion of organs is located in the following places:
- in the inguinal region;
- on the thigh from the inside or outside;
- on the lumbar sacrum;
- at the location of the perineum and pelvis;
- on the front of the body (hernia of the white line);
- in any area of the body on the scar from surgery.
A human hernia is classified as recurrent, complicated or not complicated (with the ability to correct). The first type includes protrusion, which constantly occurs again after surgery.
Symptoms of hernial protrusion
The initial stage occurs as a swelling of a round shape, which has a soft consistency, and the patient can independently level it with a light pressure. After repositioning on the surface of the peritoneum in this place, the entry gates, protruding in the form of a gap or a round defect in the abdominal wall, are felt.
Seal sizes vary from a couple of millimeters to several tens of centimeters. If a part of the intestinal wall or its body is captured in the hernial sac, then a characteristic gurgling sound of the passage of contents is heard upon palpation. Symptoms of sluggish hernia include constipation, nausea, heartburn, bloating, heaviness, and a violation of urination.
Removal of a hernia is recommended if the bulge is infringed, which is characterized by the following symptoms:
- most often there is a sudden sharp pain after weight lifting, physical exertion, bowel movements, infringement is rarely without any reason;
- at some point, the patient cannot, as before, even out the seal, it becomes hard and painful;
- along with previous symptoms, vomiting, upset stool are observed.
Causes of hernia
All causes are divided into conditionally disposed and jerky. The first group consists of reasons:
- birth defects and abnormal development of the abdominal wall;
- for some reason, the expansion of the natural weaknesses of the abdomen (femoral and inguinal rings, navel);
- decreased tissue resistance to stretching due to age-related changes or depletion of the body;
- the presence of post-traumatic weak areas on the abdomen or, if there was an operation, the laser produces the most safe incisions in this regard.
The following group refers to push or trigger factors and is the cause of an increase in pressure inside the abdominal cavity:
- hard work or power sports;
- frequent constipation;
- chronic cough;
- internal edema of the abdominal organs due to malfunctioning of the body;
- flatulence.
How to identify a hernia
The surgeon notes the presence of hernial protrusion after examining the patient and ascertaining the presence in the patient's life of the above-mentioned determining and jerking factors. Lifestyle, surgery and body injuries are taken into account. In order to find out which organs of the cavity are contained in the hernial sac, the doctor examines with the help of instruments and tools.
Ultrasound of the abdominal organs and the protrusion itself allows you to consider the internal content and diagnose differentiation with other diseases. The X-ray method is used for contrasting images of the bag and hernia collar.
Therapeutic procedures and surgical intervention
The main method of treatment is the surgical direction. Wearing a supportive bandage is prescribed for those patients who have serious contraindications against surgery, such as age-related changes or poor blood coagulation. Removal of protrusion is carried out according to the plan, if the patient is preparing for surgery, or in acute cases, surgery is carried out urgently. An example of such an unscheduled case is pinching a hernia with unbearable pain or physical bowel obstruction.
The operation consists in opening the hernial sac and examining the contents. If the internal organs are not damaged, they are straightened, and the bag and gate are sutured to impassable sizes. The plastic surgery of the gates is performed using tissues from the patient’s body or using synthetic materials of a new generation. It is mandatory to follow the doctor’s postoperative prescriptions to reduce the risk of a hernia protrusion.
In conclusion, it should be said that with the first symptoms of protrusion in the chest or abdominal wall, you should immediately consult a doctor. Surgery to remove a hernia is not a complicated operation, it is much more difficult to avoid the complications of running protrusion and pain associated with it.