Learn the memory formula of internal medicine nursing once a day-related knowledge of hernia.

1, two basic causes of external abdominal hernia:

Decreased abdominal wall strength: common in the elderly. ? Elevated intra-abdominal pressure: common in young people.

2. Basic pathological anatomy of external abdominal hernia (this metaphor is very vivid): It seems that one hand holds a balloon: (1) Blowing hole (hernia ring) (2) Gas in the ball (hernia contents) (3) Balloon (hernia sac) (4) Hand (hernia cover).

3. Clinical types of external abdominal hernia

(1) Easy renaturation: Hernia contents can be easily reintegrated into abdominal cavity.

(2) Irreversible: The contents of hernia cannot or cannot be completely reintegrated into abdominal cavity without causing serious symptoms. The content of hernia is mostly omentum. Repeated protrusion of hernia contents and friction adhesion injury to the neck of hernia sac are common reasons. Such as sliding hernia (multiple on the right side, gastrointestinal symptoms), some giant hernia.

(3) Incarcerated hernia: the hernia entrance is small and the intra-abdominal pressure suddenly increases, and the contents of the hernia forcibly expand the neck of the sac into the hernia sac, and then the contents are stuck because of the elastic recovery of the neck of the sac, making it impossible to recover.

(4) Strangulation hernia: the continuation of incarcerated hernia, including Richter hernia (that is, intestinal wall hernia, incarcerated contents are only part of the intestinal wall, mesenteric side intestinal wall and its mesentery have not entered the hernia sac, and the intestinal cavity is not completely obstructed), Littre hernia (incarcerated small intestinal diverticulum) and retrograde hernia (the intestinal tube between incarcerated intestinal loops is hidden in the abdominal cavity).

4. Recurrent hernia: Recurrent inguinal hernia includes true recurrent hernia and false recurrent hernia, and the latter includes legacy hernia and new hernia.

Two. inguinal hernia

Oblique hernia is the most common, and males account for the majority. There are more on the right than on the left.

1, inguinal canal anatomy: four walls and two rings

Four walls: the front wall: the skin, subcutaneous tissue and aponeurosis of the external abdominal oblique muscle, and the external 1/3 is covered by the internal abdominal oblique muscle.

Posterior wall: transverse fascia and peritoneum, with peritoneum at 1/3.

Upper wall: the curved lower edge of the internal oblique muscle and transverse fascia of abdomen.

Inferior wall: inguinal ligament and lacunar ligament.

Two rings: the deep ring has an inner opening and the shallow ring has an outer opening.

2. Differential diagnosis of inguinal hernia: mainly grasp the difference between inguinal hernia and hydrocele (especially the latter is positive in light transmission test).

3. The difference between oblique hernia and straight hernia (multiple choice questions can be given) and the composition of the straight hernia triangle (the outer edge of rectus abdominis, inferior epigastric artery and inguinal ligament form the straight hernia triangle).

Differences: It can be distinguished from the age of onset, the way of protrusion, the shape of hernia mass, the compression of deep ring after retraction, the relationship between spermatic cord and hernia sac neck, the relationship between hernia sac neck and inferior epigastric artery, and the probability of incarceration. According to the World Wide Web, anatomical findings (the relationship between spermatic cord and neck of hernia sac, the relationship between neck of hernia sac and inferior epigastric artery) and readmission experiment (the hernia mass of indirect hernia is no longer prominent) are of diagnostic significance, but the former can be determined by intraoperative findings, and the latter can be determined before operation. Therefore, the most commonly used and reliable way to distinguish is to press the deep ring to see if the hernia block protrudes again.

Three. Treatment of inguinal hernia

1, Non-surgical treatment: 1 year-old may not have surgery for the time being, in addition, the elderly and weak or accompanied by serious diseases and contraindications for surgery. The former may make the hernia disappear by itself, because the baby's abdominal muscles can gradually become stronger. Both can be treated with hernial bands. The former is likely to be cured without surgery, and the latter is extremely small.

2. Surgical treatment: The most effective method for inguinal hernia is surgical repair.

(1) Traditional hernia repair: The principle is high ligation of hernia sac to strengthen or repair the inguinal canal wall.

A. High ligation of hernial sac: infant

B. Strengthening the anterior wall: the most commonly used method is Ferguson's method: sewing the lower edge of the internal oblique muscle and the tendon to the inguinal ligament in front of the spermatic cord.

C. methods of repairing and strengthening the rear wall:

(a) Bassini method: Suture the lower edge of the internal oblique muscle and the tendon of the same tendon to the inguinal ligament behind the spermatic cord.

(b) halsted method: It is similar to the above method, but the aponeurosis of the external oblique abdomen is also sutured behind the spermatic cord. The spermatic cord is located between the subcutaneous layer of the abdominal wall and the aponeurosis of the external oblique abdomen.

(c) Mcvay method: suture the medial oblique muscle and the syndesmosis to the pubic comb ligament behind the spermatic cord. This method is also suitable for direct hernia.

(d) Shouldice method: hernia repair focused on transverse fascia of abdomen.

(2) Tension-free hernioplasty: It makes up for the shortcomings of traditional hernioplasty, such as large suture tension, pulling feeling, pain and poor healing of repaired tissue after operation.

The commonly used material is synthetic fiber net. Tension-free hernia repair does not require high ligation of hernia sac according to the traditional method.

(3) Laparoscopic hernia repair

3. Treatment principle of incarcerated hernia and strangulated hernia: The principle of incarcerated hernia is that emergency surgery is needed, and the contents of strangulated hernia are necrotic and surgery is necessary.

Manual reduction of incarcerated hernia is only suitable for: (1) incarceration time is short (within 3-4 hours), local tenderness is not obvious, and there is no abdominal tenderness and peritoneal stimulation.

(2) Old and weak, or accompanied by other serious diseases (not suitable for operation) and the intestinal loop has not been strangulated and necrotic.

Note: After reduction, we should closely observe whether there is peritonitis or intestinal obstruction in the abdomen, and if there is, we should explore it as soon as possible.

4. Precautions in the operation of incarcerated strangulated hernia: (1) Avoid leaving necrotic loop in abdominal cavity; (2) Patients with incarcerated strangulated bowel resection and anastomosis due to necrosis only need high ligation of hernia sac, and generally do not need hernia repair, because the operating area is polluted (caused by intestinal necrosis after surgical resection), and the repair is easy to fail. Next notice: internal medicine nursing memory formula-respiratory system