HERNIA
w h i c h
t h e
e x t e r n a l
g e n i t a l i a
a r e
n o t
c l e a r l y m a l e o r f e m a l e . T r u e h e r m a p h -
r o d i t i s m i s e x t r e m e l y r a r e a n d i t s c a u s e
i s u n k n o w n . A m
o r e
c o m
m o n
c o n d i -
t i o n i s
p s e u d o h e r m a p h r o d i t i s m
,
i n w h i c h
t h e g o n a d s o f o n l y o n e s e x a r e p r e s e n t ,
b u t t h e e x t e r n a l g e n i t a l i a a r e n o t c l e a r l y
e i t h e r m a l e o r f e m a l e ,
o r a r e t h o s e o f
t h e o p p o s i t e s e x .
hernia
P r o t r u s i o n o f a n o r g a n o r t i s s u e t h r o u g h
a w e a k a r e a i n t h e m u s c l e o r t i s s u e t h a t
n o r m a l l y c o n t a i n s i t . T h e t e r m i s u s u a l l y
a p p l i e d t o a p r o t r u s i o n o f t h e i n t e s t i n e
t h r o u g h t h e a b d o m i n a l w a l l . I n a
h i a t u s
h e r n i a ,
t h e s t o m a c h p r o t r u d e s t h r o u g h
t h e d i a p h r a g m , i n t o t h e c h e s t .
CAUSES
A b d o m i n a l h e r n i a s m a y b e c a u s e d b y a
c o n g e n i t a l
w e a k n e s s i n t h e w a l l o f t h e
a b d o m e n .
H e r n i a s
m a y
a l s o
b e
t h e
r e s u l t o f d a m a g e c a u s e d b y l i f t i n g h e a v y
o b j e c t s , p e r s i s t e n t c o u g h i n g , o r s t r a i n -
i n g t o d e f a e c a t e ,
o r t h e y m a y d e v e l o p
f o l l o w i n g a n o p e r a t i o n .
TYPES
T h e r e
a r e
s e v e r a l
t y p e s
o f a b d o m i n a l
h e r n i a ,
w h i c h a r e
c l a s s i f i e d a c c o r d i n g
t o t h e i r l o c a t i o n i n t h e b o d y . T h e m o s t
i m p o r t a n t a r e
i n g u i n a l h e r n i a s , w h i c h
m a i n l y
a f f e c t
m
e n ;
f e m o r a l
h e r n i a s ,
w h i c h a r e m
o r e c o m
m o n i n o v e r w e i g h t
w o m
e n ; a n d u m b i l i c a l h e r n i a s , w h i c h
o c c u r i n b a b i e s .
SYMPTOMS AND TREATMENT
T h e
f i r s t
s y m p t o m
o f
a n
a b d o m i n a l
h e r n i a i s u s u a l l y a b u l g e i n t h e a b d o m i -
n a l
w a l l .
T h e r e
m a y
a l s o
b e
s o m e
a b d o m i n a l d i s c o m f o r t .
S o m e t i m e s
t h e
p r o t r u d i n g
i n t e s t i n e
c a n b e p u s h e d b a c k i n t o p l a c e ( k n o w n
a s
a r e d u c i b l e h e r n i a ) . I n o t h e r
c a s e s ,
h o w e v e r , t h e h e r n i a b u l g e s o u t a n d c a n -
n o t b e p u t b a c k ( a n i r r e d u c i b l e h e r n i a ) .
T h i s c o n d i t i o n i s p a i n f u l , a n d s u r g e r y i s
u s u a l l y n e c e s s a r y t o r e p a i r t h e w e a k e n e d
a r e a ( s e e
h e r n i a r e p a i r
).
I f t h e
t r a p p e d
p o r t i o n
o f i n t e s t i n e
b e c o m e s t w i s t e d ,
t h e b l o o d s u p p l y t o
t h e a r e a w i l l b e i m p a i r e d . T h i s p r o b l e m ,
k n o w n a s a s t r a n g u l a t e d h e r n i a , n e e d s
u r g e n t t r e a t m e n t , o t h e r w i s e
g a n g r e n e
o f
t h e b o w e l m a y d e v e l o p .
U m
b i l i c a l h e r n i a s i n b a b i e s c a n u s u -
a l l y
b e
l e f t u n t r e a t e d a s
t h e y
t e n d
t o
d i s a p p e a r n a t u r a l l y b y a g e f i v e .
hernia repair
S u r g i c a l c o r r e c t i o n o f a
h e r n i a
.
S u r g e r y i s
u s u a l l y p e r f o r m e d t o t r e a t a h e r n i a o f t h e
a b d o m i n a l w a l l t h a t i s p a i n f u l o r c a n n o t
b e p u s h e d b a c k i n t o p l a c e . A s t r a n g u l a t e d
h e r n i a ( i n w h i c h t h e b l o o d s u p p l y t o a
t r a p p e d p o r t i o n
o f i n t e s t i n e i s c u t
o f f )
r e q u i r e s a n e m e r g e n c y o p e r a t i o n .
D u r i n g s u r g e r y , t h e p r o t r u d i n g i n t e s -
t i n e i s p u s h e d b a c k i n t o t h e a b d o m e n
a n d t h e w e a k e n e d m u s c l e w a l l s t r e n g t h -
e n e d .
E i t h e r o p e n
o r
m i n i m a l l y i n v a s i v e
s u r g e r y
,
u s i n g
a n
e n d o s c o p e
t o r e p a i r
t h e h e r n i a f r o m w i t h i n t h e a b d o m i n a l
c a v i t y , m a y b e u s e d .
herniated disc
S e e
d i s c p r o l a p s e
.
herniorrhaphy
S e e
h e r n i a r e p a i r
.
heroin
A
n a r c o t i c
d r u g
s i m i l a r
t o
m o r p h i n e
.
W
h e n u s e d f o r m e d i c a l p u r p o s e s , i t i s
g e n e r a l l y k n o w n a s
d i a m o r p h i n e
.
H e r o i n
m a y a l s o b e a b u s e d f o r i t s m
o o d - a l t e r -
i n g e f f e c t s ( s e e
h e r o i n a b u s e
).
heroin abuse
N o n m e d i c a l ,
i l l i c i t
u s e
o f h e r o i n .
T h e
h e r o i n t a k e n b y d r u g a b u s e r s i s a w h i t e o r
b r o w n i s h p o w d e r t h a t c a n b e
s m o k e d ,
s n i f f e d , o r d i s s o l v e d i n w a t e r a n d i n j e c t e d .
MAIN TYPES OF ABDOMINAL HERNIA
At least 2 per cent of adult males in the
UK suffer at some time from this kind of
hernia, in which part of the intestine
bulges through the inguinal canal (the
passage through which the testes descend
into the scrotum). The hernia is detected as
a bulge in the groin or scrotum; untreated,
the hernia may become stuck, so early
surgery is generally recommended.
This type of hernia occurs most commonly
in obese women; partofthe intestine
emerges where the femoral vein and
artery pass from the abdomen to the thigh.
A femoral hernia is noticed as a swelling
of the top front of the thigh. Although the
hernia itself may be large, its neck is
narrow, and the condition can only be
corrected by surgery.
Also called a ventral hernia, an epigastric
hernia is caused by a weakness in the
muscles ofthe central upper abdomen;
the intestine bulges out at a point
between the navel and the breastbone.
This form of hernia is three times more
common in men than in women and is
most likely to occur in people between
20 and 50 years old.
This occurs when partofthe intestine
protrudes through the abdominal wall at
the navel. Babies are the most common
sufferers; the hernia can be repaired
surgically or it may disappear naturally by
about the age of five. A similar problem,
a parumbilical hernia, occurs mostly in
obese, middle-aged women who have had
several children.
An area ofweakness may occasionally
develop following a surgical incision
in the wall ofthe abdomen. This area
may then develop into an incisional
hernia. The defect may become so severe
that a large amount of intestine bulges
through the abdominalwall; if this
happens, a repair using a piece of mesh
may be necessary.
378
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