Hiatal and Inguinal Hernia

• HIATAL HERNIA

  ● This is the intermittent protrusion of the stomach up through the esophageal opening in the diaphragm.
• ASSESSMENT

  ● Pain with vomiting; Shortness of breath

  ○ With a hiatal hernia, however, pain usually accompanies the

  vomiting. Shortness of breath may occur from compression of the lung space by the stomach.
• DIAGNOSIS

  ● History; Ultrasound or barium swallow

  ○ This will locate the abnormal anatomical position as shown in the photo.
• MANAGEMENT

  1. Keep baby in upright position.

  ● prevent the condition from recurring

  2. Administer medications to reduce acid secretions.

  ● such as H2 BLOCKERS and ANTACID

  3. Perform laparoscopic surgery to reduce the stomach’s ability to protrude through the diaphragm

  ● if the condition has not corrected itself by the time the infant is 6 months old, even with maintaining an upright position most of the day
• NGUINAL HERNIA

  ● This is the protrusion of a section of the bowel into the inguinal ring. It occurs usually in boys (9:1)

  1. In boys, as the testes descend from the abdomen into the scrotum late in fetal life, a fold of peritoneum also descends, this forms a tube from the abdomen to the scrotum.

  ● In most infant boys, this tube closes completely. If it fails to close, intestinal descent into it (hernia) may occur at any time when there is an increase in intra-abdominal pressure.
• 2. In girls, the round ligament extends from the uterus into the inguinal canal to its attachment on the abdominal wall.

  ● An inguinal hernia may occur because of a weakness of the muscle surrounding the round ligament.

  ASSESSMENT

  ● Appears as a lump in left or right groin

  ○ the hernia is apparent only on crying (when abdominal pressure increases) and not when children are lessactive

  ● Generally painless

  ○ pain at the site implies that the bowel has become incarcerated in the sac, an emergency that requires immediate action to prevent bowel obstruction and ischemia