A hernia occurs when tissue bulges out through an opening in the muscles. Any part of the abdominal wall can weaken and develop a hernia, but the most common sites are the groin (inguinal), the navel (umbilical) and a previous surgical incision site (incisional/ventral).
A groin (inguinal) hernia occurs when the intestine or fat tissue bulges through the opening in the muscle in the groin area. There are two types of groin hernias: An inguinal hernia that appears as a bulge in the groin or scrotum. Inguinal hernias account for 75% of all hernias and are most common in men. A femoral hernia appears as a bulge in the groin, upper thigh, or labia (skin folds surrounding the vaginal opening). Femoral hernias are 10 times more common in women.
A navel (umbilical) hernia occurs when part of the intestine or fatty tissue bulges through the muscle near the belly button (navel, umbilicus). Most (9 of 10) umbilical hernias in adults are acquired. This means that increased pressure near the umbilicus causes the umbilical hernia to bulge out.
An abdominal wall (ventral ) hernia is a bulge through an opening in the muscles on the abdomen. It can occur at a past incision site (incisional – possibly the result of weak muscles around the site or scar tissue), above the navel (epigastric), or other weak muscle sites.
A reducible hernia can be pushed back into the opening. When intestine or abdominal tissue fills the hernia sac and cannot be pushed back, it is called irreducible or incarcerated. A hernia is strangulated if the intestine is trapped in the hernia pouch and the blood supply to the intestine is decreased. This is a surgical emergency.
Signs and Symptoms
- Bulge in the groin, scrotum, or abdominal area that often increases in size with coughing or straining.
- Mild pain or pressure at the hernia site.
- Numbness or irritation due to pressure on the nerves around the hernia.
- Sharp abdominal pain and vomiting can mean that the intestine has slipped through the hernia sac and is strangulated. This is a surgical emergency and immediate treatment is needed.
The site is checked for a bulge during a History & Physical Exam. Other tests may include
- Digital exam
- Blood tests
- Electrocardiogram (ECG)—for patients over 45 or if high risk of heart problems
- Computerized tomography (CT) scan
Open hernia repair—The surgeon makes an incision near the hernia site and the bulging tissue is pushed back into the abdomen. Mesh is often used in inguinal hernia repairs to close the muscle. An open repair can be done with local anesthesia. For an open mesh repair, the hernia sac is removed. Mesh is placed over the hernia site. The mesh is attached using sutures sewn into the stronger tissue surrounding the hernia site. Mesh plugs can also be placed into the inguinal or femoral hernia space. The mesh plug fills the open site and is sutured to the surrounding tissue. An additional mesh patch is applied and may or may not be sutured. Mesh is often used for large hernia repairs and may reduce the risk that the hernia will come back. The site is closed using sutures, staples, or surgical glue. In a suture-only repair, the hernia sac is removed, then the tissue along the muscle edge is sewn together. This procedure is often used for strangulated or infected hernias or small defects (less than 3 cm). Your surgeon may inject a local anesthetic around the hernia repair site to help control pain.
Laparoscopic hernia repair—The surgeon will make several small punctures or incisions in the abdomen. Ports (hollow tubes) are inserted into the openings. The abdomen is inflated with carbon dioxide gas to make it easier to see the internal organs. Surgical tools and a laparoscopic light are placed into the ports. The hernia is repaired with mesh and sutured or stapled in place.
The appendix is a small pouch that hangs from the large intestine where the small and large intestine join. If the appendix becomes blocked and swollen, bacteria can grow in the pouch. The blocked opening can be from an illness, thick mucus, hard stool, or a tumor.
Appendicitis is an infection of the appendix, which can decrease blood supply to the wall of the appendix, causing tissue death. The appendix can rupture or burst, causing bacteria and stool to release into the abdomen. A ruptured appendix can lead to peritonitis, an infection of the entire abdomen. Appendicitis most often affects people between 10 and 30 years old.
Signs and Symptoms
Early signs and symptoms of appendicitis often are mild, consisting merely of a loss of appetite and/or nausea and a sense of not feeling well. There may not be even abdominal pain. Nevertheless, as the course of the appendicitis progresses the main symptom becomes abdominal pain.
- The pain is at first diffuse and poorly localized, that is, not confined to one spot.
- The pain is so difficult to pinpoint that when asked to point to the area of the pain, most people indicate the location of the pain with a circular motion of their hand around the central part of their abdomen.
- With time, the pain may localize to the right lower quadrant and the patient may be able to identify an exact location of for the pain.
A diagnosis of appendicitis begins with a thorough history and physical examination. Patients often have an elevated temperature, and there usually will be moderate to severe tenderness in the right lower abdomen when the doctor pushes there. If inflammation has spread to the peritoneum, there is frequently rebound tenderness. Rebound tenderness is pain that is worse when the doctor quickly releases his or her hand after gently pressing on the abdomen over the area of tenderness.
Other tests may include
- White blood cell count
- Abdominal X-ray
- Barium enema
- CT scan
- Rectal or pelvic exam in certain cases
The surgeon makes three small incisions in the abdomen. A port (nozzle) is inserted into one of the slits, and carbon dioxide gas inflates the abdomen, which allows the surgeon to see the appendix more easily. A laparoscope is inserted through another port; it looks like a telescope with a light and camera on the end so the surgeon can see inside the abdomen. Surgical instruments are placed in the other small openings and used to remove the appendix. The area is washed with sterile fluid to decrease the risk of further infection. The carbon dioxide comes out through the slits, and the sites are closed with sutures or staples and covered with glue-like bandage or Steri-Strips.
During an appendectomy, a small incision is made through the skin and the layers of the abdominal wall over the area of the appendix. The surgeon enters the abdomen and looks for the appendix, which usually is in the right lower abdomen. After examining the area around the appendix to be certain that no additional problem is present, the appendix is removed. This is done by freeing the appendix from its blood supply and attachment to the colon, cutting the appendix from the colon, and sewing over the hole in the colon. If an abscess is present, the pus can be drained with drains that pass from the abscess and out through the skin. The abdominal incision then is closed.
The gallbladder is a small pear-shaped organ under the liver. The liveer makes 1-2 liters of bile each day. Bile helps in digesting fats and some of the bile is stored in the gallbladder between meals. When fatty foods are eaten, the gallbladder squeezes bile out through the duct and into the small intestine.
Gallstones are hardened digestive fluid that can form in your gallbladder. This is called cholelithiasis. These gallstones can block the flow of bile to the ducts and cause pain and swelling.
Cholecystitis is an inflamed gallbladder, occurring either suddenly (acute)or over a longer period of time (chronic). Gallstone pancreatitis is caused by stones moving into and blocking the common bile duct, the pancreatic duct, or both.
Signs and Symptoms
Most common symptoms of cholecystitis are:
- Sharp pain in the right abdomen
- Low fever
- Nausea and bloating
- Jaundice may occur if gallstones are in the common bile duct
- Yellowing of the skin and eyes
The physician will ask you about your pain and any stomach problems during a History & Physical Exam. Other tests may include
- Blood tests, including complete blood count
- Liver function tests
- Coagulation profile
- Abdominal ultrasound, the most common study for gallbladder disease
- Hepatobiliary iminodiacetic acid (HIDA) scan
- Endoscopic retrograde cholangiopancreatography (ERCP)
- Magnetic resonance cholangiopancreatography (MRCP)
Surgical Procedure- A cholecystectomy is the surgical removal of the gallbladder.
is performed through several small incisions. The laparoscope, a small thin tube, is put into the abdomen through a tiny cut made just below the navel. The surgeon can then see the gallbladder on a TV monitor and do the surgery with tools inserted in three other small cuts made in the right upper part of the abdomen. The gallbladder is then taken out through one of the incisions. Laparoscopic cholecystectomy permits a shorter hospital stay and shorter recovery time with less pain. Possible complications may include bleeding, infection and injury to the bile duct, intestines or major blood vessels.
The surgeon makes an incision about 6 inches long in the abdomen and cuts through fat and muscle to the gallbladder. The site is stapled or sutured closed.