Abdominal hernia manifests itself as a protrusion of an entire internal organ or its separate part through the gate into the subcutaneous region of the anterior wall of the body or into the formed pocket. In half of the cases, the organs exit the abdominal cavity simultaneously with the parietal peritoneal sheet covering the subcutaneous space from the inside. A characteristic manifestation of a hernia is a symptom of a cough shock.
To identify the relationship of emerging urges with the disease, put a hand on the protrusion and trace its behavior when coughing. Usually a push is felt, which indicates the communication of an abnormal formation with the peritoneum, the absence of such indicates an infringement of the hernia. Protrusion of organs occurs through the hernial ring. The parietal peritoneum with part of the intestines, nerve endings, tendons, captured during the exit, is a hernial sac.
Functions of the peritoneum
Fixing frame for vitalimportant organs helps in the process of homeostasis, fluid exchange, maintains intra-abdominal pressure:
- performs a resorptive function, namely, it absorbs the products of protein breakdown, tissue necrosis, exudates, bacteria;
- serous cover in some parts of the small intestine and duodenum is able to release fibrin and fluid;
- large omentum, which serves as a kind of barrier for infection of the inflammatory focus, gives mechanical protection to cellular and humoral immunity.
Hernia of the abdominal line and its complications
If an inconsistent suture is made during the surgical intervention, the patient does not fully comply with the doctor's instructions, then a recurrent hernia occurs, the gate for which is a thin place of the scar. An unoperated 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 threatens with death;
- if part of the intestine is involved in the protrusion, then the passage of food masses and contents is difficult;
- marginal pinching of the lateral wall of the intestine also leads to the appearance of peritonitis, which leads to necrosis of the captured area;
- purulent process develops (phlegmon);
- A hernia of the white line increases to a huge 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 duration of illness
Whenacute inflammatory process in the abdomen, an ambulance is urgently called, delay is dangerous for human life. Peritonitis is distinguished by complete or affecting a specific area. Inflammation is caused by various aerobic and anaerobic types of bacteria that have entered 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 for the first day and is manifested by maximum symptoms;
- transition to the toxic stage is carried out within 24 to 72 hours, characterized by the appearance of heralds of intoxication and poisoning of the body;
- 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 infection
Primary peritonitis is rare, accounting for about 1% of inflammation. Infection occurs after microbes enter the peritoneum internally, hematogenously, lymphogenously, or from the female reproductive organs through the fallopian tubes.
Diaphragmatic hernia causes secondary peritonitis after surgery or due to complications of traumatized peritoneal tissues. In this case, the following causes of infection are distinguished:
- infection from the inflammatory process;
- perforated path;
- microbial exposure due to trauma;
- postoperative complication.
Varieties of peritonitis depending on other factors
The division into acute and chronic stages comes from the symptoms and clinical picture of the disease. The method of determination, depending on the exudate, allows you to identify the fibrinous, serous, purulent, fibrinous-purulent, hemorrhagic nature of inflammation.
The etiological division of the forms of peritonitis is caused by many varieties of microflora and bacteria that cause inflammation. The main pathogenic microbes today are staphylococci, streptococci, anaerobes, proteus, enterococci, Escherichia coli. The army of bacteria includes pneumococci, gonococci, hemolytic streptococcus and other species.
In the etiological groups, a non-bacterial aseptic case of the disease is distinguished separately, when a 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 becomes infectious in a matter of hours, as the walls become permeable to bacteria very soon after the onset of inflammation.
Disorders of metabolic processes
Violation of the water-electrolyte ratio in the body and protein balance is considered as an aggravating sign of external abdominal hernia. Protein excretion is accelerated due to hypermetabolism, the loss of an important building material is carried out with urine, vomit, exudate. Severe hypoproteinemia and a decrease in the amount of protein appear with extensive severe peritonitis.
Together with body fluidspotassium is released, it leaves the intercellular space, because of this, patients experience hypokalemia. After the development of the inflammatory process, the picture can change dramatically, as the excretion of fluid by the kidneys decreases, and a sufficient number of cells die. As a result of the changes, hyperkalemia develops.
Alkalosis develops in the blood in two-thirds of patients, sometimes a shift towards acidosis occurs in the tissues, resulting from circulatory disorders, disorganization of metabolic processes and hypoxia, these processes are interrupted by the removal of a hernia.
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 in acute peritonitis change rapidly, so constant monitoring of blood, urine, and other body fluids is recommended.
Symptoms of peritonitis
There are a number of standard signs by which you know how to identify a hernia and inflammation of the peritoneum:
- severe unbearable pain in the peritoneum;
- high temperature;
- stomach swells, becomes hard;
- feeling of weakness all over the body;
- vomiting and nausea;
- disruption of the gastrointestinal tract, constipation, flatulence.
Cough accompanying syndrome
Manifested in acute and chronic diseases of the abdominal cavity. Diagnosis for coughing was proposed by G. G. Karavanov and described in detail by I. M. Siomash. Many surgery clinics have adopted this symptom as a preliminary indication of an inflamed abdomen.
Method of use
The fingers are slightly bent towards the palm and the knuckles are lightly pressed on the area under study. For some time after this action, nothing is done to subside the pain from pressure. After this, the patient is checked for the symptom of a cough shock. 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.
Working principle
A sharp contraction during cough spasms of the wall of the peritoneum and diaphragm transmits a push to the surface of the liver and lower organs. The full intestine is also affected, which transmits the downward movement. The sensation of pain appears when, during movement, one or another diseased organ encounters an area pressed by the hand. If the inflammatory process affects the peritoneum, then the pain sensation is manifested by the shaking of the inner layer, while intra-abdominal pressure increases.
The author of the study A. S. Cheremskoy describes the effect of cough syndrome on the disease with appendicitis. When the patient coughs in case of inflammation of the process, pain is constantly felt in the iliac region. The effect of this effect is somewhat different from coughing with peritonitis and hernia.
Syndrome of diffuse acute peritonitis and chronic stage of the diseasecause different sensations when coughing. An old appendix reacts with shortness of breath, as if the patient were trying to hold back the pain. The acute stage is characterized by unbearable pain. The symptom of a cough shock differently reveals the stages of peritonitis.
In addition to peritonitis, hernia and appendicitis, this symptom is manifested in acute and chronic diseases of other abdominal organs. Pain from exertion when coughing appears in case of inflammation of the gallbladder, stomach ulcer, intestinal obstruction, etc. Thus, the cough shock symptom differs from other studies in that it allows to identify a large number of diseases at the initial stage.
Hernia and its varieties
Protrusions in humans can be acquired and congenital. The second option occurs in newborn babies. This violation occurs due to improperly formed peritoneum in fetal development. Acquired protrusions of the internal organs appear during the life of the patient and are divided into three types:
- with weakened muscles of the abdominal wall;
- due to significant sports or work load;
- post-traumatic, arising from a violation of the integrity of the peritoneum, if there is a previous operation; 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 groin;
- on the thigh from the inside or outside;
- on the lumbar sacrum;
- at the location of the perineum and pelvis;
- on the front side of the trunk (white line hernia);
- in any area of the body on the scar from the operation.
Human hernia is classified as recurrent, complicated or uncomplicated (with the possibility of reduction). The first type includes a protrusion that constantly reappears after surgery.
Symptoms of a hernial protrusion
The initial stage occurs as a round-shaped swelling, which has a soft texture, and the patient can even out it by himself with light pressure. After reduction on the surface of the peritoneum in this place, the gate of entry is felt, protruding in the form of a gap or a round defect in the abdominal wall.
The size of the seal varies 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 the contents is heard during palpation. Symptoms of a sluggish hernia include constipation, nausea, heartburn, bloating, heaviness, and impaired urination.
Removal of a hernia is recommended in case of infringement of the protrusion, which is characterized by the following symptoms:
- there is most often a sudden sharp pain after lifting weights, physical activity, bowel movements, rarely infringement happens for no reason;
- at some point, the patient cannot, as before, smooth the seal, it becomes hard andpainful;
- along with the previous symptoms, vomiting, stool disorder are observed.
Causes of a hernia
All causes are divided into conditionally conducive to the occurrence 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 weak points of the abdomen (femoral and inguinal rings, navel);
- decrease in tissue resistance to stretching due to age-related changes or exhaustion of the body;
- the presence of post-traumatic weak areas on the abdomen or if there was an operation, the laser produces the safest incisions in this regard.
The following group refers to push or trigger factors and causes an increase in pressure inside the abdominal cavity:
- hard work or power sports;
- frequent constipation;
- chronic cough;
- internal swelling of the abdominal organs due to improper functioning of the body;
- flatulence.
How to identify a hernia
The surgeon states the presence of a hernial protrusion after examining the patient and finding out the presence of the above determining and push factors in the patient's life. Lifestyle, surgical interventions and injuries of the body are taken into account. In order to find out which organs of the cavity are contained in the hernial sac, the doctor conducts an examination using instruments and instruments.
Ultrasound of the abdominal organs and the protrusion itselfallows you to consider the internal content and diagnose differentiation with other diseases. X-ray method is used for contrast images of the sac and hernial hiatus.
Treatment procedures and surgery
The main method of treatment is the surgical direction. Wearing a support bandage is prescribed for those patients who have serious contraindications against surgery, such as age-related changes or poor blood clotting. Removal of the protrusion is carried out according to plan, if the patient is preparing for surgery, or in acute cases, surgical intervention is performed urgently. An example of such an unscheduled event is a strangulated hernia with unbearable pain or physical intestinal obstruction.
The operation consists in opening the hernial sac and examining the contents. If the internal organs are not damaged, they are set, and the bag and gate are sutured to impassable sizes. Gate plasty 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 recurrence of hernial protrusion.
In conclusion, it should be said that at the first symptoms of a protrusion in the chest or abdominal wall, you should immediately consult a doctor. Surgical intervention to remove a hernia is not a complicated operation, it is much more difficult to avoid the complications of a neglected protrusion and the pain associated with it.
