this is an overview lesson on umbilical hernias so we're going to talk about what they are
what causes them we're also going to talk about the signs and symptoms of an umbilical hernia
how they're diagnosed and how they're treated so an umbilical hernia is a ventral abdominal
hernia located at or near the umbilicus which is the belly button so if you look in this image here
this is your abdomen and your umbilicus again is your belly button and a hernia is going to be a
bulge from a weakened abdominal fascia or weakened abdominal wall that is going to protrude out near
the umbilicus we're going to talk about a bit more in detail where this occurs in a little bit
and here's another image showing where other hernia can occur again the umbilical hernia can
occur near the umbilicus and some of these other hernias we're going to talk about them in other
lessons so this leads to abdominal contents protruding out through the abdominal wall so
we may see something like this although a lot of times an umbilical hernia are going to be smaller
than this they're going to be a small defect or protrusion around the umbilicus now they occur
anywhere from three centimeters above to three centimeters below the umbilicus so if they're
in this area if they're in this range they're known as an umbilical hernia and the majority
of cases are acquired upwards of 90 of cases are acquired and some of them are congenital where
someone is born with them but majority of the time they're going to be acquired the epidemiology of
umbilical hernia is as follows they occur in two percent of patients and umbilical hernias
are actually the second most common type of hernia in adults and females outnumber males
with this condition around three to one so three females every one male with this condition we're
going to talk about why that is in the next slide so that leads us into causes of umbilical hernia
what causes an umbilical hernia well first we have to talk about why they occur specifically hernia
develop at points of weakness in the abdominal wall so that is very key now there's a couple
of sites to note one is at the site where the umbilical vein exited the abdomen so during
development when a baby was in utero they have an umbilical cord that comes from their belly button
and there is one vein that comes out that connects to the placenta where that umbilical vein exited
the abdomen this is a location where there may be a weakness or there may be an increased risk for
a weakness occurring in this area and there may be a case where there is weakened fascia around
the embolicus this is known as weakened Richet's or umbilical fascia so the sheath
and tissue around the umbilical area now the reason why there may be a weakness that develops
is often caused by increased intra-abdominal pressure so increased intra-abdominal pressure can
lead to weakness or distortion occurring in the abdominal wall in these areas we just mentioned
and this leads us into the risk factors what might be causing that increased intra-abdominal pressure
one of them is premature birth this is more due to the development in around
the umbilical area pregnancy is also another risk factor for getting umbilical hernia so
because during pregnancy there's increased intra abdominal pressure there can be
some hernia that develop around the umbilicus this is why women outnumber men with this condition
obesity is another risk factor so having a very large abdomen so you can imagine that
if there's a very large abdomen that abdomen is stretching out it may lead to a distortion
or a tearing in parts of the abdominal wall that may lead to an umbilical hernia
ascites is also another risk factor for getting an umbilical hernia this is when there is a
buildup of peritoneal fluid within the abdomen and your abdomen becomes stretched out and you
can imagine that if there's so much fluid in there and your belly stretches out you can
imagine that there can be little tears or weaknesses in the abdominal wall from that
we often see ascites occurring in cirrhosis although it can occur in other conditions as well
and it's so common in cirrhosis patients that up to 20 percent of cirrhotic patients will develop
umbilical hernia at some point we can also see umbilical hernia being caused by other causes
of increased intra-abdominal pressure these include chronic cough so having conditions
like chronic obstructive pulmonary disease or copd or asthma which leads to a chronic cough
and continually applying pressure in the intra-abdominal space this can lead to
weakness in the abdominal wall causing an umbilical hernia to form and then physical
straining is also another risk factor so heavy lifting chronic constipation anything that's
applying a lot of pressure to that abdominal area so anything that's increasing intra-abdominal
pressure again can lead to weakness in the abdominal wall causing an umbilical hernia to form
now let's talk about the clinical features of embolical hernia there are asymptomatic hernia
which means that these are hernia that don't really cause problems so with asymptomatic hernia
we may see a bulge or a swelling or a mass at the site so so you may see something quite large like
this around the belly button or you may see a very small distortion around the belly button
so can be small or large in size and what will be noted is that the size will increase
with increased intra-abdominal pressure so when standing when coughing it may lead to this bulge
popping out a bit more and with asymptomatic hernia with hernia that don't have an issue
they can often be pushed back in so some abdominal contents can sort of pop out especially if there's
increased intra-abdominal pressure if there's heavy lifting they might pop out but they can be
pushed back in they can be reduced there may be some sensation of aching around the hernia that
radiates through the herniated area but that's about it for asymptomatic hernia now the next
type of hernia that an asymptomatic hernia can develop into is an incarcerated hernia
so an incarcerated hernia is when the mass increases in size so it can become quite large
and oftentimes the hernia becomes more painful and what's key with an incarcerated hernia is that it
is difficult to reduce or manipulate so it becomes so large it becomes difficult to push back in so
it pops out and then some of the tissue can squeeze on the hernia preventing or making it
more difficult for someone to push the hernia back into the abdomen or push the abdominal contents
back into the abdominal cavity so this is what we call an incarcerated hernia and it can become so
bad that it may progress to a bowel obstruction so you can imagine that if there's part of your small
intestine popping out and the surrounding tissue starts to squeeze on that area you may find that
bowel contents are not able to travel through that area so it can actually cause a bowel obstruction
and if that surrounding tissue squeezes so tightly on this area this can lead to a strangulated
hernia we're going to talk about that in the next slide so with incarcerated hernia we can
see mass increasing so if the hernia increases in size it becomes more painful difficult to
reduce or manipulate and then there may also be signs and symptoms of a bowel obstruction
signs and symptoms of a bowel obstruction include constipation or reduced frequency of
bowel movements there may be less passing of gas there may be some more abdominal pain there may
be some nausea and vomiting and other symptoms as well if you want more information on signs
and symptoms of bowel obstruction please check out my lesson on that topic and all this leads into a
strangulated hernia so if that surrounding tissue starts to squeeze so tightly on that protruding
abdominal content so if you have your intestines popping out and you have the surrounding tissue
starting to squeeze on that so tightly it can actually compromise the blood supply to that part
of the bowel that's popping out so this is a very serious condition it has similar symptoms to an
incarcerated hernia but with additional symptoms oftentimes the patient becomes very unstable
because essentially their bowel is dying this part that's sticking out and the blood supply is
cut off from it that part of the bowel is dying so this is a very serious condition patient's often
unstable there's sudden severe pain there's often times a fever and then the hernia even seeing it
on the outside may change in color to a red or black in color and then oftentimes bowel
obstruction sign symptoms are present so again strangulated hernia is when the blood supply gets
compromised to the area the bowel starts to die and this is very serious and this is a surgical
emergency now how do clinicians diagnose and treat umbilical hernia so the diagnosis of an umbilical
hernia is often a clinical diagnosis seeing the hernia seeing that distortion or that protrusion
or bulge in the area we mentioned before three centimeters above or three centimeters below the
umbilicus is a clinical diagnosis especially if the patient has other risk factors for getting
emblecal hernia and some imaging modalities may be performed as well although most of
the time it's a clinical diagnosis some blood work can be performed if there is bowel death
we may see an increased ldh but oftentimes blood work is not necessary either this is
again a clinical diagnosis now how do clinicians treat embile hernia first is hernia reduction so
in the case of asymptomatic or incarcerated hernia there is attempts to actually reduce the hernia
it's important to note that this should only be performed one to two times if it doesn't go
in this may need surgery or surgical intervention if there is signs that this is a strangulated
hernia do not reduce the hernia a hernia support belt is also important so this can help reduce
some of those symptoms that a patient may be experiencing so once the hernia has been reduced
a patient can wear a belt like this that can help hold the hernia and hold the abdominal contents
inside in children who do have umbilical hernia their hernia may close spontaneously on their
own so oftentimes no treatment is necessary if a child is less than five years of age
to see if it actually spontaneously closes on its own and then for definitive treatment surgery is
performed so what happens is mesh is placed so if there is an umbilical hernia surgeons will open up
and put a mesh there to ensure that the abdominal contents do not keep protruding out so the mesh
holds abdominal contents in and oftentimes surgery may be classified as the following elective
surgery if it is asymptomatic hernia urgent if it's a symptomatic hernia and emergent if
it is a strangulated hernia so these are different levels of urgency or severity so in the case of
a hernia that is causing really no problems patients can be put on the list for surgery
but it's not necessary right at the moment so they can oftentimes do these other methods we
talked about before reduction in support belt and avoiding risk factors that increase the likelihood
of an umbilical hernia if it's symptomatic if it starts to cause problems this can
lead to some urgency in getting a patient to surgery to correct it and then if it is a
strangulated hernia this is an emergency this is a surgical emergency because that part of the bowel
is starting to die because blood supply to it has been cut off so again a surgical emergency for a
strangulated hernia so if you want to learn about gastroenterology conditions please check out my
playlist on gastroenterology and if you haven't already please like and subscribe
for more lessons like this one thanks for watching and i hope to see you next