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Inguinal hernia

Description:
An inguinal hernia is a protrusion of abdominal-cavity contents through the inguinal canal. Symptoms are present in about 66% of affected people.
It occurs when tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles. The resulting protrusion can be painful, especially when you cough, bend over or lift a heavy object, exercise, or bowel movements. Often it gets worse throughout the day and improves when lying down. A bulging area may occur that becomes larger when bearing down. Inguinal hernias occur more often on the right than left side. The main concern is strangulation, where the blood supply to part of the intestine is blocked. This usually produces severe pain and tenderness of the area.

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An inguinal hernia isn’t necessarily dangerous. It doesn’t improve on its own, however, and can lead to life-threatening complications. Your doctor is likely to recommend surgery to fix an inguinal hernia that’s painful or enlarging. Inguinal hernia repair is a common surgical procedure.

Sign & symptoms:
Hernias present as bulges in the groin area that can become more prominent when coughing, straining, or standing up. They are rarely painful, and the bulge commonly disappears on lying down. Mild discomfort can develop over time. The inability to “reduce”, or place the bulge back into the abdomen usually means the hernia is ‘incarcerated’ which requires emergency surgery.

Causes & Risk Factors:
There isn’t one cause for this type of hernia, but weak spots within the abdominal and groin muscles are thought to be a major contributor. Extra pressure on this area of the body can eventually cause a hernia.

*heredity
*personal history of hernias
*premature birth
*being overweight or obese
*pregnancy
*cystic fibrosis
*chronic cough
*frequent constipation
*frequently standing for long periods of time

Significant pain is suggestive of strangulated bowel (an incarcerated indirect inguinal hernia).

As the hernia progresses, contents of the abdominal cavity, such as the intestines, liver, can descend into the hernia and run the risk of being pinched within the hernia, causing an intestinal obstruction. If the blood supply of the portion of the intestine caught in the hernia is compromised, the hernia is deemed “strangulated” and gut ischemia and gangrene can result, with potentially fatal consequences. The timing of complications is not predictable. Emergency surgery for incarceration and strangulation carry much higher risk than planned, “elective” procedures. However, the risk of incarceration is low, evaluated at 0.2% per year. On the other hand, surgical intervention has a significant risk of causing inguinodynia, and this is why minimally symptomatic patients are advised to watchful waiting.

Diagnosis:
There are two types of inguinal hernia, direct and indirect, which are defined by their relationship to the inferior epigastric vessels. Direct inguinal hernias occur medial to the inferior epigastric vessels when abdominal contents herniate through a weak spot in the fascia of the posterior wall of the inguinal canal, which is formed by the transversalis fascia. Indirect inguinal hernias occur when abdominal contents protrude through the deep inguinal ring, lateral to the inferior epigastric vessels; this may be caused by failure of embryonic closure of the processus vaginalis.

Direct inguinal hernia: Enters through a weak point in the fascia of the abdominal wall (Hesselbach triangle)

Indirect inguinal hernia: Protrudes through the inguinal ring and is ultimately the result of the failure of embryonic closure of the processus vaginalis after the testicle passes through it.

In the case of the female, the opening of the superficial inguinal ring is smaller than that of the male. As a result, the possibility for hernias through the inguinal canal in males is much greater because they have a larger opening and therefore a much weaker wall through which the intestines may protrude.

A physical exam is usually all that’s needed to diagnose an inguinal hernia. Your doctor will check for a bulge in the groin area. Because standing and coughing can make a hernia more prominent, you’ll likely be asked to stand and cough or strain.

If the diagnosis isn’t readily apparent, your doctor might order an imaging test, such as an abdominal ultrasound, CT scan or MRI.

Treatment:

If your hernia is small and isn’t bothering you, your doctor might recommend watchful waiting. In children, the doctor might try applying manual pressure to reduce the bulge before considering surgery.

Enlarging or painful hernias usually require surgery to relieve discomfort and prevent serious complications.

There are two general types of hernia operations — open hernia repair and laparoscopic repair.

Open hernia repair:
In this procedure, which might be done with local anesthesia and sedation or general anesthesia, the surgeon makes an incision in your groin and pushes the protruding tissue back into your abdomen. The surgeon then sews the weakened area, often reinforcing it with a synthetic mesh (hernioplasty). The opening is then closed with stitches, staples or surgical glue.

After the surgery, you’ll be encouraged to move about as soon as possible, but it might be several weeks before you’re able to resume normal activities.

Laparoscopy:
In this minimally invasive procedure, which requires general anesthesia, the surgeon operates through several small incisions in your abdomen. Gas is used to inflate your abdomen to make the internal organs easier to see.

A small tube equipped with a tiny camera (laparoscope) is inserted into one incision. Guided by the camera, the surgeon inserts tiny instruments through other incisions to repair the hernia using synthetic mesh.

People who have laparoscopic repair might have less discomfort and scarring after surgery and a quicker return to normal activities. However, some studies indicate that hernia recurrence is more likely with laparoscopic repair than with open surgery.

Laparoscopy allows the surgeon to avoid scar tissue from an earlier hernia repair, so it might be a good choice for people whose hernias recur after traditional hernia surgery. It also might be a good choice for people with hernias on both sides of the body (bilateral).

Some studies indicate that a laparoscopic repair can increase the risk of complications and of recurrence. Having the procedure performed by a surgeon with extensive experience in laparoscopic hernia repairs can reduce the risks.

Prevention and Outlook of Inguinal Hernias:
Although you can’t prevent genetic defects that may cause hernias, it’s possible to lessen the severity of hernias by:

*Maintaining a healthy weight
*Eating a high-fiber diet
*Not smoking
*Avoiding heavy lifting

Early treatment can help cure inguinal hernias. However, there’s always the slight risk of recurrence and complications, such as infection after surgery, scars.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
https://en.wikipedia.org/wiki/Inguinal_hernia
http://www.mayoclinic.org/diseases-conditions/inguinal-hernia/home/ovc-20206354
http://www.healthline.com/health/inguinal-hernia?isLazyLoad=false#causes3

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SID and SAD

Death is the end of life, when all brain activity ceases permanently. We all expect to die. But in Nature, the old die before the young, parents before their children. A disruption of this normal sequence results in distress, depression and an inability to cope.

CLICK & SEE....>…...SIDS………..SAD

SAD victims who simply drop dead in the middle of action may have unrecognized underlying risk factors

The unexpected death of a healthy child can be the result of SIDS (Sudden Infant Death Syndrome), also known as  cot death or  crib death  It occurs in a seemingly normal child, usually a male, under the age of one year, who goes to sleep in the night and fails to wake up in the morning.

The immature brains of children do not regulate the heart rate or breathing very efficiently, especially at night. This may be further compromised by exposure to cigarette smoke. Also, the child may be accidentally smothered when parents roll over in their sleep, or it could be that its nose and mouth get blocked by soft, fluffy sheets or pillows.

Parents are, therefore, advised to avoid sleeping in the same bed as the child and to always place the child on the back instead of the stomach. These measures appear to significantly reduce the number of SIDs.

Death in healthy young adults between the ages of 16 and 60 years may be due to accidents or violence. Some like the SIDS infants just  drop dead  or die during their sleep. Their death is sudden, unexpected, tragic and inexplicable.

These unexplained deaths have been grouped together and given the expressive acronym SAD (Sudden Adult Death). More men than women die this way. Some families are even considered cursed, with many economically productive young men in the family dying in the prime of their life.

Autopsies on SAD victims have shown that some of them actually did have unrecognized underlying risk factors. This is particularly true in India where we have many young undiagnosed diabetics and others with metabolic abnormalities of syndrome X (insulin resistance, hypertension, lipid abnormalities). Despite their youth, some had coronary arteries partially blocked with fatty deposits and plaques. In others, the vessels supplying the muscles of the heart arose from abnormal locations. The congenital heart diseases may have been mild enough to remain unrecognized and undiagnosed until it was too late. The efficient functioning of the heart may have been affected by a group of diseases called cardiomyopathies. Infection of the heart muscle (myocardium) with viruses and bacteria may have caused myocarditis. The infection can trigger arrhythmia and death. Some prescription drugs like terfenadine can also set off similar fatal reactions. Unfortunately, as such people appeared healthy and had no symptoms, they were never investigated for risk factors prior to the sudden death.

SAD has been in the news recently because of the discovery that many affected individuals had a  long QT  in their ECG (electrocardiograph). Even if the initial resting ECG is normal, the abnormality shows up on an ECG taken after exercise. These ECG changes are caused by disturbances in the electrical conduction currents of the heart and are inherited. The genetic defects causing this are of various types. The percentage of genetic carriers in the population is probably around 5 to 10 for 100,000 persons. This has lead to speculation that SID and SAD are two spectrums of the same disease.

The defects are commoner in Southeast Asia than in the western countries. The syndrome even has local names bangungutin the Philippines,  pokkuri in Japan and  lai tai in Thailand. It has been known for many centuries, although the precise defect was identified only recently.

About 60 per cent of people with hereditary long QT syndrome has non-specific symptoms like fainting spells or seizures during childhood and adolescence. Around 40 per cent has no symptoms at all and the condition may just present itself with sudden death. Many die in front of family and friends. Unfortunately, from the time the heart stops beating, irreversible brain damage occurs in three to six minutes, followed by coma and death. Cardio-pulmonary resuscitation (CPR) may have saved the lives of a few of these people. However, most people do not learn CPR, and others are too stunned by the occurrences to initiate it in time.

Once the long QT is picked up on an ECG, measures can be taken to prevent sudden death. Medications belonging to the beta-blocker group can be started. Certain prescription drugs that prolong the QT can be avoided. Potassium levels in blood need to be monitored as low levels can precipitate death. Some patients may need pacemakers.

Symptoms in persons with a long QT syndrome can be precipitated by physical exertion. The long QT has been implicated in the sudden death of trained Olympic-level athletes. Competitive sports, therefore, are risky and better avoided.

Exercise is good for health, well being, diabetic control and lipid abnormalities, but vigorous action should be undertaken only after medical advice in those with risk factors.

Source: The Telegraph (Kolkata, India)