Hernia , abdominal

Current available stainless steel sutures are twisted multifilament Flexon and monofilament Stainless Steel from Covidien, monofilament Surgical Stainless Steel from Ethicon, twisted multifilament or monument Steelex from B. Braun, and monofilament or multifilament Surusteel from SURU International. Steel-based sutures have been used in closure of stern, skin, hernia, abdominal, and intestine. Edlich et al. (2006) reported a very good review of the performance of steel sutures in wound closure. 

It is an anionic detergent which softens the stool by water accumulation in intestinal lumen and emulsifies the colon contents. It is indicated in obstetric, habitual, geriatric, paediatric constipation or when straining is to be avoided (recent myocardial infarction, severe hypertension, post-operative cases, abdominal hernia), fissures, haemorrhoids and bed ridden patients. Dose 100-200 mg/day. 

Inspection Upon inspection, pronounced cases of ascites are characterized by marked protrusion of the abdomen. The umbilicus becomes everted or bulging. The distance between the navel and the symphysis appears diminished as a result of caudal displacement of the former. With large quantities of ascitic fluid, the abdominal skin is taut and shiny. In long-standing cases of ascites, striae distensae, together with expanded collateral veins radiating from the navel, may be visible. Increased ascitic pressure sometimes causes the occurrence of a hernia (inguinal, femoral, umbilical or cicatricial). (S. fig. 16.7) (41, 48, 57)... 

Transplantation of the liver essentially gives patients with refractory portal ascites a chance to start a new life. However, in the presence of large-scale ascites, the surgeon is faced with a number of specific problems such as overdilated and thin abdominal walls, existing hernia, spontaneous bacterial peritonitis, significant volume displace-... 

Anogeissus leiocarpus C ombre taceae Asthma, cough, tuberculosis, anthelmintic, tapeworm. Gonorrhoea, tonic, enema, jaundice, body pain, chest pain, wounds, ulcers, skin rashes, itching, hemorrhoids, abscesses, hernia, diarrhea, ophthalmia, abdominal pain, rheumatism, fishing poison, stimulant, toothache. Anthraquinone, flavonoid, saponin, steroids, tannin, terpenoids. 17, 28... 

Part of the lifestyle modifieations for hiatal hernia is to limit pressure on the abdominal eavity, especially after a meal. Using the leg muscles to bend down, rather than bending over, should be taught to the client. 

The diagnosis of bowel obstruction is established on clinical grounds and usually confirmed with plain abdominal radiographs. Plain radiographs usually show distended bowel loops with air-fluid levels (Fig. 1.66). In inguinal incarcerated hernia, plain film will also show thickening of the... 

On abdominal X-ray studies, a gastric volvulus maybe suspected. In organoaxial volvulus, a subtle inferiorly displaced gastroesophageal junction may be seen. More typically in mesentericoaxial volvulus, the stomach appears spherical on supine films and a double air-fluid level can be seen in the upright position a superior one in the antrum, and an inferior one in the fundus. On chest radiograph, a ret-rocardiac gas-filled structure, consistent with a diaphragmatic hernia and/or an intrathoracic stomach maybe seen (Fig. 3.5). 

The KL-3 adhesive allows reliable gluing together of the musculo-aponeurotic leaves of anterior abdominal wall in rabbits luider conditions of high mechanical loading [438], which allows use of this preparation in the clinical plasty of massive hernias. 

Intestinal adhesion, the most frequent cause of bowel obstruction, cannot be demonstrated on sonography. Likewise, internal hernia and congenital fibrotic band can rarely be identified at sonography. Previous history of abdominal operation in patients without a sonographically visible cause of obstruction can lead to a diagnosis of adhesive ileus. 

Ventral hernia covers all protrusions through anterior and anterolateral abdominal wall, excluding groin hernias. It is suggested by the patient s clinical history and is well seen on physical examination however, the patient s history may be atypical and physical examination may be limited in obese patients, in patients with severe abdominal pain or distension, in small hernias or with hernias located in uncommon sites (Spangen 1975 Mufid et al. 1997). In certain clinical situations it may be necessary to relate the symptoms to the ventral hernia or, it may be necessary to know whether the ventral hernia is... 

Fig. 5.3. a Scan of the anterior abdominal wall with Valsalva manoeuvre shows the ventral hernia containing the bowel loops (BO) and the defect in the fascia (arrows), b Fatty epigastric hernia with herniation of the properitoneal fat (arrows), c Spigelian hernia shows the defect marked by calipers lateral to the rectus muscle (R) and the contents (BO) limited anteriorly by the Spigelian fascia (arrow), d Richter s type umbilical hernia shows fluid-filled hernial sac (arrowheads) and irreducible herniation of only a part of the circumference of the bowel (arrow), which showed wriggling peristaltic movement in real time... 

The pattern of complications is common for all types of hernia. The complications are irreducibility, obstruction and strangulation. Irreducible (incarcerated) hernia may be due to a narrow neck or adhesion of contents to the sac wall. In obstruction, the intestine in the hernia gets obstructed due to a narrow neck, adhesion or volvulus, but it is viable. Strangulation results when there is compromise to venous drainage and later arterial supply of the contents. In obstructed hernia there is colicky pain, abdominal distension and vomiting. Incarcerated hernia is present at rest it is irreducible and usually contains some fluid in the sac that can be seen on sonography (Fig. 5.2b Rettenbacher et al. 2001). In obstructed hernia the patient has symptoms of intestinal obstruction. There are dilated bowel loops... 

Ghahremani GG (1984) Internal abdominal hernias. Surg Clin North Am 64 393-406... 

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