06.08 Umbilical Hernia

Hey guys, in this lesson we're going to be talking about umbilical hernias as they happen in our pediatric patients.

An umbilical hernia is what happens when the tissue (This could be fat, fluid or intestines.) protrudes through a weakened abdominal muscle at the umbilicus. You may have heard of another diagnosis that seems really similar called an Omphalocele- With an omphalocele, intestines and other abdominal organs also push through the umbilicus, so these two things seem pretty much the same right?

Well the major difference is that an umbilical hernia is not considered to be a congenital anomaly. With an umbilical hernia everything in the abdomen and the umbilical area all developed normally it's just a weak place in the muscle that allows the bowel to protrude through. Where are as the omphalocele occurs from an actual developmental problem that occured in utero. We have a whole lesson on the diagnosis omphalocele so check that out!

When you're looking at an umbilical hernia you're probably going to see some swelling around the belly button and it can be either painful or painless. You may actually be able to push this herniated area back in and under the abdominal wall and if you can do this, this is called being reducible.

And this leads us into the topic of assessing for complications. If a hernia cannot be reduced or pushed back in then we call that being irreducible, which means the hernia is incarcerated and this means that the tissue is trapped, which can lead to bowel obstruction or strangulation. Signs of bowel obstruction and strangulation to be on the lookout for are green, bilious vomiting, severe abdominal pain and abdominal distension. If untreated, strangulation will lead to necrotic bowel.

Most of the time our management of an umbilical hernia is really just going to be observation and this is because most of them are going to spontaneously close by the time the Kids 3 to 4 years old. If the hernia doesn't spontaneously close by this time or we see any of the complications that we talked about on the previous slide then the child may need surgery.

Surgery is usually pretty straightforward it's often done in an out-patient setting and kids can go home the same day. And when they go home we’ll pretty much give the same instructions that we would give an adult who had a hernia repair. So, they need to avoid heavy lifting (or heavy playing is probably more appropriate for kids!) and straining for a couple of weeks and they should use a pillow to splint their abdomen if they need to cough or do something that might strain the incision.

Your priority nursing concepts for a pediatric patient with an umbilical hernia are gastrointestinal and liver metabolism and comfort.
Ok so your key points for this lesson are; number 1 just know that an umbilical hernia is when tissue protrudes through weakened muscles at the umbilicus. Nursing care is mostly focused on observing for complications like incarceration and strangulation. This is because if there are no complications, we can just observe and leave the hernia in hopes that it will spontaneously resolve. A lot of times they will be the time the kid is 3-4 years old.

If they don’t resolve or there are complications the umbilical hernia will need to be surgically repaired. This is a pretty simple surgery and most kids will go home the same today. Make sure to provide patient education about protecting the incision site by splinting the abdomen and avoiding things that would cause straining like constipation.

That's it for our lesson on umbilical hernias in kids. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!