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Acute Care Surgery - Paper Example

8 pages
1981 words
Vanderbilt University
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Inguinal Hernia is a disease that has been around for a long time now. A number of interventions have been proposed towards solving the menace. Mostly it appears in both males and females. However,m it is more dangerous in female patients than in makes. It is assumed by some that Acute Care Surgery may be a good option towards solving the disease (Peitzman, Leppaniemi, Kutcher, Forsythe, Rosengart, Sperry & Zuckerbraun (2015). This form of surgery is associated with treating patients who suffer from short-term illnesses. However, some debate that the use of ACS as a form of treatment for the condition may have dire effects on the patient. Additionally,m the intervention which is effected on the client through ACS may be costly for the institution. This is because the program requires much more resources. In this paper, it is argued out on the need or lack of thereof of using the ACS as an intervention.


The NCBI, AAST, and the Institution of Acute surgery were searched to retrieve information regarding the solutions proposed for trauma patients. The articles from the various sources were hand searched personally as the information on the articles was picked to try and see the information therein and its relation to the subject matter (Peitzman, Leppaniemi, Kutcher, Forsythe, Rosengart, Sperry & Zuckerbraun (2015).. Finally, the results from the searchers were analyzed numerically through the use of excel.


Results regarding the use of ACS in nontrauma patients for conditions such as those above proved some facets of the research. One of the outcomes was drawn from the 70% of patients who had responded well to the form of treatment. The other half involved patients who came ac5ross some complications which were however caused by third party conditions. For instance the failure of proper care throughout the process of treatment.


The use of ACS as a form of treatment for nontrauma patients is an effective form of treatment. This is about the results drawn from people who treated through this method and responded very positively to the treatment. It is therefore considered a noble thing to do especially for teenagers who can handle unplanned for surgeries to salvage their own lives.

2. Introduction

Rationale for the review

An inguinal Hernia is considered to be the abnormal protrusion of abdominal cavity contents. This occurs in both male and female patients. Apparently, this leads to the availability of certain very com on symptoms in such citizens such as a high level of discomfort when they are coughing. The protrusion usually takes place more on the right side than it occurs on the left side. This condition is mainly caused by the involvement of a person 9in certain activities such as obesity, appendectomy, pregnancy, smoking or even peritoneal dialysis. The condition is at times genetic since it may have a high probability of recurring in a generation where somebody in the family has had it before then where nobody has had the disease.

Hernias usually occur in the groin area in the form of a bulge. The bulge may come into form when one is standing, or they are standing up. On sitting down or lying down the bulge usually disappears (Peitzman, Leppaniemi, Kutcher, Forsythe, Rosengart, Sperry & Zuckerbraun (2015). In most cases when the bulge comes out, the person with the bulge experiences great pain until it goes down after they lie down. This action means that a hernia is incarcerated. This shows that the patient is in urgent need of operation because their abdomen is under strain from a hernia.


Lack of an ACS at the immediate realization of a hernia may lead to a number of detrimental effects., One of the biggest disadvantages of Hernia is that, with time, as a hernia contributes to existing in the body of the patient, Some contents of the abdominal cavity may move down into the area where the Hernia exists. Some of this contents include the intestines and the liver. After these contents descend, they may come across the Hernia which may pinch them (Lupinacci, Dias, Kondo & Lupinacci 2016). In return, a pinch of the abdominal contents results in intestinal obstruction. This may have a detrimental effect on the patient since they may first of all face a blockage of circulation of blood in the part of the abdomen which has been caught up. In return, they tend to have either gangrene or Ischemia. The two diseases may be very fatal to the patient.


An inguinal Hernia usually occurs in two major forms. The first form is that of the direct and the indirect type. One unique factor separates the two. The two types of the condition are mainly defined by the manner in which they relate to the Inferior Epigastric vessels. In most cases, the Direct Inguinal Hernias (IH) occurs in a medial position about the epigastric vessels when most of the abdominal contents such as the intestines move through a fragile spot existing on the fascia. This fascia is usually on the posterior wall which is usually on the Inguinal Canal. The transversalis fascia commonly forms the Inguinal canal.

The other form of IH is the indirect one which takes its form by protruding across the deep inguinal ring. This also occurs in a lateral position to the epigastric vessels. This process is mostly brought about by the unprecedented and sudden disclosure of the embryo and the processes vaginalis. Females and males who share the same condition may differ in some aspects of the disease (Lupinacci, Dias, Kondo & Lupinacci 2016). This difference mainly occurs in the Superficial Inguinal Ring. In the male victims, the ring is usually much smaller compared to that of the females. As a result, males are usually at a higher chance of contracting the disease compared to their female counterparts who have a smaller superficial inguinal ring.

Inguinal Hernias belong to the groin hernias group which additionally includes the femoral hernias. The only difference that occurs between the femoral and the Inguinal hernia is that in the femoral hernias the condition usually occurs through the femoral canal while in the Inguinal Hernia the condition occurs through the Inguinal canal. The occurrence of the condition through the femoral canal gives way to the going through of the femoral artery to the leg through the pelvis. The IH can also be different forms of a hernia through the manner in which other forms occur. For instance, in the Anand's hernia,m the contents that exist in the hernial sack is mostly the Vermiform appendix. On the other hand, in the Littres Hernia the hermail sac carries a Meckel's diverticulum.

Classification of Hernia

A hernia is mostly classified into two categories. The main categories are reducible and the irreducible or popularly known as the Incarcerated hernia. A reducible hernia can be pushed back into the abdomen when the patient is at rest. However, it does protrude when the patient is no0t in rest for instance when they are standing. Also, when a person exerts manual pressure on the hernia, it goes back into the abdomen. On the other hand, the irreducible hernia is not pushable into the abdomen even by exerting manual pressure on it. An irreducible hernia also has a further classification where they are classified into obstructed hernia and strangulated hernia (Holcomb 2015). In the situation where the intestines gets obstructed, the intestines part where the hernia exists becomes obstructed. On the other hand, if the hernia becomes strangulated then there is no blood flowing into the or out of the hernia.This in return leads to Ischemia. In such a case, the intestineds lumen may either get to become patent or fail to do so.

Direct Inguinal Hernia

The DIH enters into the fascia. This mainly occurs through a very weak point on the same part, the fascia. The Fascia is mostly on the abdominal wall whereby it has a sac that is noted to be in a medical form to be in between the inferior epigastric vessels. DIH mostly occurs in males than it occurs in females. Apparently, according to research (Hill & Nirula 2017). There is ten times chance for a male to get the disease compared to the manner in which the female could contract the disease.

When one has DIH, the protrusion of the body mostly occurs in the weakened area that exists in the Transversalis Fascia which is near the medial inguinal fossa. All this takes place within a region regarded to as the Inguinal triangle. This triangle is also known as the Hesselbachs triangle. This area is mostly defined by the edge that exists as the end of the rectus abdominal muscle, inferior epigastric artery and also the inguinal ligament. All these hernias have the capability of exiting through the superficial lingual ring. The hernias could also move extensively into the scrotum in male patients.

At certain moments, it is possible for one to have both the direct and indirect hernias. When there is such a phenomenon, the result of the occurrence is normally known as a pantaloon hernia. This is usually referred to like that because it appears as though it is a pair of pants in the groin area. The defects of such a phenomenon can either be treated together, or the practitioner could decide that it is better to treat the two hernias separately.

With age, it is common for the abdominal walls to weaken. Direct hernias usually occur during the middle periods and also in the older adults. However, for indirect hernias, the occurrence is usually at any age including very young people. The etiology of IH is in such a way that it has a congenital component whereby the inguinal canal is at a higher level of being patent (Go 2016). Other factors that may increase the risk of one contracting the disease include paternity, obesity, chronic constipation, chronic coughing, history of the illness and also family history.

Indirect Inguinal Hernia

At the moment when testicle goes through the DIR, it is expected that the embryonic closure ought to occur. However, the failure of this activity to take place results into the IIH. Similar to other forms of a hernia, there is usually a protrusion which occurs through the SIR. This occurrence is by far the most causative agent of a groin hernia.

In the most male fetus, the testicle receives coat from the peritoneum while it goes through the ring. In return, this forms a non-permanent connection which is referred to as the processes vaginalis. After the testicle is fully descended in a normal process, the process is eliminated. However, a the testicle is left with a peritoneum coat (Holcomb 2015). This is known as the tunica vaginalis. After the process of discussion is completed, the testis maintains a connection with the vas deferens and also there is a connection with the blood vessels. These form the spermatic cord and effectively go downwards through the inguinal canal directly into the scrotum.

The beginning of the inguinal ring is the deep inguinal ring which remains as the main opening which leads to the fascia transversalis. Thus consequentially forms the inner linings of the spermatic cord (Hill & Nirula 2017). An Indirect inguinal hernia usually occurs when there is a phenomenon whereby the opening becomes extremely large than it is required to be. At the moment when there is a peritoneum protrusion that occurs through the IIH, this is a complete blockade of processes. When there is an IH, the protrusion usually goes through the deeper inguinal ring and then settles in a lateral position to the inferior epigastric artery.

The occurrence of a hernia in females is usually 4% in comparison to the occurrence of the same in males. In females, the most common type of the Inguinal Hernia is the indirect inguinal hernia. When there is the occurrence of an indirect inguinal hernia in a female, then the female usually has a patent inguinal ring. Th...

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