Hernia (Abdominal Hernia)

  • Medical Author:
    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

What types of medical professionals treat and repair hernias?

Most often, primary care providers are the first to diagnose and treat a hernia. For hiatal hernias, usually medical, not surgical, care is needed and controlling the symptoms of GERD is the primary goal. Occasionally, a gastroenterologist will be involved in the care to assess the severity of GERD. Some hiatal hernias do require surgery and a general surgeon and/or a thoracic surgeon performs the operation, depending upon the location of the organs in the stomach or chest and the size of the defect in the diaphragm.

While primary care providers make the diagnosis of an abdominal wall hernia, it is the general surgeon who performs the operation and repairs the hernia.

When a hernia becomes incarcerated, often the patient goes to the emergency department and the physician there makes the diagnosis and sometimes can push the hernia back into place (reduced). If the hernia is reduced, referral as an outpatient to a general surgeon may be an option. If the hernia remains trapped (incarcerated) or if there is concern that the hernia is strangulated, an immediate consultation with a surgeon is required.

Hernias in the neonatal period are often recognized by the pediatrician or family provider in the delivery suite or the newborn nursery. A pediatric surgeon may be consulted for their evaluation.

How do health care professionals diagnose abdominal hernias?

For inguinal hernias, most patients notice a feeling of fullness or a lump in the groin area with pain and burning. Physical examination can usually confirm the diagnosis. Femoral or obturator hernias are more difficult to appreciate and symptoms of recurrent inguinal or pelvic pain without obvious physical findings may require a CT scan to reveal the diagnosis. Umbilical hernias are much easier to locate with the bulging of the belly button.

Hernias that are incarcerated or strangulated present a greater challenge since the potential complication of dead bowel increases the urgency. The health care professional seeks clues of obstruction, including a history of pain, nausea, vomiting, or fever. During a physical examination, a doctor may often discover that a patient has a markedly tender abdomen. These hernias are often exquisitely tender and firm. The exam may be enough to suspect incarceration or strangulation and require immediate consultation with a surgeon. Doctors may use X-rays or CT scans to confirm the diagnosis, depending upon the clinical situation.

Doctors may be able to diagnose hiatal hernias associated with GERD by learning a patient's medical history during his or her physical exam. A chest X-ray can reveal part of the stomach within the chest. If there is concern about complications including esophageal inflammation (esophagitis), ulcers, or bleeding, a gastroenterologist may need to perform an endoscopy.

Medically Reviewed by a Doctor on 6/23/2017

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