INCARCERATED VENTRAL
HERNIA REPAIR
Rachel Chan
Hernia
Heavy lifting
Persistent cough or sneeze
Straining during bowel movements
Smoking or habits that worsen COPD
Long term use of oral steroids
Signs/symptoms
Types of hernia
External protrusion:
Sports hernia
Ventral hernia
Internal protrusion:
Diaphragmatic hernia
Hiatal hernia
Treatment options
1. Reduce the hernia
Reducible/nonreducible
hernia
Incarcerated hernia-trapped
where its protruded so it
cant be pushed back to
where it belongs
Strangulated hernia
2. Surgical interventions
Laparoscopic surgery or
open approach
Herniorrhaphy or
hernioplasty
Case study
Patient S.B.
56 y.o. male
African American
Vendor
Lives with wife
Islamic, speaks Arabic besides English
Does not eat pork due to religious
reasons
Report on admission
Social history
Physical history
Obesity Class I
Calorie requirement
Hospital course
Timeline
Date
POD
#
Events
4/19
4/20
4/23
4/24
4/25
4/26
4/29
10
4/30
11
Labs
4/22
4/23
4/24
(VDRF
)
4/27
(VDRF
)
4/29
4/30
5/6
Na
134
140
144
147
149
143
138
4.3
3.8
2.8
3.3
4.1
4.6
Cl
101
102
102
105
112
108
102
25
24
30
31
29
26
27
14
12
11
13
24
30
21
27
27
11
1.2
1.9
1.1
1.2
1.4
1.4
76
124
110
151
117
105
94
Ca
8.2
8.1
8.4
8.6
9.1
Phos
2.3
3.1
2.8
4.1
3.4
Mg
2.1
2.4
2.3
2.3
2.2
1.9
PAB
8.1
10.2
CO2
Anion
gap
BUN
Cr
Glucos
e
PES statements
1.
2.
Nutrition interventions
Date
Diet
order/
Events
Nutrition interventions
4/19-4/23
NPO
none
4/24
Intubated
day#2
4/25
Intubated
day #3
4/29
Clear liquid
4/30
Full liquids
Surgery ok to advance.
Recs: Full liquid per surgery, check PAB, monitor and follow-up
5/1
Cardiac
TPN calculations
Figure out protein calories and non-protein
calories (NPC)
2. Grams of protein x 4 kcal/kg
3. Then subtract that number from total kcal=
NPC
Ex: 140 g pro x 4 kcal/kg= 560 calories from
pro
2200 kcal (total kcal)-560 cal= 1640 NPC
TPN order for S.B. (April 26th)
105 grams of protein, 1100 NPC,
micronutrients per PharmD
1.
Intervention
Nutrient delivery:
Monitor/Evaluation
PO intake
Bowel movements
Nutrition education
Low Na diet
Clinical improvements
Complications
Admissio Date
n
QUESTIONS