Evidence-Based Clinical Intervention in Umbilical Hernia

The Medical Problem

Umbilical hernia is one of the medical conditions that majorly affect infants. Shahani, Vaswani, and Nizamani (2015) note that “the condition arises when the abdominal wall layers don’t join completely, and the intestine or other tissues from inside the abdominal cavity bulge through the weak spot around the belly button” (p. 75). In most of the cases, the opening closes on its own after a few weeks or months. However, there are cases when the condition does not resolve on its own. Nguyen and Tudtud-Hans (2017) warn that when umbilical hernia fails to close when a child is four years old, then medical attention may be needed to address the problem. The condition may be painless and causes little discomfort among children, but for adults, it may be characterized by some form of pain. It is critical to find a solution to this problem as soon as it is detected.

Signs and Symptoms

It is important to understand signs and symptoms of this medical condition. The onset of umbilical hernia can be detected at a very early age, depending on a number of factors. The specific location that is often affected is the umbilical code. Nguyen and Tudtud-Hans (2017) observe that the primary characteristic of this condition is the swelling of the umbilical code. When the child is a few weeks old, one can detect it at the time when a child is coughing, crying, or straining. As such, Jairam, Kaufmann, Muysoms, Jeekel, and Lange (2017) advise that timing is important when one wants to ascertain if his or her child is suffering from umbilical hernia. Any physical activity that causes strain around the abdomen is an aggravating factor. They include lifting of objects, crying or laughing, and games that involve stretching of the body. Shahani et al. (2015) stated that sometimes the obvious symptoms, especially the bulging of the umbilical code) may not be easily visible among young children. In such cases, it may be necessary to look at associated symptoms. One such common associated symptom is general discomfort around the umbilical code area or the middle abdomen. The child may express discomfort by constantly touching the area while crying. The most affected age group is children below four years. Although rare, it also affects adults, especially if corrective measures were not taken at the right time.

Explaining the pathophysiology of umbilical hernia may make it easy for one to determine when one is suffering from the condition. In most of the cases, the umbilical code will start bulging out. The course since onset will involve a consistent increase in the size of the umbilical code instead of its reduction as is always the case in normal conditions. At a very early age when a child is less than six months, it is easy to assume that the condition will resolve by itself with time. However, that may not be the case, a sign that the medical problem is becoming serious. Shahani et al. (2015) warn of concomitant diseases associated with umbilical hernia. In some cases, the protrusion may be incarcerated, making it difficult to push it back into the abdominal cavity (Jairam et al., 2017). Such incidents are rare among young children but often occur among adults with this condition. The incarceration may lead to a situation where the intestine loses some of its supply of blood. The area of the intestine that is denied blood may be damaged, and that may cause a more serious medical problem. It may lead to infection of the entire abdomen, especially when the cells of the intestine that is denied blood start to die. It leads to a medical condition that Nguyen and Tudtud-Hans (2017) refer to as gangrene.

Umbilical hernia is caused by a number of factors. Premature birth is considered one of the top causes of this health problem. Those born with low weight are also likely to develop the condition. Other known factors include obesity, frequent pregnancy, abdominal surgery, and persistent heavy coughs (Cooper, Pinnola, Borowicz, & Davis, 2016). Those treated for cancer using radiation may also develop hernia, especially if the setting exposed the area around the umbilical code to excess radioactive waves. The best alleviating factor is medical surgery that addresses the problem permanently. One can take painkillers, especially when the condition becomes painful.

Differential Diagnosis

Umbilical hernia should not be mistaken for other illnesses because it may lead to administering wrong medication that can cause other serious health complications. Conducting a differential diagnosis, giving priority to those sicknesses with similar symptoms may help avoid such mistakes. Umbilical granuloma is one such complication. It majorly affects the umbilical code, resulting in growth of small tissues a few weeks after cutting the umbilical code (Nguyen & Tudtud-Hans, 2017). The main difference it has from umbilical hernia is that it has a yellow discharge. Epigastric hernia is another condition that may be mistaken for umbilical hernia. However, the main difference is that the swelling is below the sternum and may not necessarily affect the umbilical code (Cooper et al., 2016). It may also be necessary to eliminate omphalocele, a condition where a hole in the naval area of the belly allows internal organs out of the body.

Expected Outcome

The research is expected to create awareness among the target population to enable them identify umbilical hernia in its earlier stages of development. It will help eliminate cases where the problem is ignored until late in time when related complications start to emerge.

References

Cooper, N., Pinnola, A., Borowicz, M., & Davis, J. (2016). Methicillin-resistant Staphylococcus aureus infection in an umbilical hernia meshes eleven years after implantation. Surgical Infections Case Reports, 1(1), 106–107. Web.

Jairam, A., Kaufmann, R., Muysoms, F., Jeekel, J., & Lange, J. (2017). The feasibility of local anesthesia for the surgical treatment of umbilical hernia: A systematic review of the literature. Hernia, 21(2), 223–231. Web.

Nguyen, E., & Tudtud-Hans, L. (2017). Flood syndrome: Spontaneous umbilical hernia rupture leaking ascetic fluid—A case report. The Permanente Journal, 21(1), 16-152. Web.

Shahani, B., Vaswani, A., & Nizamani, M. (2015). Diagnosis of pfeiffer syndrome with umbilical hernia. Pakistan Journal of Medicine and Dentistry, 4(1), 74-77.