By Meg Marinis, Director of Research | Apr 1st, 2010
What the HECK was that thing sticking out of Little Karev's stomach?!

Pretty disgusting, right?

In Episode 619, Sympathy For The Parents, Dr. Alex Karev's little brother Aaron swings by for a visit with his older brother. He hasn't seen Alex for seven years, so he decided to veer in his direction while on a moving job for work. But when Alex questions the proximity of Portland to Seattle, Aaron gives in and lifts up his shirt: He needs some doctorly advice... for the large mass that seems to be protruding from his stomach. Should he be worried?

Um... Yes, he should.

What exactly are hernias, and where do they come from?

A hernia occurs when part of an internal organ bulges (for lack of a better word) through a weakened area of muscle. Most hernias happen in the groin, and they can either develop over time or quite suddenly. Hernias arise from one of the following conditions or combinations:

- Sudden weight gain or obesity
- Pregnancy
- Heavy lifting and straining (Aaron is a professional mover)
- Diarrhea or constipation
- Persistent coughing or sneezing
- Surgical incisions

People may develop different types of hernias...

- An inguinal hernia usually occurs in the groin (where it meets the thigh) and affects more guys than girls. Unfortunately, for men, the protruding piece of intestine may enter the scrotum, leading to swelling and pain. One would feel pain and discomfort during a cough, bending over, or if one lifted something heavy. Surgery would be performed to treat this kind of hernia, and the procedure remains the most common surgery for kids and teenagers.

- An umbilical hernia (which Aaron has) arises when part of the intestines bulge through the abdominal wall near the belly button. These hernias typically appear in babies younger than six months, and if small, they may heal without surgery.

- An epigastric hernia (also known as a ventral hernia) happens when part of the intestines protrude through the abdominal muscles located between the belly button and chest. Seventy-five percent of epigastric hernias can be seen in males, and surgery needs to correct the problem.

- An incisional hernia comes from when intestines bulge around a surgical incision since surgery naturally weakens the muscle tissue in the abdomen. An additional surgery needs to be performed to repair the hernia.

- A hiatal hernia occurs at the opening of the diaphragm where the esophagus joins the stomach. If the muscles around the opening to the diaphragm become weak, the uppermost part of the stomach can bulge through the diaphragm. These hernias present with heartburn, chest pain, and indigestion. They may be treated with diet changes and medication; extreme cases require a surgical repair.

So the main way to treat hernias is... ?

If left untreated, many hernias may grow in size and increase in pain. A piece of intestine can become trapped—called an incarceration. A true surgical emergency occurs if the blood supply is cut off due to an incarcerated piece of intestine (called strangulation). For smaller hernias, doctors may use sedation, analgesia, and trendelenburg positioning to reduce an incarcerated hernia. However, for more difficult hernias, surgeons would perform a procedure in which they implant a sterile surgical mesh to strengthen the weakened abdominal wall. Procedures may be laparoscopic or open.

Tips to prevent hernias:

- Stay at a healthy weight for your height and body type.
- Make fruits, vegetables, and whole grains a "regular" part of your diet.
- See your doctor when you are sick.
- Be careful when weight lifting or moving heavy objects. Bend with your knees!
- Quit smoking (smoking exacerbates coughing, which can lead to hernias).

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