Abdominal Bulging: Diastasis Recti or Hernia?

The main way to tell if you have a hernia or diastasis recti is whether you feel pain. Hernias can cause substantial pain while diastasis recti may increase discomfort and abdominal wall weakness.

Let’s take a deeper look into the difference between diastasis recti and hernias.

Diastasis recti

Diastasis recti happens when the connective tissue between your rectus abdominis (six-pack) muscles is stretched, creating an abnormally wide distance between the muscles. This separation can present as a bulge, usually of the upper abdomen, that you may notice when you cough, sit up in bed or lift something heavy.

The most common causes of diastasis recti are pregnancy and obesity, but abdominal wall weakness and previous abdominal surgery can also increase a person’s risk. Diastasis can also be congenital or something that developed in the womb.

Typically, diastasis recti are oval-shaped bulges between the breastbone and belly button and are not painful. A person may notice it during activities that cause them to contract the abdomen.

Aside from the prominent bulge, abdominal wall weakness could make any type of weightlifting and core exercises more difficult.

A doctor may diagnose diastasis recti when they see a “classic bulge” present when the patient sits up. A CT scan showing a separation of ab muscles may also lead to a diagnosis.

Diastasis often does not require surgery. For pregnant people, the condition typically improves after childbirth.

Following diagnosis, prescribed treatment may involve physical therapy to strengthen the ab muscles or diet and exercise for weight loss purposes.

If abdominal wall weakness associated with the diastasis recti becomes problematic, an abdominal binder may help. There are many types of abdominal binders; however, the general concept is a compressive garment worn around the belly to provide additional support.

Hernias

A hernia is a hole in the tissues of the belly wall through which fat, fluid or an organ can stick out. Hernias can be located at or near the bellybutton, in the groin, or at a previous surgical incision. Some hernias are present at birth while others develop over time.

A hernia looks like a bulge or protrusion located somewhere on the abdomen or in the groin. You may notice the hernia when you cough, sneeze, lift a heavy item or during a bowel movement. The bulge can be visible during rest periods, as well.

Hernias will often cause pain at the site of the bulge.

A hernia can often be diagnosed during an exam; a doctor may be able to see or feel the hernia’s bulge or they will use a CT scan for a better look at the abdominal wall to determine if there is a hole.

Hernias can be repaired surgically, and the goal is to repair them before tissue or a stomach intestine pushes through the hole.

Abdominal binders are recommended for hernias, as well, to reduce symptoms.

If you would like a doctor to look at your abdominal bulge, call (713) 798-6363 to make an appointment at the Baylor Medicine Hernia Center.

By Heather West, PA-C, Specialty Abdominal Wall Surgery, Division of Trauma and Acute Care Surgery

Battling a Bulging Hernia | NIH News in Health

December 2017

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Don’t Ignore Your Groin Pain

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Usually, the wall of the abdomen is strong. The muscles keep your intestine in place. But if there’s a weak spot, the intestine can push through and form a hernia. A person may be born with a weakness there, or the weakness may develop over time later in life.

“It’s like when you look at an old tire on a car and you see kind of a bulge on the sidewall of the tire. That’s because there’s a weakness in the wall of the tire. And the air is pushing the wall of the tire outward to create that bulge,” says Dr. Dana K. Andersen, an NIH hernia expert.

A hernia developing in the abdomen is extremely common. Babies, children, and adults get them. Most of the time, hernias are found in men over 40. Can lifting heavy objects give you a hernia? Maybe if you already have a weakness in the wall of your abdomen.

“The majority—three-quarters—of abdominal wall hernias are in the groin,” Andersen says. The groin region is the lower abdomen.

The first sign of a hernia is a small bulge from the lower abdomen. You may notice it only when you stand up, cough, jump, or strain. That’s because those activities increase the pressure within your abdomen. That increased pressure can make a part of your intestine pop out of an area of weakness. When you lie down, the bulge may go away.

If you think you may have a hernia, ask your doctor. A doctor can usually detect a hernia during a physical exam. Your doctor can rule out other conditions that cause bulges or lumps.

If the bulge is very soft, your doctor may be able to massage the intestine back into the abdomen. A small, soft hernia that does not cause pain may not need treatment right away. The doctor may suggest watching and waiting for changes, like pain, to develop. If a hernia is painful or large, your doctor may suggest you see a surgeon for advice. You may need surgery to repair the hernia.

If your doctor can’t massage the intestine back into the abdomen, that means it’s trapped. A trapped intestine is dangerous because its blood supply can be cut off or strangulated.“The rim of the defect is forming a sort of a noose around the abdominal contents,” Andersen explains. “If that noose is tight enough so that the loop of intestine can’t be eased back through the defect, then the concern is that the intestine itself could be injured by strangulation.”

A strangulated hernia can be very serious and even life threatening. Symptoms include severe pain that doesn’t go away, nausea, and vomiting.

Surgery is usually needed if the intestine is trapped—and emergency surgery if it’s strangulated. A hernia is one of the most common reasons for surgery in the United States. “It’s a successful and low-risk procedure done about 800,000 times a year in the United States,” Andersen says.

If you think you may have a hernia, talk with your doctor. And check out the tips in Wise Choices for how to keep a hernia from getting worse. Keep in mind that anyone with sudden pain in the groin should immediately seek medical help.

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Lipoma, or wen – causes, symptoms of the disease, diagnosis and treatment

Jaundice

Tumor

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17 December

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Lipoma: causes, symptoms, diagnosis and treatment.

Definition

Lipoma is a common tumor composed of fat cells (adipocytes) and is usually separated from surrounding tissues by a thin connective tissue capsule. Lipomas can form anywhere where fat cells are present, usually located subcutaneously, but are sometimes found on internal organs (for example, in the stomach, esophagus or intestines, bronchi, heart, or muscles).

Lipomas are benign neoplasms that do not tend to become malignant and do not cause discomfort to patients. The exception is those cases when lipomas are unsuccessfully located (for example, in the joint area) or grow rapidly, which happens extremely rarely.

Lipomas are the most common mesenchymal tumors (mesenchymal tumors are soft tissue tumors and specific bone tumors). The incidence is about 2.1 per 1000 people per year, and men are diagnosed slightly more often than women.

Causes of lipomas

The exact causes of lipomas are unknown. Some researchers agree that genetic anomalies play a role in their formation. Another theory suggests a link between the occurrence of a lipoma and previous trauma. Risk factors for the development of lipomas can be obesity, alcohol abuse, liver disease, impaired glucose tolerance, hyperlipidemia. The appearance of a lipoma may be the result of another disease, for example, familial multiple lipomatosis.

Disease classification

Lipomas can be simple or multiple (multiple lipomatosis). The latter include Derkum’s disease, benign symmetrical lipomatosis (Madelung’s disease), familial lipomatosis, congenital infiltrating lipomatosis. Multiple lipomatosis accounts for approximately 5-10% of all detected cases of lipomas.

Depending on which tissue components are involved in the pathological process, fibrolipomas (with connective tissue elements), myolipomas (they contain muscle fibers), angiolipomas (include blood vessels), myxolipomas (contain mucous tissue), myelolipomas (contain hematopoietic tissues ).

Symptoms of lipoma

Lipomas in the subcutaneous adipose tissue feel soft and mobile, not soldered to the surrounding tissues. Lipomas are characterized by slow growth, and their size is usually from 1 to 10 cm. Larger lipomas are called “giant”. The lesions are usually painless unless they involve joints, nerves, or blood vessels. The skin over the lipoma is not changed.

In the gastrointestinal tract, lipomas are submucosal fatty tumors. They are asymptomatic, but can provoke ulceration and bleeding. Esophageal lipomas can make it difficult to swallow food and liquids, causing belching, vomiting, and reflux.

Lipomas of the small intestine are diagnosed, as a rule, in older people, most often located in the ileum and dangerous by blockage (obstruction) of the intestinal lumen.

In addition, intestinal lipomas cause pain, obstructive (mechanical) jaundice, and intussusception (invasion of one part of the intestine into another).

Extremely rarely, lipomas form in the heart: subendocardially – under the inner lining of the heart (endocardium) or intramurally – inside the muscle layer (myocardium). Usually, cardiac lipomas are not encapsulated and appear as a yellow mass protruding into the cavity of the heart. Cardiac lipomas can cause chest pain, arrhythmias, and shortness of breath.

Lipomas formed in the bronchi or lung parenchyma lead to impaired respiratory function.

Lipoma Diagnosis

Diagnosis requires a clinical examination by a physician and soft tissue ultrasound.

Ultrasound of soft tissues

Examination of soft tissues to detect pathological changes and diagnose neoplasms.

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If the gastrointestinal tract is affected, contrast studies can be used, and in the case of an atypical location of the lipoma (for example, in the heart), in addition to ultrasound, computed or magnetic resonance imaging is performed.

Which doctors to contact

Diagnosis can be made by a dermatologist,
family doctor or
therapist. Surgical treatment is performed
surgeon.

Lipoma treatment

If the lipoma is painless and does not cause discomfort, no treatment is required. An indication for the removal of subcutaneous lipomas is their unfortunate location, that is, a cosmetic defect. The most effective method of correction is surgical excision of the lipoma together with the capsule.

In addition to excision for the treatment of small subcutaneous lipomas, there are conservative therapies, such as injections of lipolytic drugs, whose action is aimed at breaking down fat cells. However, after such treatment, relapses are possible.

Complications

Gastrointestinal lipomas can cause bleeding, blockage of the intestinal lumen, jaundice, and intussusception.

Cardiac lipomas can lead to embolism and cardiac arrhythmias.

Huge subcutaneous lipomas can compress nerves and surrounding structures. If a pedunculated lipoma occurs, there is a risk of its twisting, as a result of which the blood supply to the lipoma is disrupted, which is fraught with its necrosis or ulceration.

Prevention of lipoma

To prevent the occurrence of lipoma, factors that can provoke its growth should be minimized:

• avoid injury to soft tissues,
• maintain adequate weight,
• treat disorders of carbohydrate metabolism,
• monitor cholesterol levels and correct them in time.

Sources:

1. Charifa A, Azmat CE, Badri T. Lipoma Pathology. 2021 Sep 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 29493968.
2. Kolb L, Yarrarapu SNS, Ameer MA, et al. Lipoma. [Updated 2021 Oct 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from:
   www.ncbi.nlm.nih.gov
3. Usoltsev D.M., Davidyan A.A., Babich R.A. Experience in the removal of giant lipomas in the conditions of an outpatient surgery center. Inpatient replacement technologies: outpatient surgery. – 2016. – No. 1-2 (61-62). – S. 94-96.

Furuncle (boil) – symptoms, causes, signs and methods of treatment in adults in “SM-Clinic”

This disease is treated by a Dermatologist
, Surgeon

• About the disease
• Types of boils
• Symptoms of a boil
• Causes of boil development
• Diagnostics
• Expert opinion
• Treatment of furunculosis
• Prophylaxis
• Rehabilitation
• Questions and answers
• Doctors

About the disease

A furuncle is also called a boil. It occurs more often in adulthood. Men are affected somewhat more often than women. The main peak of incidence falls on the autumn and spring periods, when the body’s defenses weaken.

Unlike ostiofolliculitis and folliculitis, the formation of a furuncle is accompanied by the involvement of the surrounding tissue in the inflammatory process. This is due to the severe course of the disease.

On places devoid of hair (palms and palmar surface of the fingers, soles) boils do not develop. Most often they occur on areas of the skin that are subject to contamination (forearms, back of the hand) and friction (back of the neck, lower back, gluteal region, thighs).

Types of boils

Depending on the number of formations, single and multiple boils are distinguished. In the latter case, the disease is called furunculosis.

In the process of development, the pathology passes through three successive stages:

• infiltrative: accompanied by tissue infiltration;
• purulent-necrotic: characterized by purulent fusion of the central part of the boil and the formation of a purulent-necrotic rod;
• stage of healing: begins from the moment of spontaneous or artificial opening of the abscess and lasts until the formation of a scar.

Symptoms of a boil

At the initial stage of the development of the disease, the patient feels slight itching and tingling. On the 1st-2nd day, a formation appears that protrudes conically above the skin. The tissues turn red and become painful when touched. As the boil matures, a head appears on its top – a small accumulation of pus with a black dot in the center.

On the 3-7th day, in the form of a rod, together with the remnants of the hair, they are excreted with pus. The resulting wound is cleaned, filled with granulation tissue and healed. The swelling around it gradually decreases, the pain disappears. A small, whitish, somewhat retracted scar remains at the site of inflammation.

Multiple lesions of boils that appear simultaneously or sequentially one after another in different parts of the body – called furunculosis. A disease that lasts with small remissions for several years is considered chronic, relapsing.

Usually, a boil does not cause significant disturbances in well-being. With the defeat of a significant amount of tissue, symptoms of intoxication appear: weakness, headaches, fever. The intensity of pain depends on the location of the formation. In the face area (lips, forehead), as well as on the scrotum, the formation of a boil is accompanied by swelling of the surrounding tissues, which is explained by the looseness of the subcutaneous tissue.

Causes of the development of a boil

The main cause of the development of a boil is the defeat of the hair follicle or its surrounding tissues by Staphylococcus aureus, rarely white. An important factor is also a decrease in general or local immunity against the background of chronic diseases, metabolic disorders, and infections. Pathology occurs especially often in patients with diabetes mellitus, obesity, chronic liver and kidney damage, oncological diseases, etc. Infection of tissues often occurs against the background of skin damage: scratches, cuts, abrasions, constant exposure to sweat or purulent discharge (from the nose, ears).

The causes of localized furunculosis are most often incorrect methods of therapy and ignoring the doctor’s recommendations (use of compresses, undertreatment of residual compaction, washing the place where the elements appear).

Get advice

If you experience these symptoms, we recommend that you make an appointment with your doctor. Timely consultation will prevent negative consequences for your health.

You can find out more about the disease, prices for treatment and sign up for a consultation with a specialist by phone:

+7 (495) 292-39-72

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1

Treatment is carried out in accordance with clinical guidelines

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Comprehensive assessment of the nature of the disease and treatment prognosis

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High level of service and balanced pricing policy

Diagnosis

Diagnosis of boils is not difficult. During a visual examination of the patient, a dermatologist discovers a characteristic formation. Its appearance allows you to assess the stage of development of the disease. During the conversation, the doctor determines the possible cause of the development of boils, identifies risk factors. For an accurate diagnosis and determination of the pathogen, bakposev of the discharge is prescribed. In case of multiple lesions, additional diagnostics is carried out:

• general and biochemical blood test;
• immunogram;
• hormonal assessment;
• examination by ENT, endocrinologist and other specialists;
• examination of internal organs, paranasal sinuses, lungs, etc. depending on the specific clinical situation.

Expert opinion

Furuncle is a rather serious disease, which should be treated with great care. In no case should you self-medicate: you should not make compresses, use various ointments – in most cases this leads to the spread of the inflammatory process.

A complication of a boil can be lymphadenitis and lymphangitis (damage to the lymphatic vessels and nodes). Of particular danger are rapidly progressing acute thrombophlebitis and sepsis.

Acute thrombophlebitis usually develops with boils located near the large saphenous veins, and sepsis – with boils of the face. They are often the result of attempts to squeeze out the contents of the boil, cutting it off during shaving, trauma during massage. The prognosis for these complications is very serious.

Omarova Andzhelika Mutaevna

Coloproctologist, surgeon, Ph.D.

Treatment of furunculosis

Treatment of furuncle is only surgical, because no other therapy will be successful if the focus of purulent inflammation is not removed or opened and drained in a timely manner.

The opening of the boil is usually performed under local anesthesia and is painless for the patient. At the same time, antibiotic therapy, means for correcting immunity and eliminating background pathologies, if any, are prescribed.

Simple (uncomplicated) lesions can be treated on an outpatient basis and do not require hospitalization. But in case of a severe course, if the patient develops swelling of the soft tissues of the cheek, lip or eye, urgent hospitalization is necessary in the surgical department to constantly monitor the development of the process and prevent complications.

Strict bed rest and appropriate therapy are prescribed for high fever.

Prevention

To minimize the risk of developing boils, the skin must be regularly cleansed of impurities and fully treated for any tissue damage. People with hyperhidrosis and/or excess sebum need to pay special attention to hygiene. General measures are also important: proper nutrition, a healthy lifestyle, timely treatment of acute and chronic diseases.

Rehabilitation

After opening an uncomplicated boil, the patient goes home after 1-2. In the next 2 weeks, he needs to regularly visit a doctor for dressings, take prescribed medications. It is strictly forbidden to play sports, swim in open water or pools, overheat.

Questions and Answers

No. Self-medication and the use of folk remedies can cause complications.

Yes, when a purulent focus is located on the face, the infection can go to the meninges.

Gostishchev Victor Kuzmich. Clinical operative purulent surgery. Guide for doctors. GEOTAR-Media, 2016

Rodionov Anatoly Nikolaevich, Sydikov Akmal Abdikaharovich, Zaslavsky Denis Vladimirovich. Clinical dermatology. Illustrated guide for doctors. GEOTAR-Media, 2022

Nikolsky V. Yu., Imbryakov K. V. Furuncles and carbuncles of the face // Russian Dental Journal. 2013. No. 5.

Okulich V.K., Fedyanin S.D. RATIONAL USE OF ANTIBACTERIAL DRUGS IN PATIENTS WITH PURULENT WOUNDS, FURUNCULOSIS, BOILS AND CARBUNCULES // Bulletin of the Voronezh State Medical University. 2003. No. 4.

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Diseases referred by the Surgeon

Soft tissue abscess
liver abscess
Appendicitis
Ascites
Atheroma
femoral hernia
Crohn’s disease
Gangrene
soft tissue hematoma
Giant cell tumor of bone
Hygroma
festering wounds
Hernia
Hernia of the white line of the abdomen
hiatal hernia
Diastasis rectus abdominis
Intestinal diverticulosis
Cholelithiasis
Keratoma
liver cyst
pancreatic cyst
salivary gland cyst
Neck cyst
stab wound
stab wound
Lipoma
Mechanical jaundice
Bowel obstruction
burns
Oleogranuloma
kidney tumor
Acute pancreatitis
Felon
Pancreatic necrosis
Inguinal hernia
Peritonitis
Barrett’s esophagus
Postoperative hernia
Umbilical hernia
Cancer of the extrahepatic bile ducts
Stomach cancer
gallbladder cancer
bowel cancer
adrenal cancer
Parathyroid Cancer
Liver cancer
Esophageal carcinoma
colon cancer
thyroid cancer
Fistula of the gallbladder
Seroma
Thyroiditis
Intestinal injury
vein thrombosis
Thrombophlebitis
Furunculosis
cholestasis
Cholecystitis
Chronic cholecystitis
Esophageal ulcer
Peptic ulcer of the stomach and duodenum

Diseases referred by Dermatologist

Acne (pimples)
Allergic dermatitis
Atopic dermatitis
Warts
Human papillomavirus (HPV)
Ingrown toenail (onychocryptosis)
Herpes (herpes virus 1, 2 types)
Hyperhidrosis (sweating)
Foot hyperhidrosis (excessive sweating)
Hyperkeratosis
Hyperkeratosis of the nails
Nail fungus (onychomycosis)
foot fungus
demodicosis
Dermatitis
Nail deformation
diabetic foot
Ichthyosis
Keratoma
warts
molluscum contagiosum
contact dermatitis
Hives
Couperose
Lichen
calluses
corns
Nevuses (moles)
Neurodermatitis
Onychodystrophy
Onycholysis
Rash under the breast
Pityriasis versicolor
Papillomas
Inguinal epidermophytosis
Pediculosis
Skin pigmentation
plantar warts
Loss of skin tone and elasticity
Prickly heat
Psoriasis
Pemphigus
Rosacea
Seborrheic dermatitis
seborrhea
Cracked feet
Acne
Folliculitis
Furunculosis
Scabies
Eczema

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