Umbilicus Health Dictionary

Navel, or UMBILICUS, is the scar on the abdomen marking the point where the umbilical cord joined the body in embryonic life. (See PLACENTA.)... navel

The membranous sac, otherwise known as the vitelline sac, that lies against, and is attached to, the front of the embryo during the early stages of its existence. During development, the sac decreases proportionately in size to the body, reducing finally to a narrow duct that passes through the umbilicus. The yolk sac is believed to assist in the transportation of nutrients from the mother to the early embryo.... yolk sac

See under STOMACH, DISEASES OF; INTESTINE, DISEASES OF; DIARRHOEA; LIVER, DISEASES OF; PANCREAS, DISEASES OF; GALL-BLADDER, DISEASES OF; KIDNEYS, DISEASES OF; URINARY BLADDER, DISEASES OF; HERNIA; PERITONITIS; APPENDICITIS; TUMOUR.

Various processes that can occur include in?ammation, ulceration, infection or tumour. Abdominal disease may be of rapid onset, described as acute, or more long-term when it is termed chronic.

An ‘acute abdomen’ is most commonly caused by peritonitis – in?ammation of the membrane that lines the abdomen. If any structure in the abdomen gets in?amed, peritonitis may result. Causes include injury, in?ammation of the Fallopian tubes (SALPINGITIS), and intestinal disorders such as APPENDICITIS, CROHN’S DISEASE, DIVERTICULITIS or a perforated PEPTIC ULCER. Disorders of the GALLBLADDER or URINARY TRACT may also result in acute abdominal pain.

General symptoms of abdominal disease include:

Pain This is usually ill-de?ned but can be very unpleasant, and is termed visceral pain. Pain is initially felt near the mid line of the abdomen. Generally, abdominal pain felt high up in the mid line originates from the stomach and duodenum. Pain that is felt around the umbilicus arises from the small intestine, appendix and ?rst part of the large bowel, and low mid-line pain comes from the rest of the large bowel. If the diseased organ secondarily in?ames or infects the lining of the abdominal wall – the PERITONEUM – peritonitis occurs and the pain becomes more de?ned and quite severe, with local tenderness over the site of the diseased organ itself. Hence the pain of appendicitis begins as a vague mid-line pain, and only later moves over to the right iliac fossa, when the in?amed appendix has caused localised peritonitis. PERFORATION of one of the hollow organs in the abdomen – for example, a ruptured appendix or a gastric or duodenal ulcer (see STOMACH, DISEASES OF) eroding the wall of the gut – usually causes peritonitis with resulting severe pain.

The character of the pain is also important. It may be constant, as occurs in in?ammatory diseases and infections, or colicky (intermittent) as in intestinal obstruction.

Swelling The commonest cause of abdominal swelling in women is pregnancy. In disease, swelling may be due to the accumulation of trapped intestinal contents within the bowel, the presence of free ?uid (ascites) within the abdomen, or enlargement of one or more of the abdominal organs due to benign causes or tumour.

Constipation is the infrequent or incomplete passage of FAECES; sometimes only ?atus can be passed and, rarely, no bowel movements occur (see main entry for CONSTIPATION). It is often associated with abdominal swelling. In intestinal obstruction, the onset of symptoms is usually rapid with complete constipation and severe, colicky pain. In chronic constipation, the symptoms occur more gradually.

Nausea and vomiting may be due to irritation of the stomach, or to intestinal obstruction when it may be particularly foul and persistent. There are also important non-abdominal causes, such as in response to severe pain or motion sickness.

Diarrhoea is most commonly due to simple and self-limiting infection, such as food poisoning, but may also indicate serious disease, especially if it is persistent or contains blood (see main entry for DIARRHOEA).

Jaundice is a yellow discoloration of the skin and eyes, and may be due to disease in the liver or bile ducts (see main entry for JAUNDICE).

Diagnosis and treatment Abdominal diseases are often di?cult to diagnose because of the multiplicity of the organs contained within the abdomen, their inconstant position and the vagueness of some of the symptoms. Correct diagnosis usually requires experience, often supplemented by specialised investigations such as ULTRASOUND. For this reason sufferers should obtain medical advice at an early stage, particularly if the symptoms are severe, persistent, recurrent, or resistant to simple remedies.... abdomen, diseases of

The term describing the abnormally dilated veins that form around the umbilicus in CIRRHOSIS of the liver.... caput medusae (medusa’s head)

The term applied to a congenital HERNIA formed by the projection of abdominal organs through the UMBILICUS.... exomphalos

The protrusion of an organ, or part of an organ, through the wall of the cavity that normally contains it. The most common types of hernia involve the organs of the abdomen which can herniate externally through the abdominal wall, or internally usually through a defect in the diaphragm. External hernias appear as a swelling, covered with skin, which bulges out on coughing or straining but which can normally be made to disappear with gentle pressure.

Types Inguinal hernia appears in the groin; less common is femoral hernia, which appears just below the groin. Incisional hernia may occur through a defect in any abdominal surgical scar, a paraumbilical hernia arising just to the side of the umbilicus and an epigastric hernia in the mid line above the umbilicus. In children, herniation may occur through the umbilicus itself, which is a natural weak spot. The commonest internal hernia is a hiatus hernia, when part of the stomach slips upwards into the chest through the DIAPHRAGM (see diagram).

Site of inguinal hernia (shaded).

Causes Hernias may be due to a defect present at birth (congenital), or may develop later in life (acquired). Acquired hernias arise due to the development of a defect or injury of the abdominal wall or due to increased pressure within the abdominal cavity, which forces the organ through a potential weakness. Such causes include chronic coughing or excessive straining due to constipation.

Complications Small hernias may cause no problems at all. However, some may be large and cumbersome, or may give rise to a dragging sensation or even pain.

Although most reduce spontaneously under the effects of gravity or gentle pressure, any organs that may have been displaced inside some hernias may become stuck, when they are said to be irreducible. If the contents become so trapped that their blood supply is cut o?, then strangulation occurs. This is a surgical emergency because the strangulated organs will soon die or rupture. When strangulation – usually of a loop of intestine – does occur, the hernia becomes irreducible, red, and very painful. If the hernia contains bowel, then the bowel may also become obstructed.

Treatment Conservative treatment with a compression belt, or truss, is now used only for those un?t for surgery or while awaiting surgery. Surgical repair can be at an open operation or by laparoscope, and consists of returning the herniated organs to their proper place and then repairing the defect through which the hernia occurred. This may be done safely under local or general anaesthetic, often as a day-case procedure, and most operative repairs result in a permanent cure.... hernia

The growth of hair of the male type and distribution in women. It is due either to the excess production of androgens (see ANDROGEN), or to undue sensitivity of the hair follicle to normal female levels of circulating androgens. The latter is called idiopathic hirsutism, because the cause is unknown. The increased production of androgens in the female may come from the ovary (see OVARIES) and be due to POLYCYSTIC OVARY SYNDROME or an ovarian tumour, or the excess androgen may come from the adrenal cortex (see ADRENAL GLANDS) and be the result of congenital adrenal HYPERPLASIA, an adrenal tumour or CUSHING’S SYNDROME. However, there is a wide range of normality in the distribution of female body hair. It varies with di?erent racial groups: the Mediterranean races have more body hair than Nordic women, and the Chinese and Japanese have little body hair. It is not abnormal for many women, especially those with dark hair, to have hair apparent on the upper lip, and a few coarse hairs on the chin and around the nipples are not uncommon. Extension of the pubic hair towards the umbilicus is also frequently found. Dark hair is much more apparent than fair hair, and this is why bleaching is of considerable bene?t in the management of hirsutism.

The treatment of hirsutism is that of the primary cause. Idiopathic hirsutism must be managed by simple measures such as bleaching the hair and the use of depilatory waxes and creams. Coarse facial hairs can be removed by electrolysis, although this is time-consuming. Shaving is often the most e?ective remedy and neither increases the rate of hair growth nor causes the hairs to become coarser.... hirsutism

This is diagnosed when a couple has not achieved a pregnancy after one year of regular unprotected sexual intercourse. Around 15–20 per cent of couples have diffculties in conceiving; in half of these cases the male partner is infertile, while the woman is infertile also in half; but in one-third of infertile couples both partners are affected. Couples should be investigated together as e?ciently and quickly as possible to decrease the distress which is invariably associated with the diagnosis of infertility. In about 10–15 per cent of women suffering from infertility, ovulation is disturbed. Mostly they will have either irregular periods or no periods at all (see MENSTRUATION).

Checking a hormone pro?le in the woman’s blood will help in the diagnosis of ovulatory disorders like polycystic ovaries, an early menopause, anorexia or other endocrine illnesses. Ovulation itself is best assessed by ultrasound scan at mid-cycle or by a blood hormone progesterone level in the second half of the cycle.

The FALLOPIAN TUBES may be damaged or blocked in 20–30 per cent of infertile women. This is usually caused by previous pelvic infection or ENDOMETRIOSIS, where menstrual blood is thought to ?ow backwards through the fallopian tubes into the pelvis and seed with cells from the lining of the uterus in the pelvis. This process often leads to scarring of the pelvic tissues; 5–10 per cent of infertility is associated with endometriosis.

To assess the Fallopian tubes adequately a procedure called LAPAROSCOPY is performed. An ENDOSCOPE is inserted through the umbilicus and at the same time a dye is pushed through the tubes to assess their patency. The procedure is performed under a general anaesthetic.

In a few cases the mucus around the cervix may be hostile to the partner’s sperm and therefore prevent fertilisation.

Defective production is responsible for up to a quarter of infertility. It may result from the failure of the testes (see TESTICLE) to descend in early life, from infections of the testes or previous surgery for testicular torsion. The semen is analysed to assess the numbers of sperm and their motility and to check for abnormal forms.

In a few cases the genetic make-up of one partner does not allow the couple ever to achieve a pregnancy naturally.

In about 25 per cent of couples no obvious cause can be found for their infertility.

Treatment Ovulation may be induced with drugs.

In some cases damaged Fallopian tubes may be repaired by tubal surgery. If the tubes are destroyed beyond repair a pregnancy may be achieved with in vitro fertilisation (IVF) – see under ASSISTED CONCEPTION.

Endometriosis may be treated either with drugs or laser therapy, and pregnancy rates after both forms of treatment are between 40–50 per cent, depending on the severity of the disease.

Few options exist for treating male-factor infertility. These are arti?cial insemination by husband or donor and more recently in vitro fertilisation. Drug treatment and surgical repair of VARICOCELE have disappointing results.

Following investigations, between 30 and 40 per cent of infertile couples will achieve a pregnancy usually within two years.

Some infertile men cannot repair any errors in the DNA in their sperm, and it has been found that the same DNA repair problem occurs in malignant cells of some patients with cancer. It is possible that these men’s infertility might be nature’s way of stopping the propagation of genetic defects. With the assisted reproduction technique called intracytoplasmic sperm injection, some men with defective sperm can fertilise an ovum. If a man with such DNA defects fathers a child via this technique, that child could be sterile and might be at increased risk of developing cancer. (See ARTIFICIAL INSEMINATION; ASSISTED CONCEPTION.)... infertility

Also called peritoneoscopy, this is a technique using an instrument called an ENDOSCOPE for viewing the contents of the ABDOMEN. The instrument is inserted via an incision just below the UMBILICUS and air is then pumped into the peritoneal (abdominal) cavity. Visual inspection may help in the diagnosis of cancer, APPENDICITIS, SALPINGITIS, and abnormalities of the LIVER, GALL-BLADDER, OVARIES or GASTROINTESTINAL TRACT. A BIOPSY can be taken of tissue suspected of being abnormal, and operations such as removal of the gall-bladder or appendix may be carried out. (See also MINIMALLY INVASIVE SURGERY (MIS).)... laparoscopy

Another name for exomphalos – a HERNIA of abdominal organs through the UMBILICUS.... omphalocele

The ?eshy tube containing two arteries and a vein through which the mother supplies the FETUS with oxygen and nutrients. The cord, which is up to 60 cm long, ceases to function after birth and is clamped and cut about 2·5 cm from the infant’s abdominal wall. The stump shrivels and falls o? within two weeks, leaving a scar which forms the UMBILICUS. (See also PREGNANCY AND LABOUR.)... umbilical cord

A soft swelling at the umbilicus due to protrusion of the abdominal contents through a weak area of abdominal wall. Umbilical hernias are quite common in newborn babies and occur twice as often in boys as in girls. The swelling increases in size when the baby cries, and it may cause discomfort. Umbilical hernias usually disappear without treatment by age 2. If a hernia is still present at age 4, surgery may be needed.

Umbilical hernias sometimes develop in adults, especially in women after childbirth. Surgery may be necessary for a large, persistent, or disfiguring hernia.... umbilical hernia

a bluish bruiselike appearance around the umbilicus due to bleeding into the peritoneum. Causes include a ruptured ectopic pregnancy and acute *pancreatitis. [T. S. Cullen (1868–1953), US gynaecologist]... cullen sign

n. the presence of fragments of endometrial tissue at sites in the pelvis outside the uterus or, rarely, throughout the body (e.g. in the lung, rectum, or umbilicus). It is thought to be caused by retrograde *menstruation. When the tissue has infiltrated the wall of the uterus (myometrium) the condition is known as adenomyosis. Symptoms vary, but typically include pelvic pain, severe *dysmenorrhoea, *dyspareunia, infertility, and a pelvic mass (or any combination of these). Medical treatment is aimed at suppressing ovulation using *gonadorelin analogues, combined oral contraceptives, or the intrauterine system (see IUS). High-dose progestogens suppress *gonadotrophins (FSH and LH), shrink implanted endometrial tissue, and reduce retrograde menstruation. They have a similar efficacy to other medical treatments, are cheaper, and have fewer side-effects than gonadorelin analogues. Surgical treatment may also be necessary, usually by laser or ablative therapy via the laparoscope. More radical surgical treatment in the form of a total hysterectomy and bilateral salpingo-oophorectomy is sometimes required.... endometriosis

a fold of peritoneum separating the right and left lobes of the liver and attaching it to the diaphragm and the anterior abdominal wall as far as the umbilicus.... falciform ligament

the point on the abdomen that overlies the anatomical position of the appendix and is the site of maximum tenderness in acute appendicitis. It lies one-third of the way along a line drawn from the anterior superior iliac spine (the projecting part of the hipbone) to the umbilicus. [C. McBurney (1845–1913), US surgeon]... mcburney’s point

n. the middle portion of the embryonic gut, which gives rise to most of the small intestine and part of the large intestine. Early in development it is connected with the *yolk sac outside the embryo via the *umbilicus.... midgut

n. see umbilicus.... omphalus

(PEP) intensely itchy papules and weals on the abdomen (except the umbilicus), upper limbs, and buttocks, usually within the *striae gravidarum; it is also known as PUPPP (pruritic urticarial papules and plaques of pregnancy). It occurs in 1 in 250 first pregnancies late in the third trimester. This condition is harmless to mother and baby, but can be very annoying. It lasts an average of 6 weeks and resolves spontaneously 1–2 weeks after delivery. The most severe itching normally lasts for no more than a week.... polymorphic eruption of pregnancy

n. obstruction of the portal vein by a blood clot (see thrombosis). It can result from infection of the umbilicus in infants, pylephlebitis, cirrhosis of the liver, and liver tumours. *Portal hypertension is a frequent result.... pylethrombosis

an *adenoma of the umbilicus.... raspberry tumour

a metastatic tumour nodule in the umbilicus that originates from a tumour in the pelvis or abdomen, particularly ovarian and stomach cancer. [Sister Mary Joseph Dempsey (1856–1939), US nurse]... sister mary joseph nodule

transverse rectus abdominis myocutaneous *flap: a piece of tissue (skin, muscle, and fat) dissected from the abdomen, between the umbilicus and pubis, and used to reconstruct the breast after mastectomy. The flap of tissue is dissected along with its blood supply and moved into its new position on this pedicle.... tram flap

an overgrowth of tissue during the healing process of the umbilicus (belly button). It is a moist fleshy red lump of tissue seen in some babies in the first few weeks of life after the umbilical cord remnant has dried and fallen off. It can sometimes be seen in adults after navel piercings. If left untreated, the granuloma can take months to resolve.... umbilical granuloma

n. the remains of the cavity of the *allantois, which usually disappears during embryonic development. In the adult it normally exists in the form of a solid fibrous cord connecting the bladder with the umbilicus, but it may persist abnormally as a patent duct. —urachal adj.... urachus

a surgical needle used prior to *laparoscopy to gain access to the peritoneal cavity and allow insufflation of carbon dioxide (*pneumoperitoneum) before the insertion of a sharp *trocar. It has an outer cutting sheath and an inner spring-loaded gas-transmitting safety sheath and is inserted into the abdomen either in the midsagittal plane at the lower margin or base of the umbilicus or at *Palmer’s point. [J. Veress (20th century), Hungarian surgeon]... veress needle