Examination & Clinical Approach of hernia & Inguino-scrotal.pptx

examination of inguinal hernia and the clinical approach to it

1. Examination & Clinical Approach of hernia & Inguino-scrotal swelling By: Justin Jagdeo 34501 Samuel Mahendran Saravanan 41012

2. What is Hernia? A hernia is a protrusion of a viscus or part of a viscus through the wall of its containing cavity. A hernia comprises of a hernial sac and neck Inguinal hernia is the most common hernia (73%) because the muscular anatomy in the inguinal region is weak and also due to the presence of natural weakness like deep ring and cord structures Causes: “Increased intra-abdominal pressure” Straining, lifting of heavy weights, Chronic constipation Chronic cough (tuberculosis, chronic bronchitis, bronchial asthma, emphysema) , Urinary causes: old age (BPH, carcinoma prostate), Young age (stricture urethra), very young age Phimosis, meatal stenosis Ascites Wall weakness: Obesity, pregnancy and pelvic anatomy (especially in femoral hernia in females) Previous surgery like Appendectomy through McBurney’s incision may injure the ilioinguinal nerve causes right sided direct inguinal hernia.

3. Anatomy of hernia: The hernia comprises of: ➢ Covering ➢ Sac ➢ Content Coverings are the layers of the abdominal wall through which the sac passes. Sac is a diverticulum of peritoneum with mouth, neck, body and fundus. Body of the sac is thin in infants, children and in indirect sac, but is thick in direct and long-standing hernia Contents : Omentum—Omentocele (Epiplocele). Difficult to reduce the sac later, initially it can be reduced easily. Intestine—Enterocele—commonly small bowel, but sometimes even large bowel. Difficult to reduce the sac initially. Richter’s hernia: A portion of circumference of bowel is the content. Urinary bladder may be the content or part of the posterior wall of the sac—cystocele. Ovary, often with fallopian tube. Meckel’s diverticulum—Littre’s hernia.

4. Groin swellings Groin (inguinal region) is the junctional area between the abdomen & the thigh on either side fo the pubic bone Causes of groin swellings: Inguinal hernia; direct or indirect Femoral hernia : Undescended testis : Hydrocele : Varicocele : Inguino-scrotal swellings can be acute / chronic OR congenital / acquired

5. Inguinal Hernia Inguinal hernia is an anatomical classification of hernias, an abdominal wall hernia Inguinal hernia is a common complaint, occurring mostly in men Inguinal hernia come out through the superficial inguinal ring Indirect hernia It comes out through internal ring along with the cord. It is lateral to the inferior epigastric artery. Direct hernia It occurs through the posterior wall of the inguinal canal through ‘ Hesselbach’s triangle’ (bounded medially by lateral border of rectus muscle, laterally by inferior epigastric artery, below by inguinal ligament). Sac is medial to the inferior epigastric artery. Difference between direct & direct:

6. Approach: Demographics : name, age, sex, referral, residence Chief Complaint : Swelling in the inguinal scrotal region or lump or masses History of presenting complaint: Onset : When did he first notice the swelling? Size : Has the swelling grown? Pain : Is it painful or painless? It may be useful to use the Socrates for inquiring about pain. Site , Onset of pain (e.g. sudden, gradual) Character (e.g. sharp, dull) Radiation Associated symptoms with pain (e.g. nausea, vomiting) Timing (e.g. is the pain related to anything?) Exacerbating & relieving factors (i.e. things that make the pain worse/better) Severity (e.g. scale of 1-10) Was there any preceding trauma? Associated symptoms : Infective symptoms such as fever or dysuria, systemic symptoms such as weight loss or night sweats.

7. Does patient present with dragging pain and swelling in the groin which is better seen while coughing and standing and felt together with an expansile impulse. pain-which is mostly dragging type in nature systemic symptoms – in case of hernia, obstructing the lumen of the bowel cardinal symptoms of obstruction with appear Other complaints - The cause of the hernia must be inquired into increasing in abdominal pressure conditions. Review of systems: CVS and RS: chest pain, dyspnea, Orthopnea,, palpitations, edema. GIT: abdominal pain, bruising, nausea and/or vomiting , difficulty peeing Reproductive: discharge from your penis

8. Past medical history: Other medical diagnoses (e.g. patients with Klinefelter’s and Kallman’s syndrome have a greater risk of testicular cancer) Previous hospitalizations Previous abdominal, pelvic or perineal surgeries Specifically, ask about a history of childhood cryptorchidism (higher risk of testicular cancer) Medications/allergies Family history: Specifically, ask about a family history of testicular cancer. Social history: Smoking history Alcohol history Illicit drug use Occupation Relationships/family Fertility status