Inguinal Hernia

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of a bulge in the ‍rightleft ‍groinabdominal wall area

Onset was ‍gradualsudden, noticed ‍whileafter ‍strainingliftingcoughingexercise

The bulge is ‍painfulpainless, ‍reduciblenon-reducible, ‍changed in sizeunchanged in size

Worsening factors: ‍none

Alleviating factors: ‍nonemanual reduction, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍pain at the site of the bulge

‍swelling around the bulge

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍fever, up to ‍°, over ‍ ‍hoursdays

‍changes in bowel habits

‍constipation

‍diarrhea, ‍ episodes ‍per day, ‍

‍abdominal distension

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍discoloration of the bulge area

‍urinary symptoms



Contributing factors:

‍heavy lifting

‍chronic cough

‍constipation

‍obesity

‍pregnancy

no history of: ‍previous hernias, ‍hernia repair, ‍bowel obstructions, ‍abdominal surgeries

no use of: ‍anticoagulants, ‍steroids, ‍immunosuppressants





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Pelvic: external genitalia ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍cervical motion tenderness

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Inguinal Hernia ‍likelysuspectedpossible

DDx: strangulated hernia, incarcerated hernia, abdominal wall strain, lymphadenopathy, hydrocele, varicocele, testicular torsion, epididymitis, orchitis, lipoma





PLAN:

Investigations:

- Abdominal ultrasound

- CT scan of the abdomen

Treatments:

- ‍Analgesics

- ‍Stool softeners

- Truss for temporary support

- Avoid strenuous activities such as heavy lifting, vigorous exercise, and straining during bowel movements

Further care:

- Referral to general surgeon

- Follow-up in ‍ ‍weeksmonths

- Return if pain becomes persistent, if new symptoms develop such as vomiting or fever

- Go to the ER if severe pain, persistent vomiting, or signs of strangulation such as skin discoloration over the hernia