Dik, patient ni ada hernia la, nnti refer surgical. HO be like, baik bos🫡. Tapi nak citer apa ni?
History
Smoker?
Occupation? History of frequent lifting heavy things in the past?
Chronic cough?
Constipation?
Straining on urination?
Other lower urinary tract symptoms
History of abdominal surgery in the past?
Family history of inguinal hernia?
Any symptoms suggestive of intestinal obstruction? (vomiting, abdominal pain, not passing flatus / constipation, abdominal distension)
Physical examination
Vital signs
General – obese?
Lungs: any rhonchi / crepitations?
Abdomen:
Any abdominal distension? (ddx: obstructed hernia, ascites)
Any abdominal mass?
Per rectal:
Any impacted stool / mass?
Any prostate enlargement? (for male patients, to look for BPH)
The swelling. Features of inguinal hernia:
- Swelling at scrotum and / or inguinal region
- Single lump (if multiple lumps, think of lymphadenopathy)
- Skin color: normal / erythematous if strangulated
- Cough impulse: positive
- Soft
- Non-tender / tender if strangulated
- Unable to get above the lump
- Reducible / Not reducible (if strangulated / obstructed)
- Not pulsatile
- Transillumination test: negative (if positive think of hydrocoele)
Investigations
FBC
RP
Coagulation profile
VBG (especially if obstructed / strangulated hernia)
ECG (baseline prior to operation)
Abdominal X rays
Chest X rays (baseline prior to operation / to look for features suggestive of chronic lung disease)
UFEME
General management in ED
Keep the patient NBM first and start IV drip maintenance if the patient is likely going for operation (e.g. obstructed hernia / strangulated hernia)
Analgesia if in pain
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How to describe the hernia? 👇
1. Reducible hernia
- Contents of hernial sac can be replaced into abdomen, lumen not obstructed, blood supply is intact
2. Irreducible hernia @ Incarcerated hernia
- Contents of hernial sac cannot be replaced into abdomen, but the lumen is not obstructed and blood supply is still intact
3. Obstructed hernia
- Loop of bowel trapped in hernial sac, such that its lumen is obstructed. Blood supply is not interrupted.
4. Strangulated hernia
- Impaired blood supply to the trapped bowel -> ischaemia and gangrene of the trapped bowel
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