Abdominal And Inguinal Hernias 2006

LISTEN CAREFULLY!!!! A male patient is lying in bed in the hospital , wearing on oxygen mask over his mouth and nose still heavily sedated from a difficult four hours surgical procedure. A young student nurse appears to give him a partial sponge bath. Nurse he mumbles from behind the mask “ Are my testicles black ?” Embarrassed , the young nurse replies “ I don’t know sir, I’m only here to wash your upper body and feet “ He struggles to ask again “ Nurse , are my testicles black ?” Concerned that he may elevate his vitals from worry about his testicles , she overcomes her embarrassment and sheepishly pulls the covers . She raises his gown and holds his penis in one hand and his testicles in the other lifting and moving them around. Then she takes a close look and says “ There’s nothing wrong with them sir” The man pulls off his oxygen mask , smiles at her and says very slowly “ Thank you very much. That was wonderful but listen very closely ….”

“ Are…my …test…..results……back ….?”

ABDOMINAL AND INGUINAL HERNIAS LAMBERTO J. CAGINGIN , M.D. FPCS DEPARTMENT OF SURGERY DLSU-HSC

OBJECTIVES To

be able for the students to identify the types of abdominal and inguinal hernias

To

be able to diagnose and advice the proper treatment for such conditions

To

be able to understand the kind of surgery needed by these patients

ABDOMINAL INCISIONAL UMBILICAL INGUINAL INDIRECT DIRECT FEMORAL SLIDING PANTALOON

STAGES  REDUCIBLE  IRREDUCIBLE  BOWEL

( INCARCERATION )

OBSTRUCTION

 STRANGULATION

GOOD HISTORY IS A MUST ! ! ! - elicit the causative factor/s - consider the time element  -

PHYSICAL EXAMINATION :

examine all symptomatic and asymptomatic “ bulge” in the abdomen and groin  - INSPECTION  - PALPATION  - TRANSILLUMINATION  - D.R.E.( digital rectal exam )

DIAGNOSIS ( TSS ) INDICATE

TYPE  STAGE  SITE DIFFERENTIAL DIAGNOSIS - RULE OUT OTHER PATHOLOGIES FOR SCROTAL OR INGUINAL MASS AND OTHER ASSOCIATED CONDITIONS !!!

DIFFERENTIAL DIAGNOSES LIPOMA

OF THE CORD TESTICULAR TORSION TESTICULAR TB TESTICULAR ABSCESS EPIDYDIMITIS / ORCHITIS HYDROCOELLE VARICOCOELLE SEMINOMA

IDENTIFY OTHER CO MORBID DISEASE CONDITIONS COPD  PROSTATISM / BPH  PROSTATIC CA  HEMORRHOIDS  RECTAL CA 

TREATMENT          

HERNIORRHAPY- Non Prosthetic Anatomical repair A) Anterior Approach - Bassini , Halsted , Mcvay , Shouldice B) Pre peritoneal Approach HERNIOPLASTY – Prosthetic or Mesh repair A) Anterior Approach - Mesh Plug or Patch - Lichtenstein B) Pre peritoneal - Anterior or Posterior C) LAPAROSCOPIC HERNIOTOMY

COMPLICATIONS RECURRENCE CHRONIC

PAIN

SEROMA HEMATOMA VASCULAR VISCERAL

SUMMARY -

A GOOD HISTORY AND P.E. IS MANDATORY - DIAGNOSE BY INDICATING T S S - CONSIDER YOUR DIFFERENTIALS OR OTHER ASSOCIATED DISEASE CONDITIONS - GIVE THE APPROPRIATE ADVICE

THANK YOU !!!