HERNIA

Question 1

DDx groin mass

Answer 1

Direct / Indirect Hernia
Testicular Torsion
Hydrocele
Varicocele
Seroma
Abscess
Lymphadenopathy
Undescended testes (pediatrics)

Question 2

Risk Factors

Answer 2

Conditions that increase intraabdminal pressure: ascites, pregnancy, COPD

GU abnormalities, undescended testes

FHx

SHx: incision sites

Question 3

Workup

Answer 3

Generally not needed

CT Scan best imaging

U/S if peds or pregnant

Question 4

Steps for Hernia Reduction

Answer 4

1. NPO (precaution)
2. Analgesia
3. Trendelenburg
4. Flex and externally rotate ipsilateral leg
5. Place padded icepack to the area
6. Grasp and elongate hernia neck
7. Firm pressure to proximal hernia with the other hand at the site of the defect

Question 5

Disposition: Reducible

Answer 5

Refer for outpatient evaluation & repair
Avoid Heavy Lifting
Return if incarcerated or strangulated
Discuss S/Sx of obstruction or strangulation

Question 6

Management: Incarcerated / Strangulated

Answer 6

Emergent Surgical Evaluation
NPO
IVF
IV Opioid
Abx if perforation / strangulation

Question 7

List antiobiotic choices and doses if strangulated

Answer 7

Cefoxitin 2g IV
Piptazo 3.375 g IV
Ceftriaxone 1 g IV
Metronidazole 500 mg IV bid