Hernias: Clinical Practice Flashcards
Factores de riesgo de una hernia inguinal (groin)
- Hernia previa
- Edad adulta
- Presión intraabdominal crónica
- Lesión de la pared abdominal
- Fumar
¿Dónde están localizadas las hernias epigástricas?
En la línea media abdominal
Entre el proceso xifoides y el ombligo
A 63 year old man presents with acutely painful, tender, non-reducible swelling in his right inguinal region. The symptoms developed shortly after coitus. Past medical history is significant for obesity and hipertension. There is no history of prior herniae. Inguinal examination shows a bulge within the right escrotum. There is a noticeable increase in size of the bulge when the patient coughs. Abdominal examination shows no other abnormalities. Which is the most likely diagnosis?
A. Direct inguinal hernia B. Femoral hernia C. Indirect inguinal hernia D. Infectious epididymitis E. Obturator hernia
Indirect inguinal hernia
A 42 year old man comes to the emergency department because of difficulty urinating for the past day. He also has pain around the groin that worsens when he lifts heavy objects. He has smoked 1 pack per day for the past 12 years. An abdominal CT is obtained. Which is the most likely diagnosis?
A. Direct inguinal hernia B. Femoral hernia C. Hiatal hernia D. Indirect inguinal hernia E. Obturator hernia
Indirect inguinal hernia
A 65 year old comes to the emergency department because of groin pain, nausea, and abdominal distension. Physical examination shows the presence of a palpable mass in her left groin that cannot be reduced. Which is the most likely diagnosis?
Femoral hernia
A 94 year old man comes to the office because of a small bulge on the right side of his groin. He first noted the lesion after helping his daughter move to a new home. He reports a sharp discomfort that is worsened by walking and heavy lifting. Resting supine decreases the severity of the pain. Physical examination shows a bulge that protrudes medically to the inferior epigastric vessels when the patient coughs. There is no erythema or warmth. Which is the most likely diagnosis?
Direct inguinal hernia
An 80 year old man comes to the office because of a tender mass in his right inguinal region that is reductible with pressure. He reports significant discomfort during his daily activities and desires elective surgical repair. During the surgery, the mass is found to be medial to the inferior epigastric artery. Which is the most likely diagnosis?
Direct inguinal hernia
A 32 year old man comes to the office because of painless scrotal swelling for 2 months. He states that he first noticed the swelling in the shower, but thought that it would go away. There is no history of testicular trauma. Examination shows a hard nodule inseparable from the right testicle. A scrotal ultrasound shows a 3cm homogeneous hypoechoic mass arising within the right testicle as well. The left testicle shows no abnormalities. Laboratory studies show:
Perform a right inguinal orchiectomy
A 27 year old man with a history of exercise-induced inguinal hernia comes to the emergency department because of nausea and 3 episodes of vomiting. He complains that his hernia has increased in size about 25% after a day of moving boxes and has become somewhat painful. Physical examination shows a mildly tender, irreducible bulge in the inguinal region that is not erythematous, fluctuant, or trans-illuminant. Normal bowel sounds are heard. Besides his discomfort, he is afebrile and otherwise looks well. Which is the most appropriate management for this patient?
A. Admit the patient for intravenous hydration and parenteral antibiotics
B. Drain and culture the inguinal abscess
C. Order an immediate referral to oncology for staging
D. Order an immediate referral to surgery for reduction
E. Perform a color Doppler ultrasound
Order an immediate referral to surgery for reduction
