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40 years old lady complaining of Para umbilical hernia,examine her abdomen?

40 years old lady complaining of Para umbilical hernia,examine her abdomen?. Station 1. 1)Position . 2)Shape and size. 3)Surface and edge.

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40 years old lady complaining of Para umbilical hernia,examine her abdomen?

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  1. 40 years old lady complaining of Para umbilical hernia,examine her abdomen? Station 1

  2. 1)Position . 2)Shape and size. 3)Surface and edge. The surface is smooth and edge easy to define, except when the patient’s abdominal wall is very fat. try to feel the upper border of the mass (to get above it):scrotal neck test* 4)Composition. The lump is firm as it usually contains omentum . If it contains bowel, it is soft and resonant to percussion.it will be reducible unless the contents are adherent to the sac or the defect is very narrow. also auscultate for bowel sounds. 5)Cough impulse. 2 times ex the cough impulsive first time with inspection ,and second with palpation

  3. 6)Relations to skin (overlying skin;red….) 7)Ask patient to reduce the mass herself 8)Perform deep ring test*: to differentiate indirect from direct. 9)General examination ( respiratory , cardiovascular, abdominal: masses, ascites, PR: for BPH)

  4. *Scrotal neck test: thumb ant, index and middle post to scrotal base, try to feel the cord. If palpable>>it’s a scrotal mass, not palpable>>it’s an inguinoscrotal mass *Deep ring test: ask pnt to b supine and reduce mass him/herself, put ur finger 2cm above mid ing. ligament point*(point between ant. Sup. Ileac spine & pubic tubercle), keeping ur finger in place, ask pnt to stand up and cough.. If the mass did not appear (also u’ll feel cough impulse)>> it’s indirect.. If it appears>> it’s direct..

  5. Station2 (the pic is not the same pic in the exam but this one shows Strangulated Hernia with Evisceration: Strangulated hernia with eviscerated small bowel seen in center ) What is your diagnosis and the management ?

  6. Diagnosis : Strangulated hernia isincarcerated hernia with resulting ischemia • management : emergent surgery (to check whether the intestinal tissue has died and to repair the hernia.)

  7. NB:difference between types of hernia • femoral hernia( the most type liable to be strangulated) • indirect inguinal hernia commonest overall • Direct inguinal hernia • Umbilical hernia • Para umbilical hernia • Incision hernia • Epigastric hernia

  8. *The different between hernia & hydrocele: hernia (indirect inguinal) Hydrocele ( non- communicating type) cough impulse no cough impulse reducible Irreducible cannot get above it Can get above testis palpable Testis not palpable opaque translucent Contain bowel and fluid only fluid

  9. Station 3 DDX:Inguinal hernia It is not the same pic but was Picture of swelling in inguinal region & scrotum

  10. Station 4 • 34 years old man has a mass in the left loin, mention 5 important DDx:

  11. DDx: • LF renal tumours • LF Pheochromocytoma • massively enlarged spleen • LF adrenal tumours • LF Hydronephrosis • LF adult polycystic kidney disease • LF renal vein thrombosis • LF acute tubular necrosis

  12. N.B. :DDx of groin ( inguinal) swelling • Hernia: inguinal, femoral. • Lymphadenopathy • Psoas abscess/cyst • Femoral artery aneurysm • Saphena varix • Testis: ectopic/undescended • Cord: lipoma/hydrocele NB: Hydrocele of the cord is a groin mass Non-communicating hydrocele is a scrotal mass Communicating hydrocele is an inguinoscrotal mass.

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