[MBBS/MS/DNB] Sample Long Case on Inguinal Hernia
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- The patient presented with a 2 year history of a gradually enlarging swelling in the right groin region that increases with straining and lifting but reduces spontaneously when lying down. On examination, a 10x2cm swelling was found in the right inguinal region extending into the scrotum that was reducible on manual reduction. Based on the history and examination findings, it appears the patient has an indirect inguinal hernia in the right groin.
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![CHEST
[CARDIO-VASCULAR
&
RESPIRATORY]
CENTRAL NERVOUS
SYSTEM
&
SPINE
• CLEAR
• VESICULAR BREATH
SOUNDS
• NORMAL HEART SOUNDS
• NO ADDED SOUNDS
• WITHIN NORMAL
LIMITS](https://image.slidesharecdn.com/ccchernia-200501225130/85/MBBS-MS-DNB-Sample-Long-Case-on-Inguinal-Hernia-15-320.jpg)
![[MBBS/MS/DNB] Sample Long Case on Inguinal Hernia](https://image.slidesharecdn.com/ccchernia-200501225130/85/MBBS-MS-DNB-Sample-Long-Case-on-Inguinal-Hernia-19-320.jpg)
[MBBS/MS/DNB] Sample Long Case on Inguinal Hernia
- 2. Mr. X 45 years Male Rajagram, Bankura Manual Labourer Hindu 26th April 2020, Surgery Ward
- 3. Dragging sensation in the Right Groin Gradual onset progressive Swelling in the Right Groin Dull aching pain over the swelling. 2.5 years 2 years 1 week
- 4. •Patient was apparently well two and a half years back. •Gradual onset dragging sensation in the Right Groin 2 years back that was followed by a small Swelling in the same groin that he noticed 6 months later. •The swelling has been enlarging ever since, to attain its present size and presently it has extended to his Right Scrotum. •The swelling initially disappeared automatically when he lied down, but over the last year it had to be manually pushed back inside his abdomen.
- 5. •It aggravated when he lifted heavy weights or coughed and strained. •There is no history of urinary difficulty, chronic cough but he suffers from chronic constipation and passage of hard stools. •Over the last week has developed an occaisional dull aching pain and a sensation of heaviness over the swelling, that vaguely radiates to the centre of the abdomen for which he seeked medical aid. • However, there was no complaint of vomiting, abdominal distention or cessation of passage of stools, or the swelling being stuck recently.
- 6. PAST HISTORY • No History of : COPD /HTN/T2DM/ BA/TB • History of Right sided Renal Stone that was treated surgically 4-5 years back (Pyelolithotomy) PERSONAL HISTORY • Married, Hindu Male • Poor Socio-economic Status • Mixed regular non vegetarian diet • Addicted to smoking bidis • Sleep patterns are not altered.
- 7. FAMILY HISTORY No History of similar swellings in the family TREATMENT HISTORY Patient did not seek any medical aid, prior to this present hospital admission for the present complaint. HISTORY OF ALLERGY No Known allergy to drugs and food
- 9. • Mental Status- Conscious, alert and Cooperative • Decubitus of Choice • Built and Nutrition- Moderately built, BMI- 20 • Karnofsky Performance status - 90 • Pallor , Icterus , Clubbing , Cyanosis, Edema - Absent • Tongue – Moist • Temperature- 38 degree Celsius. • NeckVeins – Not distended • Neck Glands- Not enlarged • Pulse- 90/min, Right arm, sitting position, good volume, normal character and no asynchrony of peripheral pulses. • Temperature- 110/78 mm of Hg in Sitting Position • Respiratory Rate – 18 breaths/ min.
- 10. Inspection
- 11. • A 10X 2cm pyriform swelling was observed in the Right Inguino- scrotal region • The swelling occupies the Right Hemiscrotum and displaces the Penis to the contralateral side. • There are no scars, pigmentation, pressure marks, over the swelling.The skin over it is not inflamed. • There is no visible peristalsis over the swelling. • Expansile cough impulse is present.
- 12. • The inspectory findings were confirmed on palpation.Temperature is not raised. • The swelling lies above the inguinal ligament and originates medial to the pubic tubercle, from the root of the scrotum to reach the base of scrotum. • Anterior to the cord structures. • It is not possible to get above the swelling. • It is well defined, non tender with doughy and granular consistency • The swelling can be reduced manually by taxis, wherein the first part of the swelling reduces easily. • Deep ring occlusion test is + • The testis is felt separate from the swelling, with a normal testicular sensation.
- 13. • Inguinal lymph nodes were not palpable. • The swelling was dull on percussion. • No Peristaltic sounds were heard on auscultation over the swelling. Invagination test (painful) Zieman’s test (low sensitvity) ------------------------------------ NOT DONE ------------------------------------
- 14. ABDOMEN • There is a visible, well healed scar of an old Right Lumbar incision, that extends from the RenalAngle to the anterior abdominal wall.There are no scar related complications. • Tone of the abdominal muscles is normal. • SOFT • NO HEPATOMEGALY • NO SPLENOMEGALY • NORMALTYMPANIC NOTE ON PERCUSION • IPS + • DRE- NORMAL
- 15. CHEST [CARDIO-VASCULAR & RESPIRATORY] CENTRAL NERVOUS SYSTEM & SPINE • CLEAR • VESICULAR BREATH SOUNDS • NORMAL HEART SOUNDS • NO ADDED SOUNDS • WITHIN NORMAL LIMITS
- 16. • Dragging sensation in the Right Groin for the last 2 and a half years -> Gradual onset swelling that developed in the Right Groin for the last 2 years -> Presenting with the swelling in the right groin that increases with standing, straining or lifting heavy weights and spontaneously disappears on lying down -> Recent onset dull aching Pain for 7 days->the swelling needs manual reduction by the patient -> no urinary symptoms or features suggestive of bowel obstruction.
- 17. Local Examination – Right sided 10X2 cm pyriform inguinoscrotal swelling, above and medial to the pubic tubercle.The skin over it is not inflamed, it reaches upto the base of scrotum,lying anterior to the cord stuctures, but separate from the testis. It is doughy and granular in consistency with an expansile cough impulse. It is reducible, with the first part of the contents going in easily and the second part being difficult to reduce. Deep ring occlusion test is positive. Percussion note over the unreduced swelling is dull and bowel sounds are not audible. Systemic Examination – All other Systems are apparently Normal.The Right sided surgical scar in his lumbar region is well healed and correlates to his history.
- 18. In a 45 year old male