Podcast
Questions and Answers
What is the key difference between a direct and an indirect inguinal hernia?
What is the key difference between a direct and an indirect inguinal hernia?
Which type of inguinal hernia is characterized by protrusion into the inguinal canal through the deep inguinal ring?
Which type of inguinal hernia is characterized by protrusion into the inguinal canal through the deep inguinal ring?
What defines a complicated inguinal hernia?
What defines a complicated inguinal hernia?
How does an occult inguinal hernia differ from other types?
How does an occult inguinal hernia differ from other types?
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What distinguishes an uncomplicated inguinal hernia from a complicated one?
What distinguishes an uncomplicated inguinal hernia from a complicated one?
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How can a direct inguinal hernia be diagnosed?
How can a direct inguinal hernia be diagnosed?
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Which action signifies an uncomplicated inguinal hernia?
Which action signifies an uncomplicated inguinal hernia?
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What is a defining characteristic of a complicated inguinal hernia?
What is a defining characteristic of a complicated inguinal hernia?
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What would be the most appropriate initial step if an occult inguinal hernia is suspected?
What would be the most appropriate initial step if an occult inguinal hernia is suspected?
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What should be considered if a patient presents with a testicle that is not palpable?
What should be considered if a patient presents with a testicle that is not palpable?
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Study Notes
Inguinal Hernia
- May not be apparent until adulthood, despite being present since birth
- Location: lateral to the inferior epigastric blood vessels, outside the Hesselbach triangle
- Path: runs from the deep inguinal ring through the inguinal canal to the superficial inguinal ring
- Associated structures: surrounded by the external spermatic fascia, cremasteric muscle fibers, and internal spermatic fascia
Clinical Features
- Uncomplicated inguinal hernia:
- Typically manifests as an ill-defined mass in the inguinal region
- Increases in size when coughing or straining
- Decreases in size on lying supine
- Inguinal pain or vague inguinal discomfort that increases with physical activity
- May be painless
- Inguinodynia with no palpable groin mass is typically the only manifestation of an occult inguinal hernia
Physical Examination
- Ask the patient to perform the Valsalva maneuver and observe for an expansile cough impulse in the inguinal region
- Palpate the inguinal canal
- In male patients: invaginate the scrotal skin toward the superficial inguinal ring with the index or little finger
- In female patients: palpate the area over the inguinal ligament
- Ask the patient to perform the Valsalva maneuver
- A palpable bulge confirms the diagnosis of an inguinal hernia
Complicated Inguinal Hernia
- Incarcerated hernia:
- The hernia is irreducible
- Skin overlying the hernia: normal
- Obstructed hernia:
- Symptoms of mechanical bowel obstruction
- Sudden onset of pain, nausea, vomiting, abdominal distention, constipation, or obstipation
- Strangulated hernia:
- Sudden, severe groin pain caused by constriction and ischemia (or necrosis) of hernial contents
- Signs of sepsis or signs of shock
- Features of bowel obstruction if the hernia contains intestinal loops
- Skin overlying the hernia: warm, erythematous, tender, and may appear exfoliated or blistered
Clinical Evaluation
- Medical history should include:
- Identification of typical clinical features (e.g., of uncomplicated inguinal hernia)
- Onset and duration of symptoms
- Evaluation of risk factors for an acquired inguinal hernia
- Physical examination should include:
- Palpation of the inguinal canal
- Evaluation for signs of complicated inguinal hernia
- Identification of signs of underlying etiologies, e.g., ascites, BPH
Imaging Indications
- Uncertain clinical diagnosis
- Suspected recurrent or occult inguinal hernia
- Consider preoperative imaging for complicated inguinal hernia
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Description
Learn about the symptoms of complicated inguinal hernia in female patients, including sensation of heaviness or discomfort in the groin or pelvis, worsened by lifting or straining. Understand the difference between incarcerated, obstructed, and strangulated hernias.
