Summary about hernia including Hx, examinations, ddx & Tx

1. Inguinal Hernia
Overview
Definition:-
It can be further subdivider on Automic Location Direct inguinal hernia (medial to safer
epigastric vessels through
A
Defect
in the posterior wall of
the suguinal canal, In-Direct
in. He. (most
common type of Hernia, Lateral to
the inferior Epigastric vessels through the Deep Inguinal Ring.
*
Uncomplicated suguinal hernia:-
·
· completely Reducible
· Not
Associated With Sings of
Bowel obstruction or Strangulation
A complicated suguinal hernia:-
&IR-Reducible
&Associated with Sings of
Bowel obstruction or Strangulation
*
Occult inguinal hernia a
· Not Identifiable on Physical Examination
M
-
1- Epidemiolog]
InDirect -
most common, common in male Infant and older men
[
Direct less than indirect, common in older mee
femoral 8-5% of all cases, common in women.
2-
Etiology
InDirect ->
congenital. Acquired
- Direct & Acquired"weakening transversalis facia"
[ femoral -
Acquired" * Intra-abdominal pressure "obesity"

2. ‫ﻫ‬
‫ﺎ‬
‫س‬
‫اب‬
‫خ‬
3-Location
=Direct
[
Herniates through External + Internal Ring
·nee:
was"
ect us
-outside Hesselback triangle. M
in
cs
Lateral to the Inse. Epigastric vessels.
Direct only Herniates through external Ring
- Within Hesselbach triangle
[medial to the Infe. Ep; gastric vessels.
femoral Herniates through the femoral Ring into the femoral canal
-
Below the Inguinal ligament
[ Lateral to the Public tubercle
L medial to the femoral vein
Femoral Hernia
4 -
Clinical features
Direct ->
Mass in the Inguinal Region (Size with cough
[
Direct Mass in the Inguinal Region Walsalva man ever
femoral Grain bulge below the inguinal ligament
and lateral to the
the Public tubercle.
S-Diagnosis
[Typically
a Clinical Diagnosis
Imaging UIS
6- Treatment ->
Surgical Repair
Anatomy of
Inguinal canali.
Anter...Internal + External Abdoblique M.
past
8 -
med. conjoint
tendon
[cat. Transveralis fascia
Roof "supe":- Internal Abd oblique M. +
transversus Abd.M
floor "sufer":-
Inguinal ligament

3. DDx:-
1- Inguinal Hernia
2- Femoral Hernia
3- Femoral Lymplyadenopathy
A- Etiology
B- Clinical Features
• Increase Abdominal pressure
• Weakened Pelvic Floor
C- Diagnosis
• History And Physical Examination + U / S
D- Treatment
• Surgical Repair
A- Etiology
B- Clinical Features
C- Diagnosis
D- Treatment
• History And Physical Examination + U / S
A- Etiology
B- Clinical Features
C- Diagnosis
D- Treatment
A- indirect
> Acquired (increase intra-abdominal pressure, connective tissue disorder,
medication, Abdominal wall injury)
> Congenital (Failure processus Vaginalis)
B- Direct
> Acquired (weakening of the transversalis fascia)
• Positive Valsalva Maneuver
• Pain or Discomfort Increase with physical Activity
• History And Physical Examination + U / S
• Surgical Repair
• Positive Valsalva Maneuver
• Groin Mas (below inguinal lig, lat. pubic tubercle, med. femoral vein)
• STI ( sexually transmitted infection)
• Malignancy
• Lymph node Enlargement below inguinal lig., medial to femoral artery
• Benign (soft, tender, mobile)
• Malignant (non-tender, hard, fixed)
• Treatment of underlying cause
Hernioplasty — mesh repair (Lichtenstein repair)
— Non-mesh repair (auto-logous tissue)
Chronic cough, obesity, multiple pregnancy.
Steroid
"Premature Birth"
In Patient with high Risk
of
surgical site Infection
Chronic cough, obesity, multiple pregnancy.

4. 4- Femoral Arteriovenous fistula
5- Psoas Abscess
A- Etiology
B- Clinical Features
C- Diagnosis
D- Treatment
• Latrogenic ( access for percutaneous CV procedures)
• Trauma
• Initially Asymptomatic
• Vibratory Sensation, Bruit or pulse in the groin
• Lower Extremity (limb) ischemia
• Chronic fistulas (limb or leg edema, high-output HF, Arterial Degenration)
• Doppler + U / S
A- Etiology
B- Clinical Features
C- Diagnosis
D- Treatment
• Infection, Injury, Latrogenic
• Fever
• Lower Back or Flank pain
• Painful or painless mass
• History And Physical Examination + Ct scan
• Drainage
• Antibiotics
• small (observation)
• Large ( surgical repair)
6- Femoral Artery Aneurysm
A- Etiology
• Arterial wall weakening , Atherosclerosis
B- Clinical Features
• May be asymptomatic
• Signs and symptoms of acute limb ischemia
• DVT, Sudden leg pain, weakness, or numbness if aneurysm compresses nerves
C- Diagnosis
• Doppler + U / S
D- Treatment
• small (observation)
• Large ( surgical repair)
·
⑲
I
⑮S

5. 7- Hydrocele
8- Varicocele
9- Spermatocele
10- lipoma
Accumulation of Fluid within the Tunica Vaginalis of the Scrotum Surrounding one or both TesticleS
Dilatation of Venous Plexus in the Scrotum
abnormal cystic collection of sperm within the epididymal duct. Usually located on the upper testicular
pole and is palpable as a mass distinct from the testis.
=
s