Clinical Research Science

Hernia

Randika Rachman
Tiara Senja Dyandra
Rifa Fauzia

Preseptor :
Liza Nursanty dr., Sp.B., FInaCS

SMF BEDAH
RUMAH SAKIT AL ISLAM
2014
Identity
Name : Tn. D
Age : 61 yo
Place : Merkuri Selatan VII no 7 RT 05/08
Job : Retired
 Chief Complaint :
protrusion in the left inguinal regio

since 5 month ago patient complaining about lump

in the left groin. The lump able to protrude and
disappear when patient push the lump by him self
and disappear when lying down. Usually the lump
protrude when patient stand, sneeze, cough, and
straining. When the lump protrude patient felt
nausea. The lump is painless and no fever.
Patient has to heavy strain during defecation and

sneeze.
 Medical history :
high cholesterol
Family history :

cardiovascular disease
Physical Examination
General condition : Good
conciousness : composmentis
GCS : 15
Vital sign :

BP : 120/80 mmHg
PR : 74 x/menit
RR : 24x/menit
Temperature : 36,6
 Head :
1. Facial : simetric
2. Hair : clean
3. Eyes :
vision : clear
conjunctiva : not anemic
sklera : anicteric
pupil : CA (+)/CI (+)

Ears : clean , no secret, intact membrane tymphany

Nose : no epistaxis
Mouth : no blood , clean
 Neck :
LN (-)
JVP : normal
Thorax :
cardiopulmonary : within normal limit
Abdomen :
flat, bowel movement + (10x/minutes)
Protrusion in the inguinal regio
Extremity : warm acral, deformity (-) , CRT
normal
 Localized
Inspection : lump in the
left inguinal is more
protrude when strain,
sneeze, cough and no
redness.
Palpation : the mass is
solid, reponible, and no
tenderness
Another test : valsava test
(+), finger test (the mass
was protrude tip of the
finger)
Differential diagnosis
Inguinal Lateral hernia sinistra
Inguinal medial hernia sinistra
Examinations
Lab (complete blood count, blood glucose)
Thorax X-ray
Working Diagnosis
Inguinal Lateral Hernia Sinistra
Management
Pre-surgery :
Complete blood count and urine
Hb : 11,8 g/dL
Leukosit : 5300 se/uL
Ht : 35,3 %
trom : 156.000 sel/uL
ureum : 23 mg/dl
creatinine : 0,7 mg/dl
BG : 95 mg/dl
thorax x-ray :
cor , sinus, normal diafraghma
normal hilli ,

Surgery :
Herniorraphy + mesh
Prognosis
Quo ad bonam
ANATOMY
Hernia

Protrusion the content of abdominal cavity

through the defect or from the weak side of
the abdominal cavity
Classification
Based on the Occured
Congenital hernia
Acquired hernia
Based on the site :
Diafraghmatic Hernia
Inguinal Hernia
Femoral Hernia
Umbilical Hernia
Etc
Based on the characteristics :
Reponible Hernia
Irreponible Hernia
Incarserated Hernia
Strangulated Hernia
 The components of hernia :
Ring
Sac
Contents
Clinical manifestations of
Hernia

Type Reponible Pain Obstructio Appearanc

n e
Reponible + - - -
Irreponible - - - -
Incarserated - + + +
Stangulated + ++ + ++
Inguinal hernia
Protrusion the content of abdominal cavity
through inguinal canal.
Epidemiology
Congenital inguinal hernias are common in low birthweight
individuals with a preponderance on the right side. In a
study of male children with birthweight less than 1500
grams, 32% required a hernia operation by age 8. 4 For an
adult male, the incidence increases steadily with age, and
has been reported to approach 50% for men over the age
of 75
Table 36-1 Inguinal Hernia Prevalence by Age

Age (Years) 2534 3544 4554 5564 6574 75+

Current 12 15 20 26 29 34
prevalence (%)
Lifetime 15 19 28 34 40 47
prevalence (%)
Etiology
 The prevalence of inguinal hernias in males
is clearly age dependent. Congenital inguinal
hernias are common in low birthweight
individuals with a preponderance on the right
side. In a study of male children with
birthweight less than 1500 grams, 32%
required a hernia operation by age 8. 4 For
an adult male, the incidence increases
steadily with age, and has been reported to
approach 50% for men over the age of 75
 Classification of hernia inguinal

Medial Inguinal Lateral Inguinal

Hernia Hernia
Direct Inguinal Hernia Lateral Inguinal Hernia
Hesselbach Triangle Anulus and Inguinal
Canal
Shape : Round Shape : oval
Etiology and risk factors
Old age
Male > female
Coexisting medical illness
Pathophysiology
Increase of the intra abdominal pressure
Modifiable factor : Non-Modifiable factor :
-Chronic cough & constipation -Gender
-Over weight -Family history
-Premature birth

Increase pressure in the compartment of the intra abdominal wall

of the inguinal canal

Causing malfunction of the inguinal

Inguinal ring will not closed

 Involves to a hole or defect

Fatty substance or part of the small intestine slides through the

inguinal canal

Scrotum enlarged or swollen

Indirect inguinal hernia

Pain or discomfort to the
affected organ
 Sign and symptoms
Lump in the inguinal region
Painless
Uncomfortable heavy feeling
Radiating pain to the testicles
Dragging sensation that tends to get worse as the
day wears on
Diagnosis
Anamnesis
Physical examination :
valsava maneuveur
Finger test
Finger Test
Management
Conservative
Surgery :

Herniotomy
Hernioplasty
Herniorhapy
Terima kasih