KURSUS DIPLOMA PEMBANTU PERUBATAN CASE CLERKING NAMA PELATIH: SAMSON GAN NO MATRIKS: BPP2010-3373 TAHUN: 2 SEMESTER: 2 KAWASAN PENEMPATAN: HOSPITAL DAERAH TENOM
BAHAGIAN 1 : BUTIR-BUTIR PERIBADI PESAKIT
No. Pendaftaran : 1695
Na$a : Ma%r& B&n Ba'r& TIN(KA!OR PAN( -TIDAK PR!" DII#I)ant&na: !e*a'& Ban+%a: M,r,t A*a$at : K+. A,*0 Ke$aon+ Teno$ Teno$ #aa. -TIDAK PR!" DII#Io%&ta*/K*&n&': o%&ta* Daera Teno$ Teno$
NOMBOR K/P: 571119-12-5249 -TIDAK PR!" DII#I-
Pe'eraan : Petan&
"$,r : 54 ta,n No. Te*: Te*: -TIDAK PR!" DII#I-
Tar&': Tar&' Tar&' $a%,' 3ad: 22/6/21 Tar&' Tar&' 'e*,ar 3ad: 29/6/21
PART PART 2: PATIENT PATIENT’S ’S HISTORY CHIEF COMPLAIN •
o$*a&nt of r&+t &oondr&a a&n %&ne 5 da% a+o HISTORY OF PRESENT ILLNESS
Pat&ent Pat&ent fe*t tat te a&n tat o$e fro$ te r&+t &oondr&a &oondr&a re+&on %read to te a' or e*o3 art art of &% r&+t %o,*der. %o,*der. Oter %&+n and %$to$ tat %o3n and 3a% o$*a&nt te at&ent 3a% - 8eer - &**% - R&+or - Na,%ea - o$&t&n+ - !o%t of aet&te - Taard&a te *aorator te%t for te at&ent *ood a*%o %o3n te &nrea%&n+ n,$er of *e,ote 'no3n a% *e,oto%&%. Te%t Te%t for M,r;% #&+n &% o%&t&e- Tender r&+t ,er <,adrant Ortner;% #&+n- Tenderne%% Tenderne%% 3en and% ta% te ed+e of r&+t o%ta* ar. (eo+&e%'&- M,%%&;% #&+n =ren& nere %&+n> ? Pa&n 3en re%% et3een ed+e% of %terno*e&do$a%to&d. Boa%;% #&+n ? &nrea%ed %en%&t&&t e*o3 te r&+t %a,*a =a*%o d,e to ren& nere &rr&tat&on>. @en te a*at&on $aded0 $a%% an e ea%&* a*ated on te r&+t &oondr&a re+&on
• •
1.
on at&ent te od. No &%tor of tra,$a or fa**. No d&ff&,*t &n ora* &nta'e. No anor$a*&t &n o3e* or ,r&nar noted. noted. PAST MEDICAL ICAL ! SURG SURGIICAL CAL HIS HIST TORY
5 ear% a+o0 at&ent 3a% ad$&tted to te %a$e o%&ta* &n Teno$ d&a+no%ed a&n+ ron& o%tr,t&e a&r3a d&%ea%e=OAD> d&%ea% e=OAD> and P,*$onar T,er,*o%&%=PTB>. No &%tor of a%t %,r+&a* &%tor. &%tor. No &%tor of an a**er+&e%.
1."
FAMILY HISTORY
•
1.7
Not &%tor of D&aette% Me**&t,% and erten%&on a$on+ fa$&* $e$er%. $e$er%. SOCIAL HISTORY
•
#$o'er: e %$o'er=aoe 1 %t&'% a da da %&ne e 3a% 2 ear% ear% o*d and %toed %$o'&n+ %$o'&n+
•
3en e 3a% 49 ear% o*d. > A*oo* dr&n'er: e dr&n'er =aro&$ate* ott*e of a*oo* a*oo* for 1 3ee'% %&ne e 3a% 2 ear% o*d and %toed dr&n' a*oo* 3en e 3a% 49 ear% o*d. >
####################### ################################## ####################### ####################### ####################### ################ ####
PART 2 2.1
PHYSICAL E$AMINATION
GENERAL • • • •
Pat&ent 3a% &n a&n. a &n. A*ert and on&o,% Not re%&rator d&%tre%%. No a**or and entra* ano%&% noted. &ta* %&+n%:
B*ood re%%,re: 17/6 $$+ Te$erat,re: Te$erat,re: C. de+ree ent&+rade P,*%e rate: C6/ $&n,te Re%&rator rate: 2/ $&n,te #O2: 9C P,*%e rt$: Re+,*ar Pa&n %ore: 4
2.2 PHYSICAL 2.2.1 HEAD
2.2.2 2.2 .2
EYES EYE S
2.2.3 2.2 .3
In%et&on o No *,rr&n+ of &%&on. o No d&%ar+ed fo,nd fro$ ot of te ee%. o Ee**o3&n+ Ee**o3&n+ of te 3&te ee% =a,nd&e>. Pa*at&on o No er&or&ta* tenderne%% or %3e**&n+ noted.
EARS EAR S
2.2.% 2.2 .%
In%et&on o No %3e**&n+ or at&e *eed&n+. o Ee**o3&n+ of te %'&n. Pa*at&on o No %3e**&n+.
In%et&on o No at&e *eed&n+ or %3e**&n+. Bot ear% re$a&n &n %a$e %&Fe. o o No d&%ar+ed at ot ear% noted. o No anor$a*&t&e% of ear&n+ noted. Pa*at&on o No tenderne%% o No $a%% a*ated.
NOSE NOS E In%et&on o No *eed&n+ and %3e**&n+. In nor$a* %ae of no%e. o o No d&%ar+ed fro$ te no%e. o No na%a* o*% %een. o No na%a* o%tr,t&on noted. Pa*at&on o No tenderne%%. o No $a%% fo,nd.
2.2. 2.2 .
THROAT THR OAT In%et&on o No &nf*a$$at&on aro,nd te troat. o No ton%&* en*ar+e$ent.
2.2." 2.2 ."
2.2.7 2.2 .7
MOUTH MOU TH In%et&on o Nor$a* &n %ae Dr *&% o NECK NEC K In%et&on o No anor$a*&t &n %ae o No o$*a&nt of d%a+&a. o No %3e**&n+. A*e to %3a**o3ed o Pa*at&on o No tenderne%%
o o
2.2.& 2.2. &
No $a%% a*a*e No *$ node %3e**&n+
RESPIRATORY RESP IRATORY SYSTEM SYST EM
In%et&on #ae and %$$etr of e%t- Nor$a*. o e%t 3a** $oe$ent anter&or* and o%ter&or*- Nor$a* and no anor$a*&t&e% o No o,+&n+. o No reat*e%%ne%% Pa*at&on e%t ean%&on- Nor$a* o o Ae eat- Nor$a* o No oa* =tat&*e> fre$&t,%. o R&%- no a&n *oa*&%ed. Per,%%&on o ard&a d,**ne%%- Nor$a*. o Nor$a* re%onane at ot *,n+%. A,%,*tat&on Breat %o,nd- No ron&0 no reetat&on%. o o No added =adent&t&o,%> %o,nd%. A&r entr e<,a* &*atera* o o
2.2.' 2.2. '
CARDIO(A CARD IO(ASCUL SCULAR AR SYSTEM SYST EM In%et&on o No re&o,% ard&a oerat&on %ar% on te e%t 3a**. o No anor$a*&t&e% %een.
Pa*at&on o No e%t 3a** a&n or tenderne%%. o No re%ene of anor$a* tr&**. o Ae eat at 5 t &ntero%ta*% %ae $&d*a&,*ar *&ne. Per,%%&on o Nor$a* ard&a d,**ne%% on te f&ft &ntero%ta* %ae of te *eft eart order. A,%,*tat&on o #o,nd 1 and %o,nd 2 eard *ear* . o D,a* rt$ no $,r$,r. eart eat- Nor$a* o
2.2.10 2.2. 10 ABDOMEN ABDO MEN In%et&on
R&+t &oondr&a re+&on noted. Red,&*e. Not etend&n+ to %rot,$. o,+ &$,*%e re%ent. No %&+n of %tran+,*at&on or o%tr,t&on. o No %,r+&a* %ar %een. o No 3o,nd. Pa*at&on o !eft &n+,&na* ern&a. Red,&*e o,+ &$,*%e re%ent o
Tender oer te %3e**&n+ area. Tender o
Ado$en &% tender
Per,%%&on o Nor$a* re%onane. o No f*,&d tr&**. A,%,*tat&on Bo3e* %o,nd re%ent: 6 t&$e% er $&n,te o o No r,&t %o,nd eard.
2.2.11 2.2 .11 GENITALIA GEN ITALIA o !eft %rota* droe*e noted. 2.2.12 2.2. 12 RECTUM RECT UM o
P%&a* ea$&nat&on not done.
2.2.1 PEL(IC In%et&on o Not&n+ anor$a*&t noted. Pa*at&on o Not&n+ anor$a*&t noted. 2.2.14 UPPER E$TREMITIES )RIGHT AND LEFT* o No defor$&t / anor$a*&t %een. A*e to $oe ot and% 3&to,t re%tr&t&on%. o U++, E/,/
M,%*e Tone M,%*e Po3erG a. #o,*der . *o3 . @r&%e Ref*e'%GG a. B&%e% . Tr&%e% . Bra ra&o &ora rad& d&a* a*&% &% #en%at&on Te%t
R4/
L,5/
Nor$atan&a
Nor$atan&a
5/5
5/5
2H 2H 2H Intat
2H 2H 2H Intat
Ta*e 2.1 Result Of Patient’s Patient’s Muscle Muscle And Tendon Tendon Reflexes For Upper Extremities
2.2.15 LOWER E$TREMITIES )RIGHT AND LEFT* o R&+t !e+ !eft !e+ No defor$&t / anor$a*&t deteted. No *o%% of %en%at&on. No &tt&n+ oede$a. A*e to $oe r&+t *e+ 3&to,t re%tr&t&on. a&**ar ref&** 2 %eond%. Po%ter&or t&&a arter and dor%a*&% ed&% arter are a*a*e.
L6, E/,/
M,%*e Tone M,%*e Po3erG a. &% Ref*e'%GG . J,adr&e% . An+'*e )& )&r' d. P*an P*anta tarr Ref* Ref*e' e'%% #en%at&on Te%t
R4/
L,5/
Nor$atan&a
Nor$atan&a
5/5
5/5
HH HH HH
HH HH HH
Intat
Intat
Ta*e 2.2 Result Of Patient’s Patient’s Muscle Muscle And Tendon Tendon Reflexes For Lower Extremitie
SCORE 5 4
2 1
DESCRIPTION Nor$a* o o3er or or $, $,%*e %t %tren+t &n &n e etre$&t&e% @ea' etr etre$ e$&t &t&e &e%0 %0 ,t ,t at at&e &ent nt an an oe oer ro$ o$ee re% re%&% &%ta tan nee a a*& *&ed ed ea$ ea$&n &ner er Pat& Pat&en entt an an oer oero o$e $e +ra +ra&t &t =an =an *&ft *&ft etr etre$ e$&t &t&e &e%> %> ,t ,t an anno nott oer oero o$e $e re%&%tane a*&ed ea$&ner @ea' $,% $,%*e *e on ontr tra at& t&on on00 ,t ,t not not eno eno,+ ,+ to to oe oer ro$ o$ee +ra +ra& &t t =$o =$oe$ e$en ent0 t0 ,t ,t annot *&ft etre$&t&e%> Pa* Pa*a a*e *e or &% &%& &*e *e $,%* ,%*ee f*& f*&' 'er er or t3& t3&t t0 0 ,t no $oe $oe$ $ent ent No re%on%e to %t&$,*,%0 o$*ete ara*%&% Ta*e 2. Muscle Strengt Strengt Scale!
SCORE 1H 2H H 4H reflexes!!
DESCRIPTION A%ent D&%$&n&%ed Nor$a* Inrea%ed0 $ore r&%' tan aera+e erat&e0 *on,%
Ta*e 2.4 Scale for deep tendon
PART 3
SUMMARIES AND RELE(AN IMPORTANT IMPORTANT FINDING F INDING
(enera* ond&t&on:
A*ert0 &n a&n0 (#: 15/15
ENT t cyanosis,no -no ABDOMEN swelling -scha!oid -no bleeding -so!t,non tender, -li"er,spleen, NECK kidney not palpable# -Normal shape -bowel sound present -JP not raised -$t# %nguinal hernia - trachea not shi!ted noted# -tender# -reduceble# -not etendig to scrotum# -'ough impulse present#
EYES -no hematoma -Pink -both pupil equel & react to light CARDOIVASCULAR -DRNM -re ular ular hear heartt beat beat
RESPIRATORY - clear -equal air entry
GENETALIA -$t#scrotal swelling noted# (hydrocele)#
UPPER EXTREMITIES (right & let! -no de!omity -R*M !ull -capillary re!ill "+sec
Posterior tibia artery LO#ER EXTREMITIES (right & let! -no de!omity -R*M !ull -capillary re!ill "+sec
Dorsalis pedis ############################################################################################## ####################################################### ####################################### artry palpable
PART %
DIAGNOSIS
Pro&%&ona* D&a+no%&%: o Ind&ret !eft In+,&na* ern&a. D&fferent&a*% D&a+no%&%: o #tran+,*ated !eft In+,&na* ern&a ####################### ################################## ####################### ####################### ####################### ##################### #########
PART
.1 .1
BLOOD BLOO D IN(E IN(EST STIG IGA ATIONS IONS AND $-RAY FINDING
BLOO BL OOD D URE UREA A SE SERU RUM M EL ELEC ECTR TROL OLIT ITE E )BU )BUSE SE**
B8669 U, N/6,; )BUN* To $ea%,re o3 3e** te '&dne% are 3or'&n+. "rea &% a n&tro+en-onta&n&n+ o
3a%te 3a%te rod, rod,tt tatL% tatL% reated reated 3en 3en te od rea'% rea'% do3n rote&n rote&n.. If te '&dne% are not 3or'&n+ roer*0 te *ee*% of B"N 3&** ,&*d , &n te *ood. Dedrat&on and ee%%&e *eed&n+ an a*%o e*eate te B"N *ee*% &n te *ood.
S,< E8,=/68/,> )SE*
o
T&a**0 te%t% for e*etro*te% $ea%,re *ee*% of %od&,$0 ota%%&,$0 *or&de0 and &aronate &n te od. od.
o
S69< )NA* *a% a $aor ro*e &n re+,*at&n+ te a$o,nt of 3ater &n te
od. od. A*%o0 te a%%a+e of %od&,$ &n and o,t of e**% &% nee%%ar for $an od f,nt&on%0 *&'e tran%$&tt&n+ e*etr&a* %&+na*% &n te ra&n and &n te $,%*e%. Te %od&,$ *ee*% are $ea%,red to detet 3eter tereL% te r&+t a*ane of %od&,$ and *&<,&d &n te *ood *ood to arr o,t to%e f,nt&on%.
o
If a &*d eo$e% dedrated dedrated ea,%e ea,%e of o$&t&n+0 d&arroea0 d&arroea0 or &nade<,ate &nade<,ate f*,&d &nta'e0 te %od&,$ *ee*% an e anor$a** &+ or *o30 3& an a,%e a &*d to fee* onf,%ed0 3ea'0 and *etar+&0 and een to ae %e&F,re%.
o
P6/>>< )K* &% e%%ent&a* to re+,*ate o3 te eart eat%. Pota%%&,$ *ee*%
tat are too &+ or too *o3 an &nrea%e te r&%' of an anor$a* earteat. !o3 ota%%&,$ *ee*% are a*%o a%%o&ated 3&t $,%*e 3ea'ne%%.
o
C4869, )CHLO*0 *&'e %od&,$0 e*% $a&nta&n a a*ane of f*,&d% &n te
od. od. If tereL% a *ar+e *o%% of *or&de0 te *ood $a eo$e $ore a&d& and reent erta&n e$&a* reat&on% fro$ o,rr&n+ &n te od tat are nee%%ar &t to 'ee 3or'&n+ roer*. o
C,/;;, )CREAT* *ee*% &n te *ood tat are too &+ an &nd&ate tat
te '&dne% arenLt 3or'&n+ roer*. Te '&dne% f&*ter and erete reat&n&ne &f teLre not f,nt&on&n+ roer*0 reat&n&ne an ,&*d , &n te *ood%trea$. Bot dedrat&on and $,%*e da$a+e a*%o an ra&%e reat&n&ne *ee*%.
Date : 1.5.2 9 T,>/ NA K !O "RA RAT •
.2
BUSE R,><8/
<;/
1C $$o*/! . $$o*/! 99 $$o*/! 4.1 $$o*/! 75 ,$o*/! Ta*e 5.1 Patient’s Patient’s "USE Result
Interretat&on: A** re%,*t% are 3&t&n nor$a* ran+e. o
FULL BLOOD COUNT )FBC*
N68 R;,
15 -145 . ? 5.1 9C ? 17 1.7 ? C. 4 - 9
A f,** *ood o,nt =8B> &% a er o$$on *&n&a* roed,re and often te %tart&n+ o&nt for $o%t $ed&a* &ne%t&+at&on%. An 8B not on* te%t% for d&%order% and anor$a*&t&e% of te *ood te *ood ,t0 ,t0 a% *ood trae*% tro,+o,t te 3o*e od0 &t an +&e an &nd&at&on of d&%ea%e re%ent &n oter or+an%.
H,686?; )H?* To deter$&ne an an+e% &n at&ent;% ea$o+*o&n %, a% *o3 %o a**ed o
anea$&a anea$&a tat &nd&at &nd&ate% e% *ood *ood *o%% *o%% =&ntern =&nterna* a* or etern eterna*> a*> and Po*tae$&a 3& &% a%%o&ated 3&t an a n anor$a** &+ ae$o+*o&n onentrat&on &n te *ood0 and &% an &nd&at&on tat red *ood e** n,$er% are a*%o too &+. T&% o,*d e d,e to re%&rator or &r,*ator d&%order% or0 &n %o$e a%e%0 to a t,$o,r. #o$et&$e% #o$et&$e% a &+ red r ed *ood e** o,nt &% d,e to dedrat&on dedrat&on.. T6/8 W4/, C,88> )WBC* o To deter$&ne &nfet&on.
P8/8,/ )PLT* To ea*,ate te ant& oa+,*at&on fator &n te *ood. o
Date : 1.5.29 =2.44$> T,>/
FULL BLOOD COUNT RESULT R,><8/
N68 R;,
C.67 1 / ,* 4. ? 1 6 5.C5 1 / ,* 4.4 ? 6.1 17.4 +/d* 12.2 ? 1C.1 25 1 / ,* 142 - 424 Ta*e 5.2 Patient’s Patient’s Full "lood "lood #ount Result
@B RB (B P!T •
U;/
Interretat&on: A** re%,*t% are 3&t&n nor$a* ran+e. o
PART " •
REASON FOR DIAGNOSIS =Arod&n+ To Pat&ent &%tor And P%&a* a$&nat&on% a$&nat&on% 8&nd&n+> Pat&ent &%tor. o o
•
!eft &n+,&na* %3e**&n+ for one ear. One dee*oed one e&%ode of &rred,&*e *eft &n+,&na* on Ar&* Ar&* 29.
P%&a* ea$&nat&on. o o
#3e**&n+ of *eft &n+,&na* re+&on. Red,&*e %3e**&n+ 3&t o%&t&e o,+ &$,*%e.
####################### ################################## ####################### ####################### ####################### ##################### #########
PART 7
TREATMENT @ PRIMARY
EMERGENCY EMERGENC Y CARE 1. TRIAGING.
2. 3.
%.
. ".
7.
Tr&a+&n+ 3a% done and at&ent 3a% %ent to e**o3 Fone. AIR AIRWAY. A&r3a not *o'ed. Pat&ent an ta*' and 3a% &n a&n. BREA REATHING ING. Pat&ent an reat&n+ free* 3&to,t d&ff&,*t. Re%&rat&on: 2/$&n,te. CIRC CIRCUL ULA ATION. ION. Rad&a* ,*%e re%ent. C4 / $&n,te. B*ood re%%,re: 1/C$$+. od. No o&o,% *eed&n+ fro$ te &n,r %&te or an art of te od. DIS DISABI ABILITY ITY. No ne,ro*o+&a* def&&t noted. E$POSURE #3o**en noted at *eft &n+,&na* ,t red,&*e. !eft %rota* %3e**&n+ d,e to droe*e. IN(E IN(EST STIG IGA ATIONS IONS.. B*ood and Q-ra &ne%t&+at&on 3a% not done &n $er+en and Tra,$a Deart$ent.
&. PROCE ROCEDU DURE RES. S.
#3e**&n+ of te *eft &n+,&na* ern&a 3a% red,e %ontaneo,%*. '. MEDI MEDICA CAT TIONS IONS.. #TAT 3a% +&en ea,%e at&ent 3a% &n a&n. I Pet&d&ne 5$+ #TAT 10. MONITORI MONITORING NG &ta* %&+n% (/8 S;>
R,><8/
B8669 +,>><,
1/C $$+
P<8>,
C4/ $&n,te
T,+,/<, R,>+/6;
7o 2 / $&n,te
Ta*e 7.1 Patient’s Patient’s $ital $ital Signs.
9C
S+O2
11. 11. PLANNI PLANNING. NG. Ad$&%%&on to Ma*e #,r+&a* for *eft &n+,&na* ern&a rea&r.
PART &
WAD MANAGEMENT AND PATIENT PATIENT PROGRESSIO PRO GRESSIONS NS
DAY ONE 13.0.200' 1. GE GENE NERA RAL L COND CONDIT ITIO ION N Pat&ent 3e** and a*ert. • Ta'&n+ Ta'&n+ ora** 3e**. • A$,*at&n+ 3e**. • 2. PHYS PHYSIC ICAL AL E$AM E$AMIN INA ATION ION: !,n+% : •
*ear and e<,a* a&r entr. • •
#: DRNM Ado$en: #oft. Non tender. !eft &n+,&na* ern&a noted ,t red,&*e. o,+ &$,*%e: o%&t&e.
3. PROCEDURE No roed,re done. %. IN(E IN(EST STIG IGA ATION ION B*ood o 8,** *ood o,nt o B"# o reat&n&ne o (# o PT/PTT . MEDI EDICAT CATIONS IONS Not on an $ed&at&on. •
end&n+ re%,*t.
". MONITORING (/8 >;> (/8 S;>
R,><8/
B8669 +,>><,
14/9 $$+ C/ $&n,te
P<8>, T,+,/<,
7o
R,>+/6;
2 / $&n,te
S+O2
1
Ta*e C. Patient’s Patient’s $ital $ital Signs.
7. PLANNING no,ra+e ora**. • To d&%,%% 3&t %,r+eon for f,rter *ann&n+. •
DAY TWO 1%.0.200 1% .0.200' ' 1. GE GENE NERA RAL L COND CONDIT ITIO ION N Pat&ent %ta*e and o$forta*e. • Ta'&n+ Ta'&n+ ora** 3e**. • 2. PHYSIC PHYSICAL AL E$AMI E$AMINA NAT TION: !,n+% : • *ear and e<,a* a&r entr.
• •
#: DRNM Ado$en: #oft. Non tender. !eft &n+,&na* ern&a noted ,t red,&*e. o,+ &$,*%e: o%&t&e.
3. PROCEDURE
-#een %,r+eon t&% $orn&n+. !eft &n+,&na* ern&a rea&r to$$oro3. o !arato$ Tran% Ado$&na* Ado$&na* Pre Per&tonea* $etod =!a. TAPP>. TAPP>. %. IN(E IN(EST STIG IGA ATION ION B*ood: Result B*ood: Result refer to table 5.1 and and 5.2. 5.2. . MEDIC DICATIONS IONS Not on $ed&at&on. • ". MONITORING (/8 >;> (/8 S;>
R,><8/
B8669 +,>><,
1/C $$+ C6/ $&n,te
P<8>, T,+,/<,
7o
R,>+/6;
1C / $&n,te
S+O2
99
Ta*e C.4 Patient’s Patient’s $ital $ital Signs. 7. PLANNING N&* $o,t at 12 $&dn&+t. $&dn&+t. • ID 2.5 !/da =N/# a*ternate 3&t D5>. • ####################### ################################## ####################### ####################### ####################### ################## ######
DAY THREE 1.0.200' 1. GE GENE NERA RAL L COND CONDIT ITIO ION N Pat&ent %ta*e and o$forta*e. • 2. PHYSIC PHYSICAL AL E$AMI E$AMINA NAT TION:
•
!,n+% : *ear and e<,a* a&r entr.
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FINAL DIAGNOSIS
1. LEFT INGUI INGUINAL NAL HERNIA HERNIA )INDIR )INDIRECT* ECT*.. ################################ ################################################# ########################### ##########
SUMMARY O$ DISEASE
INGUINAL HERNIA
DEFINITION
In+,&na* In+,&na* ern&a% ern&a% o,r 3en 3en %oft t&%%,e t&%%,e ,%,a** ,%,a** art of te &nte%t&n &nte%t&nee rotr,de% rotr,de% tro,+ tro,+ a 3ea' 3ea' o&nt or tear &n o,r *o3er ado$&na* 3a**. Te r e%,*t&n+ ,*+e an e a&nf,* e%e&a** 3en 3e o,+0 end oer or *&ft a ea oet. SYMPTOMS
#o$e &n+,&na* ern&a% donLt a,%e an %$to$%0 and o, $a not 'no3 o, ae one ,nt&* o,r dotor d&%oer% &t d,r&n+ a ro,t&ne $ed&a* ea$. Often0 o3eer0 o, an %ee and fee* te ,*+e reated te rotr,d&n+ &nte%t&ne. Te ,*+e &% ,%,a** $ore o&o,% 3en o, %tand ,r&+t0 e%e&a** &f o, o,+ or %tra&n. In+,&na* ern&a %&+n% and %$to$% &n*,de:
A ,*+e &n te area on e&ter %&de of o,r ,& one.
Pa&n or d&%o$fort &n o,r +ro&n0 e%e&a** 3en end&n+ oer0 o,+&n+ or *&ft&n+ .
A ea or dra++&n+ %en%at&on &n o,r +ro&n.
Oa%&ona**0 &n $en0 a&n and %3e**&n+ &n te %rot,$ aro,nd te te%t&*e% 3en te rotr,d&n+ &nte%t&ne de%end% &nto te %rot,$.
SIGNS AND SYMPTOMS IN CHILDREN CH ILDREN
Ao,t f&e &n eer 1 &*dren ae &n+,&na* ern&a%. In+,&na* ern&a% &n ne3orn% and &*dren re%,*t fro$ a 3ea'ne%% &n te ado$&na* 3a** tatL% re%ent at &rt. #o$et&$e% te ern&a $a e &%&*e on* 3en an &nfant &% r&n+0 o,+&n+ or %tra&n&n+ d,r&n+ a o3e* $oe$ent. In an o*der &*d0 a ern&a &% *&'e* to e $ore aarent 3en te &*d o,+%0 %tra&n% d,r&n+ a o3e* $oe$ent or %tand% for a *on+ er&od of t&$e.
WHEN TO SEE S EE A DOCTOR DO CTOR
#ee o,r dotor &f o, ae a a&nf,* or not&ea*e ,*+e &n te area on e&ter %&de of o,r ,& one. Te ,*+e ,*+e &% *&'e* to e $ore not&ea*e 3en o,Lre %tand&n+ ,r&+t0 ,r&+t0 and o, ,%,a** an fee* &t &f o, ,t o,r and d&ret* oer te affeted area. Eo, Eo, %o,*d e a*e to +ent* and ea%&* ,% te ern&a a' &nto o,r ado$en 3en o,Lre *&n+ do3n. do3n. If not0 a*&n+ a*&n+ an &e a' to te area $a red,e te %3e**&n+ eno,+ eno,+ %o tat te ern&a %*&de% &n ea%&*. ea% &*. !&n+ !&n+ 3&t o,r e*&% &+er tan o,r ead a*% o $a e*.
If o, %t&** arenLt a*e to ,% te ern&a &n0 te ern&ated &nte%t&ne $a ae eo$e traed =&narerated> &n te ado$&na* 3a** a %er&o,% ond&t&on tat $a re<,&re &$$ed&ate $ed&a* attent&on. T&% ond&t&on $a e ao$an&ed na,%ea0 o$&t&n+ or a feer0 and a ern&a ,*+e tat t,rn% red0 ,r*e or dar'. If an of te%e %&+n% or %$to$% o,r0 a** o,r dotor r&+t a3a.
CAUSES
#o$e &n+,&na* ern&a% ae no aarent a,%e. B,t $an o,r a% a re%,*t of:
Inrea%ed re%%,re 3&t&n te ado$en
A re-e&%t&n+ 3ea' %ot &n te ado$&na* 3a**
A o$&nat&on of te t3o In $an eo*e0 te ado$&na* 3a** 3ea'ne%% tat *ead% to an &n+,&na* ern&a o,r% at &rt 3en te ado$&na* *&n&n+ =er&tone,$> doe%nLt *o%e roer*. Oter &n+,&na* ern&a% dee*o *ater &n *&fe 3en $,%*e% 3ea'en or deter&orate d,e to fator% %, a% a+&n+0 %tren,o,% %&a* at&&t or o,+&n+ tat ao$an&e% %$o'&n+. % $o'&n+. In $en0 te 3ea' %ot ,%,a** o,r% a*on+ te &n+,&na* ana*. T&% &% te area 3ere te %er$at& ord0 3& onta&n% te a% deferen%0 te t,e tat arr&e% %er$0 enter% te %rot,$.
In 3o$en0 te &n+,&na* ana* arr&e% a *&+a$ent tat e*% o*d te ,ter,% &n *ae0 and ern&a% %o$et&$e% o,r 3ere onnet&e t&%%,e fro$ te ,ter,% attae% to t&%%,e %,rro,nd&n+ te ,& one.
MORE COMMON COMMO N IN MEN
Men are $ore *&'e* to ae an &nerent 3ea'ne%% a*on+ te &n+,&na* ana* ea,%e of te 3a $a*e% dee*o &n te 3o$. In te $a*e fet,%0 te te%t&*e% for$ 3&t&n te ado$en and ten $oe do3n te &n+,&na* ana* &nto te %rot,$. #ort* after &rt0 te &n+,&na* ana* *o%e% a*$o%t o$*ete*0 *ea&n+ ,%t eno,+ roo$ for te %er$at& ord to a%% tro,+0 ,t not *ar+e eno,+ to a**o3 te te%t&*e% to $oe a' &nto te ado$en. #o$et&$e%0 o3eer0 te ana* doe%nLt *o%e roer*0 *ea&n+ a 3ea'ened area. TereL% *e%% ane tat te &n+,&na* ana* 3onLt *o%e after &rt &n fe$a*e a&e%. In fat0 3o$en are $ore *&'e* to dee*o ern&a% &n te fe$ora* ana*0 an oen&n+ near te &n+,&na* ana* 3ere te fe$ora* arter0 e&n and nere a%% tro,+. @ea'ne%%e% an a*%o o,r &n te ado$&na* 3a** *ater &n *&fe0 e%e&a** after an &n,r or erta&n oerat&on% &n te ado$&na* a&t.
@eter or not o, ae a re-e&%t&n+ 3ea'ne%%0 etra re%%,re &n o,r ado$en an a,%e a ern&a. T&% re%%,re $a re%,*t fro$:
#tra&n&n+ d,r&n+ o3e* $oe$ent% or ,r&nat&on
ea *&ft&n+
8*,&d &n te ado$en =a%&te%>
Pre+nan
e%% 3e&+t en ron& o,+&n+ or %neeF&n+ an a,%e ado$&na* $,%*e% to tear.
RISK FACTORS
Eo,Lre far $ore *&'e* to dee*o an &n+,&na* ern&a &f o,Lre $a*e. Near* 1 t&$e% $ore $en tan 3o$en ae &n+,&na* ern&a%0 and te a%t $aor&t of ne3orn% and &*dren 3&t &n+,&na* ern&a% are o%.
Oter r&%' fator% &n*,de:
F8 4>/6. Eo,r r&%' of &n+,&na* ern&a &nrea%e% &f o, ae a *o%e re*at&e0 %, a%
a arent or %&*&n+0 3&t te ond&t&on.
C,/; ,9=8 =6;9/6;>. a&n+ %t& f&ro%&%0 a *&fe-treaten&n+ d&%order tat a,%e%
%eere *,n+ da$a+e and often a ron& o,+0 $a'e% &t $ore *&'e* o,L** dee*o an &n+,&na* ern&a.
C46;= =6<4. A ron& o,+0 %, a% o,r% fro$ %$o'&n+0 &nrea%e% o,r r&%' of
&n+,&na* ern&a.
C46;= =6;>/+/6;. T&% *ead% to %tra&n&n+ d,r&n+ o3e* $oe$ent% a o$$on
a,%e of &n+,&na* ern&a%.
E=,>> ,4/. Be&n+ $oderate* to %eere* oer3e&+t an ,t etra re%%,re on o,r
ado$en.
P,;;=. T&% an ot 3ea'en te ado$&na* $,%*e% and a,%e &nrea%ed re%%,re
&n%&de o,r ado$en.
C,/; 6==<+/6;>. a&n+ a o tat re<,&re% %tand&n+ for *on+ er&od% or do&n+ ea
%&a* *aor &nrea%e% o,r r&%' of dee*o&n+ an &n+,&na* ern&a.
P,/<, ?/4. Infant% 3o are orn %ooner tan nor$a* are $ore *&'e* to ae
&n+,&na* ern&a%.
H>/6 65 4,;>. If o,Le ad one &n+,&na* ern&a0 &tL% $, $ore *&'e* tat o,L**
eent,a** dee*o anoter ,%,a** on te oo%&te %&de.
COMPLICATIONS
Mo%t &n+,&na* ern&a% en*ar+e oer t&$e &f teLre not rea&red %,r+&a**. !ar+e ern&a% an ,t re%%,re on %,rro,nd&n+ t&%%,e% &n $en te $a etend &nto te %rot,$0 a,%&n+ a&n and %3e**&n+. B,t te $o%t %er&o,% o$*&at&on of an &n+,&na* ern&a o,r% 3en a *oo of &nte%t&ne eo$e% traed &n te 3ea' o&nt &n te ado$&na* 3a** =&narerated ern&a>. T&% $a o%tr,t te o3e*0 *ead&n+ to %eere a&n0 na,%ea0 o$&t&n+ and te &na&*&t to ae a o3e* $oe$ent or a%% +a%.
It an an a*%o a*%o d&$& d&$&n& n&% % *oo *ood d f*o3 f*o3 to te te tra traed ed ort ort&o &on n of te te &nte &nte%t& %t&ne ne a ond ond&t &t&o &on n a**e a**ed d %tran+,*at&on tat $a *ead to te deat of te affeted o3e* t&%%,e%. A %tran+,*ated ern&a &% *&fetreaten&n+ and re<,&re% &$$ed&ate %,r+er.
TESTS AND DIAGNOSIS
A %&a* ea$ &% ,%,a** a** tatL% needed to d&a+no%e an &n+,&na* ern&a. Eo,r Eo,r dotor &% *&'e* to a%' ao,t o,r %&+n% and %$to$% and to e' for a ,*+e &n te +ro&n area. Bea,%e o,+&n+ an $a'e a ern&a $ore ro$&nent0 o, $a e a%'ed to o,+ or %tra&n a% art of te ea$.
TREATMENTS AND DRUGS
If o,r ern&a &% %$a** and &%nLt oter&n+ o,0 o,r dotor $a reo$$end a 3at-and-3a&t aroa. B,t en*ar+&n+ or a&nf,* ern&a% ,%,a** re<,&re %,r+&a* rea&r to re*&ee d&%o$fort and reent %er&o,% o$*&at&on%. Tere are t3o +enera* te% of ern&a oerat&on%:
H,;64+4. In t&% roed,re0 o,r %,r+eon $a'e% an &n&%&on &n o,r +ro&n and
,%e% te rotr,d&n+ &nte%t&ne a' &nto o,r ado$en0 ten rea&r% te 3ea'ened or torn $,%*e %e3&n+ &t to+eter. After te oerat&on0 o,L** e eno,ra+ed to $oe ao,t a% %oon a% o%%&*e0 ,t &t $a e a% *on+ a% fo,r to %& 3ee'% efore o,Lre a*e to f,** re%,$e o,r nor$a* at&&t&e%.
H,;6+8>/. In t&% roed,re0 3& &% %o$et&n+ *&'e at&n+ a t&re0 o,r %,r+eon
&n%ert% a &ee of %ntet& $e% to oer te ent&re &n+,&na* area0 &n*,d&n+ a** otent&a* ern&a oen&n oen&n+%. +%. Te Te at at &% ,%,a** ,%,a** %e,red %e,red 3&t 3&t %,t,re %,t,re%0 %0 *&% *&% or %ta*e% %ta*e%.. ern&o ern&o*a *a%t %t an e erfor$ed onent&ona**0 3&t a %&n+*e *on+ &n&%&on oer te ern&a. B,t &tL% often done *aaro%o&a**0 ,%&n+ %eera* %$a** &n&%&on% rater tan one *ar+e one. A f&er-ot& t,e 3&t a t&n a$era &% &n%erted &nto o,r ado$en tro,+ one &n&%&on0 and $&n&at,re &n%tr,$ent% are &n%erted tro,+ te oter &n&%&on%. Eo,r %,r+eon ten erfor$% te oerat&on ,%&n+ te &deo a$era a% a +,&de. Adanta+e% of *aaro%o& rea&r &n*,de *e%% d&%o$fort and %arr&n+ after %,r+er and a <,&'er ret,rn to nor$a* at&&t&e% $o%t eo*e are a' to 3or' 3&t&n a fe3 da%. Te roed,re &% a +ood +ood o&e o&e for eo*e eo*e 3o%e 3o%e ern&a ern&a%% re,r re,r fo**o3 fo**o3&n+ &n+ trad&t& trad&t&ona ona** ern&a ern&a %,r+er %,r+er ea,% ea,%ee *aaro%o& $etod% a**o3 %,r+eon% to 3or' aro,nd %ar t&%%,e fro$ ear*&er rea&r. ItL% a*%o +ood for eo*e 3o ae ern&a% on ot %&de% of te od =&*atera* &n+,&na* ern&a%>. D&%adanta+e% of *aaro%o& rea&r &n*,de an &nrea%ed r&%' of o$*&at&on% and of re,rrene fo**o3&n+ %,r+er. Te%e r&%'% are red,ed &f te roed,re &% erfor$ed a %,r+eon 3&t eten%&e eer&ene &n te%e '&nd% of rea&r%.
Eo, $a not e a and&date for *aaro%o& ern&a rea&r &f o, ae a er *ar+e ern&a0 &f o,r &nte%t&ne &% ,%ed do3n &nto te %rot,$ or &f o,Le ad re&o,% e*& %,r+er %, a% a ro%tateto$.
PRE(ENTION
Eo, Eo, anLt reent te on+en&ta* defet tat $a $a *ead to an &n+,&na* ern&a0 ,t te fo**o3&n+ %te% an e* red,e %tra&n on o,r ado$&na* $,%*e% and t&%%,e%:
M;/; 4,8/4 ,4/. If o, t&n' o, $a e oer3e&+t0 ta*' to o,r dotor ao,t
te e%t eer&%e and d&et *an for o,.
E+4>, 44-5?, 5669>. 8re% fr,&t% and e+eta*e% and 3o*e +ra&n% are +ood for
o,r o,r oera* oera*** ea*t. ea*t. TeLre TeLre a*%o a'ed a'ed 3&t 3&t f&er f&er tat tat an e* e* reen reentt on%t& on%t&at& at&on on and %tra&n&n+.
L5/ 4, 4, 6?,=/> 6?,=/> =,5< =,5<88 88 6 69 4, 85/; 85/; 8/6,/4, 8/6,/4,. . If o, ae to *&ft
%o$et&n+ ea0 a*3a% a*3a% end fro$ o,r 'nee%0 not fro$ o,r 3a&%t.
S/6+ >6;. In add&t&on to &nrea%&n+ o,r r&%' of %er&o,% d&%ea%e% %, a% aner0
e$%e$a and eart d&%ea%e0 %$o'&n+ often a,%e% a ron& o,+ tat an *ead to or a++raate an &n+,&na* ern&a.
D6;/ ,8 6; /<>> 56 ><++6/. ontrar to 3at o, $a ae eard0 3ear&n+ a tr,%%
&%nLt te e%t *on+-ter$ %o*,t&on for an &n+,&na* ern&a. A tr,%% 3onLt rotet a+a&n%t o$*&at&on%
or orret te ,nder*&n+ ro*e$0 a*to,+ o,r dotor $a reo$$end 3ear&n+ one for a %ort t&$e efore %,r+er. ############################################################################################## ####################################################### #######################################
