History & examination of patients with ABDOMINAL WALL HERNIAS & perineum problems Prof M K Alam

Abdominal wall hernias Definition: A hernia of the abdominal wall is a protrusion of the abdominal contents through an acquired or congenital area of weakness or defect in the wall. Inguinal, paraumbilical, incisional and femoral are most common.

Abdominal wall hernias- presentation Swelling Vary in size: Disappear or reduce with rest. Increase in size with activity- standing, coughing Reducibility: uncomplicated hernias Pain- mild to severe Irreducibility

Examination of abdominal wall hernias Inspection: (?standing vs lying) Site - groin, over scars, umbilicus Extension to scrotum (inguinal hernia) Cough impulse Reducibility

PUH

Epigastric hernia

Palpation: Inguinoscrotal swellings, ? Can you get above it Cough impulse Reducibility Defect Control by blocking internal ring Irreducibility/tenderness Inguinal vs Femoral Percussion- resonant if content is bowel Auscultation- bowel sound

THE PERINEUM

Presentation Pain: perianal abscess, fissure in ano, anal fistula, thrombosed piles Bloody discharge: Piles, fissure, fistulae, tumours (polyp, carcinoma anus/ rectum) Purulent discharge: perianal abscess, fissure in ano, anal fistula Mass or swelling: Abscess, piles, neoplasms

EXAMINATION OF THE PERINEUM External genitalia Perineum examination : left lateral position, hips flexed to 90º and knees flexed to less than 90° Lift uppermost buttock to expose the area

Inspection: scar of previous surgery, Sinus- one opening blind track Fistula- track connecting two epithelial surfaces Fecal soiling, blood/mucous discharge Mass protruding from anus Palpation: tenderness, discharge, mass Rectal examination: Tone, tenderness, mass, prostate, blood, stool

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