1. Groin swellingg

2. Groin swelling History : when the lump 1st notice ?
what are the symptom related to lump?
Has lump change ? in size ,shape ,color since it was appear ?
Dose the lump ever disappear ?what makes the lump disappear ?
Has the patient had any ather lump ?
What dose the patient think cause the lump ?
Is there any discharge ?
What ttt has been suggested or administered ?

3. Also we have to ask potential complication of hernia :
Irreducibility
Obstruction :abdo pain , distension , constipation ,vomiting
Strangulation :tender, painfull
Also we ask about risk factor for hernia :
Chronic cough
B.A
Chronic constipation
Straining with urination
Occupation
 Social hx : smoking ,occupation , heavy lifting

4. Examination:
 •Inspection , palpation , auscultation
•Asymmetry ( swelling ): site , size , tenderness , mobility
•Neck……..defect
Sac…………content
Overlying skin
Reducibility Expansilecough

5. Differential diagnosis of groin swelling :
Inguinal hernia
Femoral hernia
Femoral aneurysm
Lymphadenopathy
Ectopic testis undescending testis
Lipoma of spermatic cord
Hydrocele of cord
 abcess

6. For dx of swelling we have to do :
Ultra sound
CT abdomine
AXR erect + supine

7. Hernia : is protrusion of viscus into an area in which it is not normally contained .
Male>femal = 9:1
Most common surgical disease of males .

8. Type of common hernia :
Inguinal :80%
Umbilical : 15 %
Femoral : 5 %

9. Inguinal hernia Direct vs indirect direct indirect
Directly through the abdominal wall muscle (hesselbach’s triangle )
Originate at deep inguinal ring pass to ext.inguinal ring
Medial to I.EpiGAstric vessel
Lateral to inferior epigastric vessel
Less likely to be in carcerated than indirect
More likely to be incarcerated
Usually not pass to scrotal
Etiology : aquired weakness in transversalis fascia or increase intra-abdominal pressure
Pass to scrotal sac
Etiology : congenital persistence of processus vaginalis in 20% of adults
Direct vs indirect
All inguinal hernia reduced to point above and medial to pubic tubercle

14. Complication of hernia
Incarceration
Strangulation
Ischemia
Necrosis
Intestinal obstruction
This complication need ergent surgery and laproscopic exploration

15. Sign and symptom of peritonitis are absolut indication for abdominal exploration

16. Treatment
1- observation for asymptomatic small inginal hernia and reducible and repaired electively
2- can be reduced manually if no strangulation .how?
3- don’t attepmt to reduce hernial sac if sepsis or gangernous occure it is surgical emergency
4- surgical repaire for indirect : tension free mesh repaire

17. Treatment
Surgical repaire for direct : bassini ,Mcvay ,lichtenstienrepaire Can be done open or laproscopic Laproscopic usefull for patient has recurrent or bilateral hernia .

18. Post -operative complication
Recurrence
Scrotal hematoma
Nerve entrepment
Ischemia and occlusion of femoral vein
Wound infection
Temperary urinary retintion
Injury to spermatic cord structure

19. Femoral hernia
Origin from femoral ring and pass to saphenous hiatus through femoral canal .
Pass medially to femoral vein artery nerve .
Occure mush more in women but still the inguinal is most common .
Prone to incarceration and strangulation
Point of reduction ( below and lateral to pubic tubercle )

21. Treatment
Femoral hernia are generally repaired because it is high risk for strangulation .
Reduction is often difficult
Is nessery to assure adequate closure of femoral canal

22. Hematoma Blood collection within muscles layer of ant abdominal wall
Due to mild truma or blood disease
Present with abdominal pain and painfull abdominal mass and may be ecchymosis over abdomine
fothergill’s
Dx by CT + u/s
Usually resolve without surgery and evacuation done if clot with adequate hemostasis with sever pain and persistent

23. Tumar of abdominal wall
Mostly benign ( lipoma , hemangioma , fibroma )
Rarly malignant and often from mets from intra-abdominal sourse