Inguinal hernias and cute MO

SureClerked a patient with right-sided reducible inguinal hernia today.

Basically, hernia refers to any structure passing through another and ending up in the wrong place. Indirect inguinal hernias pass through the internal inguinal ring and if large, out through the external ring. During the embryonic development, the testis is led down from its original position in the posterior abdominal wall into the scrotum by the gubernaculum. Hence, if the connection between the peritoneal cavity and the tunica vaginalis fails to close behind the testis, there'll be a patent processus vaginalis. It's through this that an inguinal hernia occurs. Indirect hernias are more common (80%) and chances of strangulation are high as the external inguinal ring is very narrow.

Whereas, direct hernias push their way directly forward through the posterior wall of the inguinal canal, into a defect in the abdominal wall. Predisposing conditions include chronic cough, constipation, urinary obstruction, heavy lifting, ascites and previous abdominal surgery ( damage to the iliohypogastric nerve during appendectomy).

To distinguish a direct from an indirect inguinal hernia, reduce it and occlude the internal inguinal ring (mid-point of inguinal ligament) with 2 fingers. Then, ask the patient to cough or stand -- if the hernia is restrained, it is indirect. If it pops out, it is direct.

Hmm. A medical officer talked to me in the surgical ward. Dr. Aarron. A pleasant surprise. He's kind of cute. I'm not sure of his race. He took the first move to talk to me thrice. I literally tagged along him while he was doing his ward round. I'm gonna linger in the surgical ward tomorrow!!!