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7/25/2019 Case Presentation - Hernia
1/19
A Case of M.C.
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7/25/2019 Case Presentation - Hernia
2/19
PATIENT PROFILE
M.C. is a:32 year old
FilipinoRoman Catoli!
married
Male
From "or#on$ Ce#%
CC: In&%inal pain and red%!i#le mass$ ri&t
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7/25/2019 Case Presentation - Hernia
3/19
PA'T ME(ICAL )I'TOR*
No prior ospitali+ations or s%r&eries
Not a ,no-n ypertensie$ dia#eti! or
astmati!
No maintenan!e medi!ations
No ,no-n food or dr%& aller&ies
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7/25/2019 Case Presentation - Hernia
4/19
PER'ONAL AN( 'OCIAL
)I'TOR*/.0 pa!, year smo,er
Preio%sly an al!ooli! #eera&e drin,er
of 12 #ottles #eer 12 per mont
)istory of metampetamine %se$ last%se #a!, in 2412
In!ar!erated sin!e 5555 in CP(RC
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7/25/2019 Case Presentation - Hernia
5/19
PER'ONAL AN( 'OCIAL
)I'TOR*No parti!%lar food preferen!e orrestri!tions
No re!ent #o-el or #ladder pro#lems
Preio%sly -or,ed as a !onstr%!tion-or,er for 3 years
Eer!ises re&%larly -ile in in!ar!erationin!l%din&
liftin& free -ei&ts
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7/25/2019 Case Presentation - Hernia
6/19
FAMIL* )I'TOR*
"irt ran, of 360$ si#lin&s apparently -ell
Eldest #roter died
7no-n eredofamilial diseases in!l%de:)ypertension 8 #ot
sides
(ia#etes 8 paternal
Astma 8 maternal
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7/25/2019 Case Presentation - Hernia
7/19
)I'TOR* OF PRE'ENT
ILLNE''*ears PTA:Re!%rrent in&%inal mass asso!iated
-it in&%inal pain of 9614$ d%ll -itradiations to ri&t
ilia! re&ion
No !ons%lt made$ selfmedi!ates -itpain relieers -it some
relief
Patient sometimes perform tais ofmass -ito%t asso!iated
adersee;e!ts
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7/25/2019 Case Presentation - Hernia
8/19
)I'TOR* OF PRE'ENT
ILLNE''1 mont PTA:Noted re!%rren!e of same in&%inal mass
stillasso!iated -it in&%inal pain no- -it P'14614$ d%ll -it
radiation to ri&t ilia! re&ion
No medi!ations ta,en
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7/25/2019 Case Presentation - Hernia
9/19
)I'TOR* OF PRE'ENT
ILLNE''Patient -as told to ae la#oratoriesta,en and to !ome #a!,
for s!ed%lin&.
(ay of admission:Patient !ame in -it la# res%lts ands%#se?%ently
s!ed%led t%s tisadmission
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7/25/2019 Case Presentation - Hernia
10/19
P)*'ICAL E@AMINATION
ENERAL: A-a,e$ !ons!io%s$ !oerent$afe#rile patient not in
respiratory
distress>ITAL 'IN':
"P 8 1146/4mm)& RR 8 21 !pmPR 8 B0 #pm T 8 3./C
)EENT: ani!teri! s!lerae$ pin, palpe#rae$moist oral m%!osae
NEC7: s%pple$ no lympadenopaties
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7/25/2019 Case Presentation - Hernia
11/19
P)*'ICAL E@AMINATION
C)E'T6LDN': e?%al !est epansion$!lear #reat so%nds #ilaterally$
': adynami! pre!ordi%m$ distin!t '1
and '2$
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7/25/2019 Case Presentation - Hernia
12/19
P)*'ICAL E@AMINATION
(RE: no s,in ta&s$ ti&t spin!ter tone$smoot re!tal -all$
empty re!tal a%lt$
r%##ery nontender smoot prostate$no fe!al material or #lood on
eaminin&Gn&er
E@T: stron& periperal p%lses$ CRTH2se!s
CN': -itin normal limits
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7/25/2019 Case Presentation - Hernia
13/19
IMPRE''ION
Indire!t in&%inal ernia$ ri&t$ red%!i#le
)ydro!ele$ ri&t
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7/25/2019 Case Presentation - Hernia
14/19
LA"ORATORIE'
)"sA&8 nonrea!tie
Dltraso%nd8 ydro!ele formation$ ri&t8 1.9 2.0 2. !m$ !omple
fo!%s.
Consider in&%inal ernia ri&t.
8 normal si+ed and appearan!e of #ottesti!les
Cest ray$ PA ie- Normal !est
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7/25/2019 Case Presentation - Hernia
15/19
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7/25/2019 Case Presentation - Hernia
16/19
LA"ORATORIE'
CBC
"C 14.2J 14JL 9.B 8 14.B
)" 1/ &6L 194 8 1B4
)CT 4.9 4.92 8 4.02
PLT 33J 14JL 104 8 944
(i; Co%nt
NED 0.34 K 94 8 /9
L*M 2B.04 K 1J 8 9B MON 3.B4 K 3 8 J
EO' 2.24 K 4 8 /
"A' 4.24 K 4 8 2
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7/25/2019 Case Presentation - Hernia
17/19
LA"ORATORIE'
UA
Color *ello-
Transparen!y Clear
'pe!iG! &raity 1.424
p) .4
l%!ose Ne&atie
Protein Ne&atie
R"C 416pf "C 416pf
'?%amo%s E. !ells Rare
"a!teria Rare
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7/25/2019 Case Presentation - Hernia
18/19
LA"ORATORIE'
Prothrombin Time
Patient 12.B se!s
K a!tiity 110.BK
INR 4.J3
Control 13.3 se!s
Control K A!t 140K Control INR 4.J/0
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7/25/2019 Case Presentation - Hernia
19/19
LA"ORATORIE'
Chemistries
Creatinine 1.42 m&6dl
'odi%m 193.0 mmol6L
Potassi%m 3.0 mmol6L
Cloride 141.9 mmol6L
