Groin swelling

Nota:

• inguinal lig: from ASIS to pubic tubercle deep ring: at midpoint of ing lig

1. inguinal hernia
   1. indirect: (thru deep ring)
   2. direct (thru post wall of canal)
   3. test to determine which:
      1. after reducing indirect, press over deep ring (mid-point of inguinal lig), ask pt to cough. Should NOT come out if indirect. if pops out = direct

         Nota:

         • *in reality, this test meaningless. but need to do for exam
   4. reduce/originate above pubic tubercle
2. other places: epigastric, umbilical
3. complications
   1. incarcerated hernia
      1. irreducible but blood supp NOT compromised
   2. strangulated hernia
      1. irreducible, blood supp compromised
         1. usuall obstruct as well, so absolute constip
         2. overly skin color change
         3. necrotic bowel
4. femoral hernia
   1. thru femoral canal (medial to fem vein, below ing lig)
      1. reduce/originate below pubic tubercle
   2. easily strangulates b/c tight ring
   3. females more likely this kind
5. diff diag:
   1. skin: sebaceous cyst
   2. subcut- lipoma, fibroma
   3. arterial- femoral aneurysm/pseudoaneurysm
   4. venous- saphena varix
   5. lymphatics- lymphadenopathy
   6. psoas abscess
   7. ectopic testis
   8. hernia- inguinal, femoral