4.5 Clinical
All
these hernias present
with a vague pain
or discomfort
associated with a bulge in the groin.
Clinical diagnosis is made on the basis of the relationship
of
the hernia to the pubic tubercle.
Inguinal hernias are lateral to
the tubercle femoral hearnia is medial
to the tubercle.
Inguinal hernias also need to be differentiated
from a
scrotal
hydrocele, spermatocele, orchitis,
testicular tumours and
hydrocele of the cord.
75% of all hernias occur in the groin
half of these are indirect
hernias and a 25% direct only 3% are
femoral hernia
4.6 DIFFERENTIAL DIAGNOSIS
All hernia patients are examined
supine and standing.
A scrotal hydrocele is not reducible.
There
is no cough
impulse and is situated entirely in the
scrotum, the
testis may not be palpable
seprately but it is
possible to
get above the hydrocele
and to feel
the cord
seperately. The hydrocele is also
transilluminant.
A
spermatocele is a distension of the epididymis and is
filled
with fluid and sperms.
The clinical features are similar to
those of a hydrocele except
the swelling is smaller and situated
above and behind the testes
which is palpable separately.
An
orchitis presents as a firm and
tender scrotal swelling of
recent
onset accompanied with fever.
The cord may
also be
tender (funniculitis).
A
testicular tumour is a painless
usually symptomless scrotal
swelling which
is firm in feel and heavy. There
may be an
accompanying secondary hydrocele.
A
hydrocele of the cord is an unobilaterated portion of
tunica
vaginalis. The
cyst is palpable, along the
course of the
spermatic cord and may be in the inguinal canal or scrotum,
it
moves
with a pull on the cord and there
is no reducibility or
cough impulse.
Any questions be sent to drmmkapur@gmail.com
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