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  #1  
Old 11-19-2010
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Anatomy A 25 year old body builder presents to his physician with a swelling in the groin

Question:
A 25 year old body builder presents to his physician with a swelling in the groin.He has never been to see a doctor before. On examination,the patient is afebrile, the mass is 3cm x 3 cm .It can be reduced on gentle palpation. When asked to cough,an impulse is felt by the physician and a mass appears inferomedial to the external ring in the inguinal region. The most likely diagnosis is
a) enlarged lymph node
b) ectopic testes
c) indirect inguinal hernia
d) saphena varix
e) direct inguinal hernia
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  #2  
Old 11-19-2010
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Simple though a basic question... Any one wants to try?
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Quote:
Originally Posted by Dr.Sidd View Post
Simple though a basic question... Any one wants to try?
d) saphena varix
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  #4  
Old 11-19-2010
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should be direct inguinal hernia..medial to epigastric arteries..
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Any otehr guesses? Think guys and please explain your answers...
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Old 11-19-2010
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The answer should be E) Direct Inguinal hernia.

Reason: The key point is Pt. is a body builder. Heavy lifting more likely causes Direct Inguinal Hernia. It occurs in Hesselbach's triangle.
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C) Indirect inguinal hernia

Explanation:

An indirect inguinal hernia is an inguinal hernia that results from the failure of embryonic closure of the deep inguinal ring after the testicle has passed through it. Like other inguinal hernias, it protrudes through the superficial inguinal ring. It is the most common cause of groin hernia in body builders.


A hernia occurs when intra-abdominal contents, commonly including preperitoneal fatty tissues, the peritoneum itself, and eventually omentum and intestines, traverse the ring to enter the inguinal canal. As time passes, the hernia contents may enlarge, extend the length of the canal, and even exit the canal through the external inguinal ring, an opening in the external oblique fascia, into the scrotum.
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Spot on both the answer and the logical reasoning!
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I was refering to whocares13! Answer E is correct!
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Explanation:
Heavy lifting is more likely to result in a DIRECT hernia. Direct inguinal hernias are secondary to a developed weakness of the transversalis fascia in the floor of Hesselbach's triangle. The sac is usually composed of a single layer, the peritoneum. It passes through or around the conjoint tendon to reach the superficial inguinal ring; thus it does not pass through the deep inguinal ring. Some have suggested that these hernias are related to heriditary or acquired defects in collagen synthesis or turnover. hernia and saphena varix can give a cough impulse, however the incidence of hernia is higher
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Old 11-19-2010
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Quote:
Originally Posted by Dr.Sidd View Post
Explanation:
Heavy lifting is more likely to result in a DIRECT hernia. Direct inguinal hernias are secondary to a developed weakness of the transversalis fascia in the floor of Hesselbach's triangle. The sac is usually composed of a single layer, the peritoneum. It passes through or around the conjoint tendon to reach the superficial inguinal ring; thus it does not pass through the deep inguinal ring. Some have suggested that these hernias are related to heriditary or acquired defects in collagen synthesis or turnover. hernia and saphena varix can give a cough impulse, however the incidence of hernia is higher
You could have also known that the answer was E: direct inguinal hernia, based on the location. Direct inguinal hernias are medial to the inferior epigastric vessels and occur when the intestines protrude through the superficial inguinal ring.

Indirect inguinal hernias protrude through the deep inguinal ring, lateral to the inferior epigastric vessels.

Also, indirect are usually congenital whereas direct are acquired, due to straining in weight-lifting, chronic constipation, etc
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Old 06-09-2011
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Quote:
Originally Posted by heights View Post
You could have also known that the answer was E: direct inguinal hernia, based on the location. Direct inguinal hernias are medial to the inferior epigastric vessels and occur when the intestines protrude through the superficial inguinal ring.

Indirect inguinal hernias protrude through the deep inguinal ring, lateral to the inferior epigastric vessels.

Also, indirect are usually congenital whereas direct are acquired, due to straining in weight-lifting, chronic constipation, etc
yup, remember:

Indirect = Infantile
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