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2 a 26 year old builder presents with a lump over his

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2A 26-year-old builder presents with a lump over his left groin which has been there for thelast 3 years. Examination reveals cough impulse and a reducible hernia over the left groinextending to the scrotum. Internal ring occlusion test is positive.3A 60-year-old obese woman is referred with a history of painful lump around her umbilicus.Examination reveals an irreducible lump just above the umbilicus.4A 78-year-old woman is referred to your clinic with a 6-week history of suspected enlargedleft groin lymph node. Examination reveals a 2 cm hard and irreducible lump over the medialaspect of the left groin. There is no cough impulse.
57: HERNIA, UMBILICUS AND ABDOMINAL WALL4275A 40-year-old woman is referred to your clinic with a history of a gradually increasing lumpover the lower abdomen. She has had three caesarean sections in the past. Clinical examinationreveals a Pfannenstiel scar. There is cough impulse and a reducible lump over the right lateralaspect of this scar extending to the right groin.6A 76-year-old man is referred to you with a 2-year history of lumps over both his groins. Theseare only causing him minimal discomfort. Clinical examination confirms reducible hernias overboth his groins. Internal ring occlusion test is negative.7A 50-year-old man presents with a lump below the umbilicus and lateral to the rectus. A coughimpulse is felt over the area and the lump reduces with difficulty.8A 22-year-old fit male presents with an epigastric bulge. This becomes prominent whileexercising in the gym. It is otherwise asymptomatic. Clinical examination reveals a midlinegutter in the upper abdomen.9A 30-year-old female presents with a localised sharp pain in the upper abdomen. Clinicalexamination reveals a button-like soft swelling equidistant between the xiphisternum and theumbilicus. There is no cough impulse and the lump is not reducible.2. Complications of herniaAStrangulationBObstructionCIncarcerationDPerforationEIrreducibilityChoose and match the correct diagnosis with each of the scenarios given below:1A 70-year-old male is referred to your clinic with a long-standing left inguinal hernia. He has notnoticed any recent changes in his hernia and his bowels have been normal. On examinationyou see a giant inguinoscrotal hernia which is not completely reducible.2A 40-year-old male is referred with irreducibility and increasing pain over his right inguinal herniaover the past 8 h. On examination the hernia is extremely tender with signs of peritonitis.3A 60-year-old female is referred with a history of increasing abdominal pain and distension overthe past 2 days. She has been vomiting repeatedly over this period. Clinical examination revealsa right groin lump which is not reducible and abdominal examination reveals a distended butsoft abdomen with increased bowel sounds.

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