1. CONTENTS SOPEPEL Subjective ObjectiveInguinal herniaTREATMENT Diagnose Treatment Anatomy Definition Risk factor Cause Sign / symptom

2. SOEPEL SUBJECTIVE : A MIDDLE AGE MALE PATIENT ENTER THE HOSPITAL WITH LEFT LOWER ABDOMINAL PAIN . HISTORY: MR.A 30 YEARS OLD , FALL DOWN BEFORE 7 MONTHS AND THE PAIN STARTED.NO HISTORY OF GLYCEMIA , BP, AND ASTHMA. 3. PAIN ANALYSIS 1.SITE: R. ILEAC FOSSE.2.ONSET: SUDDENLY.3.CHARACTER: SHARP.4.RADIATION: TO BACK.5.ASSOCIATED FACTORS: DURING COUGHING.6.TIME/DURATION: START BEFORE 3 MONTHS.7.EXAGGERATED AND RELIEVING FACTORS:8.SEVERITY: MODERATE. 4. O E P E LBJECT: ABDOMINAL EXAMINATIONVALUATION DD, VAGINAL HYDROCELE, FEMORAL HERNIA. LAN: ULTRASOUND,.LABORATION: HERNIOTOMY.EARNING GOAL: INGUINAL HERNIA. 5. DEFINITION IS AN AREA OF MUSCULAR WEAKNESS OR A HOLE IN THE LOWER ABDOMEN OR GROIN THROUGH WHICH A PERSONS INTESTINES CAN PROTRUDE. 6. ANATOMY 7. TYPES DIRECT INGUINAL HERNIA: THE SAC PASSES THROUGH A WEAKNESS OR DEFECT OF THE TRANSVERSALIS FASCIA IN THEPOSTERIOR WALL OF THE INGUINAL CANAL. INDIRECT INGUINAL HERNIA: THE HERNIATION IS THROUGH THE INTERNAL RING WITH BOWEL OR OMENTUM TRAVELING DOWN THE INGUINAL CANAL AND MAY PROTRUDE THROUGH THE EXTERNAL RING INTO THE SCROTUM. 8. INDIRECT INGUINAL HERNIA 9. SIGN AND SYMPTOMS A BULGE IN THE AREA ON EITHER SIDE OF YOUR PUBIC BONE A BURNING, GURGLING OR ACHING SENSATION AT THE BULGE PAIN OR DISCOMFORT IN YOUR GROIN, ESPECIALLY WHEN BENDING OVER, COUGHING OR LIFTING A HEAVY OR DRAGGING SENSATION IN YOUR GROIN WEAKNESS OR PRESSURE IN YOUR GROIN OCCASIONALLY, PAIN AND SWELLING AROUND THE TESTICLES WHEN THE PROTRUDING INTESTINE DESCENDS INTO THE SCROTUM 10. CAUSES INCREASED PRESSURE WITHIN THE ABDOMEN STRAINING DURING BOWEL MOVEMENTS OR URINATION HEAVY LIFTING FLUID IN THE ABDOMEN (ASCITES) PREGNANCY EXCESS WEIGHT CHRONIC COUGHING OR SNEEZING 11. RISK FACTORS BEING MALE. FAMILY HISTORY. CERTAIN MEDICAL CONDITIONS. CHRONIC COUGH. CHRONIC CONSTIPATION. EXCESS WEIGHT. PREGNANCY PREMATURE BIRTH. HISTORY OF HERNIAS. 12. DIAGNOSEPhysical examination 13. TREATMENT HERNIOTOMY: ENTAILS DISSECTING OUT AND OPENING THE HERNIAL SAC, REDUCING ANY CONTENTS AND THEN TRANSFIXING THE NECK OF THE SAC AND REMOVING THE REMAINDER LAPAROSCOPIC. 14. REFRRENCE BAILEY AND LOVE'S. OXFORD AMERICAN CLINICAL EXAMINATION. KUMAR AND CHLARK.