Gastrointestinal System


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S17_F1.jpg"}},{"insert":"\n\n"},{"insert":"Roy, a 35-year-old butcher, comes into your clinic with a left-sided inguinal mass which has been slowly enlarging for five years. \r\n\r\n\u0022I\u0027ve been ignoring the lump all this while, doctor. It wasn\u0027t painful and was really only apparent when I was at work at the meat shop,\u0022 explains Roy.\n"}]}


{"ops":[{"insert":"\u0022It\u0027s started hurting now, for the last three days, especially in the afternoons, so I decided have it checked out,\u0022 he continues. You learn that the pain score is 4-5\/10.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S17_F3.jpg"}},{"insert":"\n\n"},{"insert":"Roy denies any recent changes in bowel habits. He is non-hypertensive and non-diabetic and denies previous hospitalization or surgical procedures.\r\n\r\nYou request to examine him and find his vitals and systemic findings to be normal.\n"}]}


{"ops":[{"insert":"A soft globular mass can be palpated in the left inguinal area, above and medial to the pubic tubercle. It measures 4 cm in diameter and is non-erythematous, but mildly tender.\r\n \r\nThe mass is mobile, reducible, and increases in size with the Valsalva maneuver.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S17_F5.jpg"}},{"insert":"\n\n"},{"insert":"Roy looks unperturbed when you tell him that he has an inguinal hernia, as if he knew what was coming.\r\n \r\nHowever, you sense his uneasiness as you detail a plan of management.\n\n\u0022I don\u0027t want to be cut open,\u0022 he starts before you can speak. \u0022That\u0027s not really necessary, right?\u0022\n"}]}