The following medical news items are relevant to diagnosis and misdiagnosis issues for Hernia:
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Diagnosis of hiatal hernia is based on typical clinical features and on the results of these laboratory studies and procedures:
❑ In barium study, hernia may appear as an outpouching containing barium at the lower end of the esophagus. Small hernias, however, are difficult to recognize. This study also shows diaphragmatic abnormalities.
❑ Endoscopy (esophagogastroduodenoscopy) and biopsy differentiate among hiatal hernia, varices, and other small gastroesophageal lesions; identify the mucosal junction and the edge of the diaphragm indenting the esophagus; and can rule out malignancy that otherwise may be difficult to detect.
❑ Esophageal motility studies assess the presence of esophageal motor abnormalities before surgical repair of the hernia.
❑ pH studies assess for reflux of gastric contents.
Source: Professional Guide to Diseases (Eighth Edition), 2005
In a patient with a large hernia, physical examination reveals an obvious swelling or lump in the inguinal area. In the patient with a small hernia, the affected area may simply appear full. Palpation of the inguinal area while the patient is performing Valsalva’s maneuver confirms the diagnosis. To detect a hernia in a male patient, the patient is asked to stand with his ipsilateral leg slightly flexed and his weight resting on the other leg. The examiner inserts an index finger into the lower part of the scrotum and invaginates the scrotal skin so the finger advances through the external inguinal ring to the internal ring (about 1 ½" to 2" [4 cm to 5 cm] through the inguinal canal). The patient is then told to cough. If the examiner feels pressure against the fingertip, an indirect hernia exists; if pressure is felt against the side of the finger, a direct hernia exists.
A patient history of sharp or “catching” pain when lifting or straining may help confirm the diagnosis. Suspected bowel obstruction requires X-rays and a white blood cell count (may be elevated).
Source: Professional Guide to Diseases (Eighth Edition), 2005
Hiatal hernia is diagnosed based on typical clinical features and the results of the following laboratory studies and procedures:
❑ Chest X-ray occasionally shows an air shadow behind the heart with a large hernia and infiltrates in the lower lobes if the patient has aspirated.
❑ In a barium study, the hernia may appear as an outpouching that contains barium at the lower end of the esophagus. (Small hernias are difficult to recognize.) This study also shows diaphragmatic abnormalities.
❑ Endoscopy and biopsy differentiate between hiatal hernia, varices, and other small gastroesophageal lesions; identify the mucosal junction and the edge of the diaphragm indenting the esophagus; and can rule out malignant tumors that otherwise might be difficult to detect.
❑ Esophageal motility studies assess the presence of esophageal motor abnormalities before surgical repair of the hernia.
❑ pH studies assess for reflux of gastric contents.
❑ Acid perfusion (Bernstein) test indicates that heartburn results from esophageal reflux when perfusion of hydrogen chloride through the nasogastric (NG) tube provokes this symptom.
The following laboratory tests may indicate GI bleeding as a complication of hiatal hernia:
❑ Complete blood count may show hypochromic microcytic anemia when bleeding from esophageal ulceration occurs.
❑ Stool guaiac test may be positive.
❑ Analysis of gastric contents may reveal blood.
Source: Handbook of Diseases, 2003
In a patient with a large hernia, physical examination reveals an obvious swelling or lump in the inguinal area. In a patient with a small hernia, the affected area may simply appear full. Palpation of the inguinal area while the patient is performing Valsalva’s maneuver confirms the diagnosis.
To detect a hernia in a male patient, the patient is asked to stand with his ipsilateral leg slightly flexed and his weight resting on the other leg. The examiner inserts an index finger into the lower part of the scrotum and invaginates the scrotal skin so the finger advances through the external inguinal ring to the internal ring (1 ½" to 2" [4 to 5 cm] through the inguinal canal). The patient is then told to cough. If the examiner feels pressure against the fingertip, an indirect hernia exists; if pressure is felt against the side of the finger, a direct hernia exists.
A patient history of sharp or “catching” pain when lifting or straining may help confirm the diagnosis. A suspected bowel obstruction requires X-rays and a white blood cell count (which may be elevated).
gender iNFLUENCE Many symptomatic inguinal hernias go undiagnosed in women because they’re nonpalpable. Obesity, a family history, and obstipation are risk factors.
Source: Handbook of Diseases, 2003
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