Gow | Khwaja Yunus Ali i vaja Yunus : Medical College way) BShort Co. ‘Signatreoffnvigiator ‘Start writing from here: Rankiculans 6f Yue Patients Name: Ma. Alodul Halen Age: 4Oyeens 6ex! Male Religion: Tslam. Manitel Slahuy: Mamnied Occupation: Faamer ‘Addrtes' Solonga. Sir0y9™| Date, adnicsion: € 12: 2019 Date of paminaien: 10-12: 2019. chief Complain: 1. Seoalling ir Oth gavin. for Z yeas 2. Raia over Hee seadlli _for 34 montis F History of Recent iluess: Aecesdi fo Hae ctatement af the pobient he Wan eaponaldy el abou Qyeons back. Than be. eppeers deviloped stolti in, gavin Cloth side), Hat oppeaned insidious joitially. in Hee wight rein § qyedually Inereanes eand [alan ry developrrent g ctbcey cunalliug on lft aide, The swellig is disappe -s pantially when We ling daon Wut Hu cvvelling we es ON standing cand inereares in size a the patient wolks, coughs & Shain at Aafecotion Patient aléo ecamplain. c dull clavespain over Mu euoallityg fo lant 3 mon he Rain fnerennes & Gfraining bul subsided 2 726t len ‘Swelling get reduced Mig Vedder & voael raat is normal .No bi: of chrowie, constipation or difficulty # michnahon. {tient Nah eeexpaticned occosional History of cirowie cough & reatilessness for last 9 yeons pattaalanly aggsevales dustig winter seonon., | “History. of Rakilless : He har no Wistogy of, OM Tuberculesis & Uypastension Treatment /Dayg, Hisfoay: Patient had faléen fore medication but con nok mention. Allergic History: He han no ollecyy to amy days ox food. Toomunygakon Hisiry! Plient ie immunized ob per sedate fasonal_Hishony: He is a smoker, taking 20 shckes (dey in. last 26-yecors Louk sivec. Jont @ months We abstained from gmeking. He ig non -alecholic Fax Hisleny None ef us fomily rremone is oulfeing fom. such kype- sf ‘illwsss, Gerio-ecomie History: He. loelongs 0 middle elobs fomily.Gy Gravaral_Baminatien + Appecnaner, - ill tedlci = Body built - Avaage -@ tion - Cooperative. “Dekel! Arne » Natritim'— Average Anaemia ~ Alosent + Jaundice, — Alosent » Cynosis — Absent . Deluydration— Absent + Cadema — Alosent » kin condition — No pigmentahan + Neck vein — Not engaged « lympheede — Nok petals + Bony tendemess- Absent « Thapeid gland — Not enlarged «Ase — 70 bealyfnin + Goud) presoure — 1ty0/ eS nly + Tempah — 96°F + Respiratory Rate— (6 brealtn/rinTy Systemic Examination: 4 Alotomen- «+ Snape of clodornen ~ Seaphold + Flants - Not fel Umbilieus— Cenbally, Raced invert verily tit + kein condition - Normal ,6¢an mark absent «+ Hair dishiloution- Normal + Visita, pevistalsis - Absent eMisille pulsatin- Absent + Visilole engorged vein - Abosant ‘Velpation: “Termperchare : Normal « Tendesnwss: Non- fender «Liver, spleen eidney: Not palpable No collar epee lap i. alomen 6 Fereunsion: | Percussion note: Tyepanie ; + Upper bender of Uver dullness: In sth interecslal space . Siting dullwuss & fluid till alosent » Auneultation : = Gavel Sound ‘Pearent 4 Digital Riclel Examinations Slee Nob done.Cy Oley. Systemic Examination: : Renpirates Seiten. — Reveals no abnomaii + Condiovodcuden System. - Reveals no dnormlily . Nervows’ System “Rivals no alsnovnali [Bh Local _Exarninatin (Boll. Inquino serolal a ely FB SIC Inguioseall sali + Meanurement ~ 4X6 em Sunface,- smooth - Margin © well defined + Exponsitempulbe on over the evaling «= No seat/ Pigmentation Jeneprged vein + Panis (a not Geviated to tiller side 4 Talpalion: WTemperakere over Her givdlgg nevinal + Non ~ fender + Get aloe the seni io not dene. howe. + Swelling extends alocye upto inguinal eomal lot upto beat ypginysis, pubis, : Soft and alagtic in consishene ? Palpalae cougn impulse, negative . Deep ing ‘occlupion Fest posi 4 Perewnion ? Resonant over the, saclle 4 Aunullahon:? Bowel sound present ive tose epididymis Lcorel ane nemaHy Soliont feature: Md, Abad Halkine AO\edns old) feovrer hail Gem Bhalonga»Snelgon] presented fo me with gual in Woot inguinal seqian fe years Yak io gradually inereaney its size , disgpptons pantally don We Lies down. bub He a yeappecns on standing and thevedne tn side a7 He poten oalks, coughs or any an also or alaoul a dull acting pain. over thy soe 4 for lant Smobth, Pain imcreanes Eeraiuiug and subsided c wh alan. He aadlling get veduded. He \down’t give ry chronic conetipation or any difficedly in micharabin, Tahient is smoker and give bislony of'ehronie. cough & breathlessness for lot By Suyectrs whic aggreater in winter, He war faking 15/20 Stick (dag in lant 20 yeons, bub olnee lank @ ments he abstained from hrekiig On caminalion, His qeneral & eystemie examination ‘veals no aloormality. On| lecal or inquino seal ragion excrniviation reveals ~Hhure i a be ee ovoellivg om bol inguinal region extend fom Anquival canal fo pubic area This laboad! Gxt em iu size, pysiform in hope, Sun face ig moot, mangin well defined , Skin over the sealing16’ narmal, Get aleve swoallivg tect 16 & not dene ia» itis al cae cE lo redueilale and, deep ving eae test is part, ‘pereundion note rasonants. awreultation reve! laowel Sound present. &y Provisional Diggness Both sidect {ncomplite, veducitole inguival havi, Sa intestine Gu Differenbal Diagnosis: + Divect Inguinal Hera + Femoral Hernia ‘ Hydweele « Gpidicyral cust « local sachin (tipoma) Gh Investigation: + CBC é Hb? + ROS, 15,ureq, $.creatinine 1 Uriue R/M/E 1 Clust X-ray CPA view) + ECG o USh of UB region Wdirecl FCay Treatment! Heep under’ Spinal /epiduaal omasntlnsia. Associated Cuunians Lohal i lernia? Whatis dircel/indivect wer nio? Whaat 16 redueitole Wervnia ? wal 6 complete /Socomplete Vervia?, woriat io loulouno cele 7 , What io feanicutem type § inquinal erwia? whal is olidi hernia? Lonat is Litter’ henwia? thal i¢ Cooper's Ligament ? vamat one Hic, complication of Hernia? fo, What one Hue cares sf vecuunenee f Wernia? W, What io Herniotomy ? 2 waat is Hervioplanty ? 13, Hw will you ai flecentiale dive! Lindirect wemia? Ly, Hao will you differentiate inquiveal /Femeral Hania? (5, Qouendan § inguinal canal? 16, Pants of bervial sac 2 17, Wha ane He Covering SPHOHKE ED E Sf Complete inguinal Hernia?Short Core ULCER J, Inhoduehiens Grectings ane Permission, spr 2, Exposure of Hee ek 2 Quotion: 1 What is yeu paola? Site? « Mode 6f emstt - Insidion (Trawnchie + Duration st exorret ss Paan ful /painee# + Diselange - present/alosent + Adsociated, disease ,if 204? + Rasenee in often sift or not? 4 Smoker /add smelter ? 9, Examination: a. Tnspeetion + paite, oie 4 Cape Number 1 Edge «Margin 9 Flovr se Digehonge « Suvroundliyg reer an role els)») falyation: ‘ Nempavelure (Normal ~ Mleer site - Nowmal!) ‘ Tenderaso aurrauetigs skin « Edge & Mengin « one oTypt & dieeheage * Fixily [celation sf uleer & underlying, shuchare ¢ Surrounding stin 6) Bxamiuatien ef lace regional Lamp note 4) Examination of peripural pulse © Sf pint ianvelvernent, Examine tos affected eink maversent, Qecerbatan’ Thee is an uleer on the eft latel matin fF axy em whieh is (civesiea/evalfivegtn) in shape _ edge. Hoe floor io coves ea T foul smelting vail /aitheut ghanulet S tensed , Tempera alooul with purulent discharge [serour disevenge , Suvroundivg ski 6 rad, edematows , shi is fraived /Nerteal), Uleer Is Clender/ANen-tercen), mang (oe defined tl defi), Bore is (vdurated /om inducted Eileen io Cmotae/ fixed), This, Goes fold avtoueh)Regional \ymphnede ane not palpable B. periploral pulse ane dntoet, So His is may be a cane ffi lear on Uf} lateral ralleclu>