Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:40

Inguinofemoral Hernia Inner Ear Disorders Producing Vertigo 837

■incarceration: when hernia cannot be reduced, may present with

bowel obstruction

■strangulation: when contents of an incarcerated hernia become

ischemic/gangrenous (more common in femoral hernias)

tests

■usually not necessary; diagnosis based on physical examination

■CT scan or ultrasound may be helpful in obese patients

differential diagnosis

■Testicular cancer; inguinal lymphadenopathy

management

What to Do First

■Watchful waiting: acceptable in asymptomatic or patients with sig-

nificant comorbidities

General Management

■Determine if incarcerated or strangulated vs reducible

specific therapy

Surgery

■anterior repair with or without prosthetic mesh; usually performed

using local/regional anesthesia

■posterior repair with mesh: laparoscopic or open

follow-up

■Periodic examinations for symptoms if nonoperative approach taken

■Usual postoperative visits to confirm healing and absence of recur-

rence

complications and prognosis

■Recurrence with prosthetic mesh 1–3% and higher if mesh not used

Inner Ear Disorders Producing Vertigo.....................

ANIL K. LALWANI, MD

history & physical

History

■Define symptom: vertigo (illusion of movement); imbalance or dis-

equilibrium (postural instability or difficulty with gait); lightheaded