Expanded
Gastrointestinal System
0
{"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.\n\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 he explains.\n\n\u0022It\u0027s started hurting now, for the last three days, especially in the afternoons, so I decided have it checked out.\u0022\n\nYou learn that the pain score is 5 out of 10.\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S17_F3.jpg"}},{"insert":"\n\n"},{"insert":"Roy denies any recent changes in bowel habits. He denies any medical issues, previous hospitalizations or surgical procedures. You request to examine him and find his vitals and systemic findings to be normal.\n\nA 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. The mass is mobile, reducible, and increases in size with the Valsalva maneuver.\n"}]}
2
{"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. However, 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"}]}
3
{"ops":[{"insert":"How do you answer?\n"}]}
1. "Surgery isn't necessary yet. We can observe your hernia for some time."
2. "Surgery is necessary, but we can schedule it for when you're mentally prepared."
5
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6
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4
{"ops":{"insert":"\n"}}
