any questions?

[Mattie]

That wasn't my idea. There are many different types of hernias (umbilical, femeral, inginal...). There might be hernias that cause umbilical pain but i'm not sure about that. The pain obviously depends where the hernia is. If you get a hiatus hernia where part of the stomach rolls or slides up above the diaphragm you might experience symptoms similar to a heart attach. You are probably thinking of a inginal hermia in the groin region. With hernias you would typically have a swelling or protrusion, may need to be induced by coughing.

Try and think of things that would aggrivate the mid gut (this is basically the small bowel and part of the large bowel.)

There might be a raised temperature with this patient. (think of causes of increased temp.)

The progression of pain from the umbilical region is a clue. This is likely to occur over a day or so. This is usually due to inflammation of the peritonium as well as the gut.

Any more guesses???

[milly]

ooh, mattie, u been looking at the indicative presentations on emily?!

he he

xx

[noworries]

Ok. What about appendicitus?

[Mattie]

Lol. No I haven't actually. That's a good idea though. We covered this a bit in LSRC. The guy ran over into our lunch break talking about hernias and the thing i'm trying people to guess.

[Mattie]

Yey. Well done no worries. You win... er.... street cred.!!!
Shame you diagnosed the patient with a hernia first as now he's got a ruptured appendix. What a mess!

[noworries]

Ssshh! Complete guesswork.
If it wasn't appendicitus my third guess was going to be that the person had an infection after having an operation. And if THAT was wrong...total humiliation.

[Mattie]

Lol. Good guess work. If you learn the presenting symptoms of appendicitis you'll have one less thing to learn at med school.

[noworries]

Do you know the sad thing is that I'm sitting here all pleased with myself.....lol

[Mattie]

Lol. Oh dear. That is sad. OK... I'll give you a reason for being pleased with yourself if you can answer this question: Why do you feel pain in the umbilical region during appendicitis rather than directly over where the appendix is located???

Good luck. There's a lot at stake!!!!!!

[milly]

ooh, the answer to this one actually has very interesting clinical signs

about pain/tenderness upon compression and non-compression of the area

am i making any sense?