TUTOR GUIDE OF GASTROINTESTINAL BLOCK

SEMESTER 3

TUTOR GUIDE OF GASTROINTESTINAL BLOCK

(first session)

Case title: Mr. Hary

Mr. Hary, 62 years old, came to Primary Health Care with the main complaint of a lump in
the right inguinal since 1 year ago

Page 2 session 1
Recent history of illness:
Lumps appear in the right inguinal, lumps appear when standing and walking and sometimes
painful.
The lump can enter again (deflated) if the patient is sleeping.

Page 1 session 1
Past medical history:
Patients have a history of diabetes mellitus 5 years ago and are regularly controlled. There is
no history of hypertension and chronic cough or bowel movements

4 session 1
Family history No family suffers from this disease.

5 session 1
Medication history: Patients with a history of taking oral anti-diabetes drugs

Page 6 session 1
Social history: Retired patient of the Navy. Work history on Navy ships

Objective:
At the end of the first session, the student should be able to:
1. Make identification of the patient problem
2. Get to know the inguinal hernia
3. Explain the symptoms and clinical signs of inguinal hernia
4. Describe the anatomy of the abdominal wall of the inguinal area
5. Explain the anatomy of the intra-abdominal organ in the right iliac fossa region
6. Explain the anatomy of the inguinal canal
7. Explain the anatomy of funiculus spermaticus
TUTOR GUIDE OF GASTROINTESTINAL BLOCK
SEMESTER 3

Guiding questions and answer:

1. What seems to be his problem?

Student must be able to identify:
Man 62 years old
The right inguinal lump can come in and out

2. General list of hypothesis of each problem

a. Inguinal hernia
b. Lymphadenopathi
c. Hidrocele
d. Lipoma

What further information do you need?

The doctor performs physical examination

Physical examination:
 Height 165 cm weight 70 kg
 GCS 4-5-6
 Temp 36 ° C
 BP 125/80 mmHg
 Heart rate 88 / men
 Respiratory rate 20 / men
 Eye Anemia (-) icterus (-)
 ENT is within normal limits

Thorax:
 Heart is within normal limits
 Lungs within normal limits
 Abdomen within normal limits
 Extermitas within normal limits

Localist status
The patient's right inguinal position is standing and told to strangle
 Lump oval shaped soft consistency and sounds of bowel sounds
 Finger test bump is felt at the tip of the finger
 Lumps are not painful

Right English position in the passive range

 Not palpable lumps
 Zieman test (+)
 Thumb test (+)
TUTOR GUIDE OF GASTROINTESTINAL BLOCK
SEMESTER 3

Digital rectal examination:

 Around the normal anus
 Normal sphingter tone
 Mucosa rectum is slippery.
 palpable pool over the horizontal prostate sulkus and flat soft consistency does
not overlap

3. Does this information change your hypothesis?

Yes

4. What are your hypothesis

Right lateral inguinal hernia

5. Able to explain the anatomical structure of the abdominal wall

6. Able to explain the anatomical structure of the right iliac fossa region

7. Able to explain the anatomy of the internal ring, external annulus, Hasselbach trigon and
funiculus spermaticus and its contents
TUTOR GUIDE OF GASTROINTESTINAL BLOCK
SEMESTER 3

´HERNIA INGUINALIS ′
(SECOND SESSION)

At the Naval Hospital of Dr. Ramelan, the clinical examination found an oval-
shaped right inguinal lump, found intestinal peristalsis on the lump. Finger test bump feels
finger tip, thumb test (+) Zieman test (+)

Objectives:
At the end of the session the two students were able to:
1. Know the definition, signs and symptoms and causes of inguinal hernia
2. Explain the types of inguinal hernias
3. Explain the risk factors for inguinal hernia
4. Explain the pathophysiology of inguinal hernia
5. Explain how to make a diagnosis of inguinal hernia
6. Explain how to manage inguinal hernias
7. Explain the complications of inguinal hernia
8. Explain the prognosis of inguinal hernia

Guiding questions and answer:

1. How would that information change your hypothesis
Inguinal hernia
2. What is the definition and etiology of inguinal hernia
3. Explain the types of inguinal hernias
4. Explain the cause of inguinal hernia
5. Explain the signs and symptoms of inguinal hernias
6. Explain the pathophysiology of inguinal hernia
7. Explain how to diagnose inguinal hernia
8. Explain the management of inguinal hernias
9. Explain the complications of inguinal hernia
TUTOR GUIDE OF GASTROINTESTINAL BLOCK
SEMESTER 3

῎ INGUINALIS HERNIA ῎
(Third session)

The Primary Health Care doctor refers to the Navy's hospital from Ramelan Surabaya for
surgery.

Objectives:
At the end of the third session students were able to:
1. describes the management of inguinal hernias
2. Explain therapy and indications and contra indications of inguinal hernia surgery
3. Explain the prognosis of inguinal hernia

Guiding questions and answer:

1. What is the purpose of inguinal hernia therapy
2. How is inguinal hernia therapy and its prevention
3. Explain some inguinal hernia surgery techniques
4. Explain indications and contra indications of inguinal hernia surgery
5. Explain the prognosis of inguinal hernia