2026-01-SR Newsletter

Clinical Corner

• A 72F pt. came to the ED with Colicky abdominal pain & vomiting for 24 hrs. she states that the pain is Severe and "It Just Hurts Everywhere". O/E The abdomen is distended with diffuse tenderness but no board-like rigidity. On the right groin, below the inguinal ligament, there is a small, firm, tender lump roughly 2 cm in size. The lump feels remarkably hard and tense & -Ve expansile cough impulse. the lump didn't transilluminate either, so the student examining the pt. excluded hernia from his ddx due to -ve cough impulse and made the provisional dx is Lymphadenopathy (Cloquet’s Node) his plan was discharge with Antibiotics .

• IF this pt. in this scenario was let go home on Abs, She Would Most definitely come back with gangrenous bowel ! because this is a strangulated Femoral Hernia (Most likely).

• In strangulation, the neck is plugged, blocking the transmission of intra-abdominal pressure, so cough impulse is -Ve.

Take away here is that Treat any irreducible, tender groin lump in a patient with vomiting as a strangulated hernia until proven otherwise, regardless of "hardness."

Resource Corner

• This month I found a free resource website called Operative Review which is a High Yield Short Article formatted Review of Surgical Topics Written by Surgeons and doctors (Not AI).
• I used it when i wanted a quick (15 mins) review of a surgical topic or procedure whenever i don't time to review the whole topic. It has received the 2023 Accreditation Council for Graduate Medical Education (ACGME) David C. Leach award for Annovation in Medical Education. ^[1]
• imo, it is easily one of my top 10 surgery learning resources. Its High Yield, useful text, easy to read and supplemented with EBM.

Literature Corner

• i found out about this paper titled "Microplastics and Nanoplastics in Atheromas and Cardiovascular Events" ^[2] from youtube video by Dr. Mel Herbert. ^[3]
• so basically the Answer right now is NO You don't get a stroke or MI from all there plastics your body is exposed to on a daily basis, BUT it could be a risk factor for ACS.

Discussion Corner

• from little clinical exposure i got this month, I noticed lack of adequate Hx taking & Physical Exam, Why Do Think that is the case in our hospitals?

• (imo) it's due to many factors, most important one would be overconfidence & Carelessness by the examiner. In addition to that, experienced consultants often use "short-cut" methods for examination based on pattern recognition. Students sometimes mimic this "spot diagnosis" approach. However, this is inherently dangerous, we should use standard, exhaustive routines to avoid missing pathology. Disagree with me, Great ! Please correct me by clicking here

Quote of the Month

❝ Once men turned their thinking over to machines in the hope that this would set them free. But that only permitted other men with machines to enslave them ❞ , Frank Herbert

Personal Updates

• none for this month.

Get Involved

• Submit cases or questions via email

Learn More

• Bailey & Love's Short Practice of Surgery: Chapter 63 (History Taking) & Chapter 64 (Hernia).
• Browse's Introduction to the Symptoms & Signs of Surgical Disease: Chapter 1 (History Taking).
• Clinical Scenarios in Surgery: Hernias.

References

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