64years male,non diabetic known copd case .usg shows epigastric hernia. Is surgery needed or can be managed by oral medications.and cbc and other reports also attached please suggest rx and dx

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Your concern is epigastric hernia NONE OF KIND OF HERNIA can be managed conservatively EVERY HERNIA needs to be repair surgically Here in this case if hernia is asymptomatic we need to address infection first as leucocytosis and as pt is kco COPD hence most likely chest infection and need xray chest His sr widal is positive as per report so need to study the contradictory reports

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? COPD..WITH.. PRE ENTERIC FEVER.. ENTERIC FEVER.. NEED'S.. BS..ANTIBIOTICS WITH.. ANTIPYRETICS.. SYMPTOMATIC T/T.. HERNIA.. NEED'S.. SURGEONS OPINION.. INVESTIGATIONS..SOS.. HEMOGRAM.. URINE ROUTINE.. MP..TYPHIDOT..DENGUE TEST.. CXR STUDY..

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Repeat widal slide agglutination with typhi antigen Leucocytosis Epigastric hernia Para umbilical hernai Opinion of gastroenterologist 2 gm if typhi antigen positive monocef uptill 5 days of afebrile period Ppi sucrafil ondem Bland diet Seat upright 1 hr after lunch& dinner

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Dx-Copd with epigastic and supraumblical hernia.with infection most likely lung parenchyma. Rx-1-Treat infection with antibiotics and cough syrup with bronchodilator and becomplex for10days. Thereafter surgical intervention intended for epigastic and supraumblical hernia.

USG finding epigastric hernia contains preperitoneal fat Blood count leukocytosis may be due to sepsis may due secomdary infection on cold leading to pneumonitis.There is no option other than surgery in case of epigastric hernia As there is pneumonitis or sepsis first of to treat pneumonitis with higher antibiotic then to consider to repair hernia which is nothing but protrusion of pre peritoneal fat through an opening of the ant abdominal walll due to difficiency of the ant abdominal wall between xiphisternum and umbilicus after mobilisation and repositioning of the fat by suturing or by mesh. If left or treated conservatively usually causing pain in rare cases may be complicated due to irriducibility.

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Well explained & suggestion by All Senoirs Doctors it's a case of Epigastric Hernia with Enteric Fever, ForHernia consult GIT Surg. and for mild Enteric fever start broad spectrumantibiotics with PPI, NSAIDS, ANTIPYRETIC, FOR COPDOCK RULE OUT PNEUMONITIS, DO CARDIAC P/A, AND TREAT SYMPTOMATICALLY

Respected all senior doctors pt now is a febrile. And family members are not ready to operation of hernia due to marriage in their home. Pt right now complain discomfort in abdomen and copd polroblem.is it ok to postpone surgery.and can be managed on oral medications.

2 Problems EPIGASTRIC HERNIA SURGEON OPINION PRE-ENTERIC FEVER ? CHECK FOR DENGUE ? LEPTOSPIROSIS? MALARIA? TYPIOD VACCINE ORAL TYPHIORAL WIDAL TEST HAS LESS P.P VALUE

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definitive treatment of hernia is surgery. you can start broad spectrum antibiotics prior to surgery in view of high WBC count

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