Which doctor checks for an abdominal hernia?

WHICH DOCTOR CHECKS FOR AN ABDOMINAL HERNIA

A general surgeon is the primary specialist who evaluates and diagnoses abdominal hernias, though initial assessment may be done by a primary care physician. The diagnostic process typically involves physical examination followed by appropriate imaging studies when necessary.

Diagnostic Process for Abdominal Hernias

Initial Assessment

• Primary care physicians often perform the first evaluation when patients present with symptoms suggestive of an abdominal hernia
• Physical examination should focus on:
  • Visible bulge in the abdominal wall
  • Palpation of the abdomen while the patient is standing and during Valsalva maneuver
  • Assessment of reducibility of any bulge
  • Examination of common hernia sites (umbilical, inguinal, incisional)

Specialist Referral

After initial assessment, patients are typically referred to:

1. General Surgeon:

   • Primary specialist for comprehensive evaluation of abdominal hernias
   • Can perform both diagnosis and surgical repair when indicated
   • Evaluates the need for surgical intervention based on symptoms and risk of complications

2. Other Specialists (in specific situations):

   • Gastroenterologist: May be involved if hernia is discovered during endoscopy or if digestive symptoms are prominent
   • Emergency physician: Often the first to evaluate acute hernia complications like incarceration or strangulation

Diagnostic Imaging

When physical examination is inconclusive or complications are suspected, imaging studies may be ordered 1:

1. CT Scan:

   • Gold standard for diagnosing diaphragmatic hernias with sensitivity and specificity of 14-82% and 87%, respectively 1
   • Can accurately determine presence, location, and size of diaphragmatic defects
   • Evaluates intrathoracic complications of herniated abdominal organs
   • Shows key findings such as diaphragmatic discontinuity, "collar sign," and "dependent viscera" sign

2. Fluoroscopy/Upper GI Series:

   • Particularly useful for hiatal hernias
   • Provides anatomic and functional information 1
   • Recommended by the Esophageal Diagnostic Advisory Panel Consensus of the American College of Surgeons for patients considered for antireflux surgery

3. Chest X-ray:

   • Often the first imaging study but has limited sensitivity (2-60% for left-sided hernias, 17-33% for right-sided hernias) 1
   • May show abnormal bowel gas pattern, air-fluid level, or hemidiaphragm elevation

Common Pitfalls in Diagnosis

• Obesity can make physical examination difficult, requiring greater reliance on imaging
• Small hernias may be intermittent and not apparent during examination
• Abdominal wall hernias may be confused with other conditions such as tumors, hematomas, or abscesses
• Diaphragmatic hernias can be misinterpreted in around 25% of cases on initial radiographic findings 1

When to Suspect Complications

The surgeon should evaluate for potential complications requiring urgent intervention:

• Incarceration: Hernia contents cannot be reduced
• Strangulation: Blood supply to herniated contents is compromised
• Bowel obstruction: Indicated by vomiting, abdominal distention, and constipation

In summary, while initial evaluation may occur in primary care settings, general surgeons are the specialists who comprehensively evaluate abdominal hernias and determine appropriate management strategies.