Inguinal hernia examination

Inguinal hernia examinationCreated OnApril 12, 2020Last Updated OnApril 15, 2020byadmin You are here: Main Clinical Examination Inguinal hernia examination < All Topics Table of Contents General inspection: Ask the patient to stand (if able) or lay down whilst you observe for the following: Note any evidence of pain (e.g. stance/grimacing) Note the patient’s overall colour (e.g. pallor secondary to anaemia or jaundice) Note any evidence of abdominal distension (may suggest bowel obstruction, possibly due to an incarcerated hernia) Note any muscle wasting or cachexia suggestive of underlying malignancy Look around the bed for evidence of vomit bowels or medication boxes Inspect the patient from the front and both sides (whilst the patient is standing or lying down), looking for evidence of: Asymmetry Reducibility of lump Scars on the abdomen and in the groin Obvious lumps protruding from the abdomen or groin Any testicular lumps or swellings Ask patient to cough, which should accentuate any hernia that is present unless is complicated Inspection Site: Mid-point of the inguinal canal Unilateral- mostly on the right side (this is because right testis descend later) Bilateral, caused by poor abdominal musculature evident by Malgaigne’s bulges If there is multiple lumps, this is more suggestive of superficial lymph nodes, superficial lesions (e.g. lipoma) or dermatological problems (e.g. large skin lesions) Size: Use a tape measure to measure the size Shape: Describe shape of lump Unilateral-Pyriform (when complete because it descend into scrotum, if incomplete its oval) Bilateral-Oval (always incomplete)   Skin changes Normal unless strangulated Texture of the skin overlying the lump. Is it same as rest of the skin, or thick/rough/scaly/smooth/shiny?     PALPATION Consistency Depends on the contents (either enterocoele or omentocoele, while strangulated hernia feels tense, hot and tender Cough impulse Ask the patient to cough whilst palpate the lump A positive cough impulse occurs when you see and/or feel the lump increase in size when the patient coughs A cough impulse indicates a communication between the intra-abdominal cavity and the lump (e.g. a hernia)   Position, Extent, Get above swelling If swelling descends into scrotum or labia majora it’s inguinal, but if it’s confined to groin, it should be differentiated with femoral hernia. Examine for if can get above the swelling (Hernia can’t get above the swelling) Tenderness Press on the lump and look at the patient’s face to see if they grimace Temperature Significantly increased temperature suggests infection (e.g. abscess) and will normally be associated...

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