Hernia Examination

Question 1

Introduction

Answer 1

Wash hands, PPE
Introduce yourself
Patient ID, DOB
Explanation
-Hello, I'm An Nakamura a 3rd year medical student. Today, I'd like to examine your groin for lumps which will involve me looking and feeling for any lumps. This may be uncomfortable but should not be painful. If you want me to stop at any time, please let me know. A male member of staff will be present to act as a chaperone, will this be alright? I will need you to remove your trousers and underwear and be standing for the 1st part of the examination and to lie flat for the latter part. I will draw the curtain so you can get undressed and provide you with a sheet to maintain your dignity throughout. Do you have any questions? Do I have your consent to carry out this examination?

Question 2

General inspection

• surroundings
• patient

Answer 2

Surroundings

• Stoma bags - contents, colour, parastomal hernias?
• surgical drains - loocation, contents
• mobility aids

Patient

• Do you have any pain anywhere?
• scars
• abdo distension
• pallor - anemia (GI bleed, malignancy?)
• cachexia (malignancy, liver failure)
• hernias

Question 3

Examination of groin when standing

Answer 3

Inspect - masses around inguinal/femoral canal, scrotum, penis

Palpate testis, epididymus, spermatic cord

Palpate scrotal contents - can you get above the mass?

• yes - not a hernia
• no - hernia

Palpate lump - describe it

• site, size, shape
• consistency, contours, colour
• tenderness, temperature

Question 4

How to assess the type of hernia

Answer 4

Cough impulse -

• compress lump firmly
• ask patient to turn head to opposite direction and cough
• tension and swelling => hernia

Reducibility -

• locate deep ring - midway between ASIS and tubercle
• push hernia towards deep ring
• apply pressure on deep ring
• cough
• reappear - direct
• no reappearnce - indirect

Question 5

Examination of groin supine

• what would you do
• what are you looking for

Answer 5

Inspect - masses

Palpate femoral pulses
Palpate inguinal LN
-horizontal - immediately inferior to inguinal ligament
-vertical - 3cm lateral to pubic tubercle and palpate down

Question 6

To finish the examination

Answer 6

I’ve come to the end of my examination. Thank you for allowing me to examine you. You’re free to get dressed, would you like any help?

To complete my examination

• Hx
• abdominal examination
• US of groin