Hernia Examination

Expose Groin + chapernone

STANDING INSPECTION:

1. lump ?
2. ‘cough’… lump ?
3. Skin changes
4. Scars PALPATION:
5. Land marks a. PT b. ASIS
6. Align hand with 3 digits a. ‘cough’ b. if top finger: inguinal c. if bottom: femoral
7. Examine CONTRALATERAL side

LYING: INSPECTION:

1. lump PALPATION:
2. cough impulse
3. Reduce hernia (or ask pt to reduce)
4. Occlude deep ring (at Mid-point inguinal lig) a. ‘cough’ b. to distinguish direct vs indirect
5. Scrotum a. Can you get ABOVE mass - Inguinoscrotal hernia vs Primary testicular b. Examine testicle bilateral c. Ensure 2 + no masses. d. +/- transluminate
6. DRE
7. Abdomen exam- umbilical hernia / ascites>)

MID-INGUINAL POINT: Femoral Artery MID POINT of INGUINAL LIG: deep ring

DIFFERENTIAL GROIN LUMP:

1. lipoma
2. LN
3. Psoas abscess
4. Femoral aneurysm
5. Saphenous Varix
6. AV fistula
7. Ectopic testicle
8. Sarcoma
9. Hyrocele of cord
10. Lipoma of cord