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    Hernia Examination

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    jackfruit5887
    This document provides instructions for examining a patient for a hernia or groin issue. The exam involves introducing oneself, inspecting the groin area for signs of pain, swelling or prior injuries, palpating lumps to determine their contents and reducibility, and assessing for cough impulse. Additional steps include percussion and auscultation to detect bowel sounds if present. The exam aims to characterize any hernia and rule out other related issues.

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    Hernia Examination

    Uploaded by

    jackfruit5887
    7 views3 pages
    This document provides instructions for examining a patient for a hernia or groin issue. The exam involves introducing oneself, inspecting the groin area for signs of pain, swelling or prior injuries, palpating lumps to determine their contents and reducibility, and assessing for cough impulse. Additional steps include percussion and auscultation to detect bowel sounds if present. The exam aims to characterize any hernia and rule out other related issues.

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    This document provides instructions for examining a patient for a hernia or groin issue. The exam involves introducing oneself, inspecting the groin area for signs of pain, swelling or prior injuries, palpating lumps to determine their contents and reducibility, and assessing for cough impulse. Additional steps include percussion and auscultation to detect bowel sounds if present. The exam aims to characterize any hernia and rule out other related issues.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    7 views3 pages

    Hernia Examination

    Uploaded by

    jackfruit5887
    This document provides instructions for examining a patient for a hernia or groin issue. The exam involves introducing oneself, inspecting the groin area for signs of pain, swelling or prior injuries, palpating lumps to determine their contents and reducibility, and assessing for cough impulse. Additional steps include percussion and auscultation to detect bowel sounds if present. The exam aims to characterize any hernia and rule out other related issues.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    of 3

    HERNIA AND GROIN EXAM

    1. INTRODUCE SELF TO PATIENT AND GET PERMISSION


    Well lit warm room
    2. INFER ABOUT PAIN
    3. EXPOSURE
    Take off pants. Nipple to Mid-thigh
    4. POSITION

    5. INSPECTION
    - Age, health status, afro-caribbean, gender
    - Position in bed
    - Whether or not the patient is in cardiopulmonary distress
    - Weight
    - Look around the bed:
    o Oxygen mask , placed on how many litres of oxygen
    o IV access
    o Bandages
    o Nasal prongs
    o Nasal drip
    o Cigarettes
    o Special foods
    o Diabetic diet
    o Wound drainq
    o Catheter
    o NG tube
    - Ask patient to stand
    Examine both inguinal regions

    - Comment on swelling if seen in the groin:


    Inguinal
    Scrotal
    Femoral

    Over time will be able to differentiate between inguinal and femoral. Inguinal begins well
    above the crease of the groin while femoral is more medial and is related to the medial
    end of the groin crease

    - Ask patient to cough


    Comment on if cough impulse is seen
    Location and site noted
    - Colour of skin over hernia
    Strangulated- red
    - Size
    Small
    Large
    - Shape
    Pear-shape with stalk at superficial inguinal ring
    - Scars
    Prior hernia
    - Abdominal distention
    - Look carefully for any scars near the hernia. It may have been repaired in the past. There
    is an increased incidence of direct right inguinal hernia in patients who have had an
    appendicectomy through a right iliac fossa incision because this incision weakens the
    adjacent muscles and occasionally divides the iliohypogastric or ilioinguinal nerves.

    6. PALPATION
    - Feel from front
    Examine scrotal contents
    - Determine if lump is hernia or true scrotal swelling by examining upper edge
    - If you can 'get above it' (i.e. feel its upper edge between your thumb and index finger and
    a normal spermatic cord above it), it must be a scrotal swelling and not a hernia. If you
    cannot feel the upper edge of the lump because it passes into the inguinal canal, it is
    likely to be a hernia, except in children, when it might be an encysted hydrocele of the
    cord
    - Feel from the side
    Having examined the scrotal contents and decided that you cannot get above the lump,
    you can make a provisional diagnosis of inguinal hernia and proceed to examine the lump
    itself

    - Lump:
    Position
    Temperature
    Tenderness
    Shape
    Surface
    Usually smooth
    In very large hernias, will indent because of faces present
    Size
    Tension
    Contents (composition)
    Bowel- soft and fluctuant, bowel sounds heard, visible peristalisis if small bowel
    Omentum- firm, rubbery, non-fluctuant, dull to percussion
    Compressibility
    Compressed by steady pressure
    Reducibility
    State of local tissues
    As acquired inguinal herniae are caused by weakness of the tissues of the inguinal canal,
    bulging of both inguinal regions with coughing is common. Minor bilateral bulging of the
    inguinal canal in slim individuals is normal and known as Malgaigne's bulges.
    Transillumination
    Expansile Cough Impulse
    Ask patient to cough to see if it increases in size. If this occurs, it is a positive cough
    reflex. Absence does not exclude hernia, adhesions may prevent the moving of contents
    through the sac
    - Reduce Hernia
    Control it at deep inguinal ring (mid-inguinal point- 1.5cm superior to midpoint of line
    running from ASIS to pubic symphysis), and ask to cough again, comment on if it is
    controlled or not. If controlled it is an indirect hernia. If not controlled it is an indirect
    hernia. Direct controlled at superficial inguinal ring.
    - Remove hand and watch hernia reappear

    7. PERCUSSION
    Rarely done
    If gut in sac , may be resonant
    8. ASCULTATION
    Bowel sounds may be heard over gut in sac
    9. FEEL OTHER SIDE
    Inguinal hernias commonly bilateral
    10. EXAMINE ABDOMEN
    Look for anything that may be raising intraabdominal pressure:
    Large bladder
    Pregnancy
    Enlarge prostate
    Ascites
    Chronic intestinal obstruction
    11. CARDIOVASCULAR AND RESPIRATORY ASSESSMENT
    12. THANK PATIENT

    GLOSSARY

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