Hernia

Question 1

Positioning

Answer 1

If supine and swelling visible then leave supine

If not visible then ask pt to stand

Question 2

Inspection

Answer 2

Look carefully and compare both sides

Ask pt to cough and look for a cough impulse

Question 3

Palpation

Answer 3

Palpate lump
Note size and extent
Heat, tension and tenderness = strangulation
Feel for cough impulse
No cough impulse suggests incarceration
Note location relative to pubic tubercle: superior = inguinal, inferior = femoral (not 100% reliable)

Question 4

Reduction

Answer 4

Ask pt to lie down (see if hernia reduces)
Ask pt to attempt to reduce hernia - if unable then attempt yourself
If inguinal and reducable place 2 finger on midpoint between ASIS and pubic tubercle and ask pt to cough - indirect won’t appear, direct hernia will appear (not 100% reliable)

Question 5

Auscultation

Answer 5

Listen over lump for bowel sounds
Bowel sounds = bowel
No bowel sounds = omentum (or not a hernia!)

Question 6

Completion

Answer 6

Examine the other side
Examine the scrotum
Perform an abdo exam