Hernia examination

Question 1

Introduction

Answer 1

WIPER QQ

E - from xiphisternum to pubis pymphisis but will provide a blanket and a chaperone
R - supine on bed
Q - abdo pain, change in bowel habits, masses?

Question 2

General inspection

Answer 2

Abdo
-shape, symmetry
-scars
-equipment

Surroundings
-medication
-monitoring
-catheter bag contents

Question 3

Groin examination - supine

Answer 3

Inspection
-masses in groin

Palpation
-femoral pulses
-inguinal LN - along inguinal ligament and femoral artery

Question 4

Groin examination - stand

Answer 4

Ask patient to stand
Inspection
-inguinal canal, femoral canal, scrotum for hernias
Inguinal hernia - proximal and medial to pubic tubercle
Femoral hernia - lateral and distal to pubic tubercle

If inguinal
-invaginate scrotum with little finger, palpate external inguinal ring and posterior wall for muscle defects - DIRECT?
-hold hand over hernia, ask patient to cough => impulse felt? - hernia
-reducible? - push hernia towards internal ring
Y :) - not trapped
N :( - incarcerated
-if reducible, occlude internal ring with finger pressure at MIP, and cough
Reappears - direct

ASSESS BOTH SIDES