Inguinal Hernia

Question 1

General Inspection

Answer 1

Pt: well / unwell, pain / discomfort, pallor, abdominal distention

Around bed: vomit bowels

Question 2

Local inspection

Answer 2

Lumps: size, shape, position, scrotal extension

Observe cough impulse

Question 3

Palpation

Answer 3

Scrotal contents
Lump / inguinal area (both sides)
Feel cough impulse (on each side separately): compress lump / inguinal area firmly
Reducibilty*

Question 4

• Reducibility

If you cannot reduce then try again with pt supine

Answer 4

Locate deep inguinal ring (midway between ASIS and pubic tubercle)
Press firmly on lump and starting inferiorly, try to lift it up and compress it towards the deep inguinal ring
Once its reduced, slide fingers up and maintain pressure over the deep inguinal ring
Ask pt to cough
If hernia reappears then direct
Release and watch hernia reappear (indirect will slide down obliquely, direct will project forwards)

Question 5

Percussion and auscultation

Answer 5

May reveal bowel sounds

Question 6

Direct inguinal hernia

Answer 6

Superior to the pubic tubercle - position of superficial inguinal ring
Herniated abdominal contents come directly out of abdomen in straight line
Hernia emerges through superficial inguinal ring
If reduced cannot be contained by applying pressure over deep inguinal ring

Question 7

Indirect inguinal hernia

Answer 7

Anywhere between deep inguinal ring and scrotum
Herniated abdominal contents run within the inguinal canal
Hernia emerges through the deep inguinal canal
Hernia can extend all the way down the canal into the scrotum in men (inguinal scrotal hernia)
If reduced, hernia can be contained by applying pressure over the deep inguinal ring

Question 8

Femoral hernia

Answer 8

Always inferior and lateral to pubic tubercle