Inspection | |
Site: above the fold of the groin (direct or indirect); below the fold (femoral) Size and change in size in supine position Extension to the scrotum in men Skin changes: redness in inflamed or strangulated hernia Scars Cough impulse |
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Palpation | |
Direct vs indirect | To differentiate between direct and indirect inguinal hernia: apply pressure over the midinguinal point (midway between the anterior superior iliac spine and the pubic tubercle and just above the inguinal ligament) with the fingertip to control an indirect hernia and prevent it from protruding when the patient strains. A direct hernia will not be controlled with this maneuver. |
Hernia vs scrotal mass |
Examine the scrotum and its contents Confirm that protrusion is a hernia and not a scrotal mass by examining its upper edge (if upper edge is felt between thumb and index finger, with a normal spermatic cord above it, it must be a scrotal swelling and not a hernia; if upper edge cannot be felt because it passes into the inguinal canal, it is likely a hernia) |
Examine the hernia |
Site Temperature Shape and size Reducibility Tenderness Expansile cough impulse Always feel the other side Examine the abdomen |