EXAMINATION OF INGUINAL HERNIA
1. Introduction and consent
2. Exposure
Umbilicus to mid thigh
3. Position
First on standing and then on lying down
4. Inspection
On standing
Shape of swelling
Position
Inguinal
Inguino scrotal
Femoral (below inguinal ligament)
extent
bubonocele (confined to inguinal canal)
funicular (up to upper end of scrotum)
complete (up to base of scrotum)
color of overlying skin (reness indicates strangulated hernia or
abscess)
scar mark
COUGH IMPULSE
inspection of genitalia
5. Palpation
Temperature
Tenderness
Put on the gloves
Get above the swelling
Consistency
Doughy and granular---------omentum
Tense…Obstructed/irreducible hernia
Cough impulse
Palpation of external genitalia
Transillumination if swelling is irreducible( in scrotum, most likely
hydrocele)
Supine Position
Reducibility (ask the patient to do it)
Mark superficial and deep ring and sephanous opening
Deep ring: ½ inch above mid inguinal point , made by fascia
transversalis
Superficial inguinal ring: ½ inch above pubic tubercle, made by
external oblique
Sephanous opening: 4cm below and lateral to pubic tubercle
RING OCCLUSION TEST
Occlude deep inguinal ring with thumb and ask pt to cough, if swelling
appears even after occlusion, the its direct hernia coming from posterior
wall
Zeiman technique: put index finger on deep inguinal ring, middle finger on
superficial ring and ring finger on sephanous opening
Then ask the patient to cough…….
If impulse is felt on index finger------------indirect hernia
“ “ “ “ “ middle “ ------------direct hernia
“ “ “ “ “ ring “ -------------femoral hernia
6. Percussion
In case of huge swelling
Resonant-----------gut
Dull -----------------omentum
7. Ascultation
Bowel sounds in swelling and abdomen
8. Palpation of abdomen
For any mass in abdomen
9. Chest ascultation
COPD (cause of hernia)
10. Digital rectal examination
Prostate
Rectal tumor
Impacted fecal matter
11. Cover and thanks
