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Hernia:
History:
1. Lump:
Duration
When was first noticed
Location left or right
Is it always there or does it diappear?
Progression changes in size
Painful or painless
Is it reducible?
Skin changes over the lump
2. Risk factors
History of heavy lifting
Chronic constipation, cough
Pregnancy, ascites, obesity
3. Bowel obstruction
Colicky abdominal pain
Abdominal distension
Vomiting
Constipation
1. Inguinal hernias
Anatomy
o The inguinal canal extends from the pubic tubercle to the anterior superior
iliac spine. In the male, it carries the spermatic cord (vas deferens, blood
vessels and nerves). In the female, it is much smaller and carries the round
ligament of the uterus.
o After testicular descent, the canal closes but the site is weakened.
1
Bader Al-Mukhtar RCSI-MUB SC (2)
Inspection:
1. Scars from previous surgery
2. Obvious lumps and swellings.
3. Ask the patient to turn the head away and to cough (with your eyes
fixed in the region of pubic tubercle noting the presence of any visible
cough impulse).
4. Ask the patient to cough again with the examiner inspecting the
opposite side.
Palpation:
1. Begin with the fingers placed over the pubic tubercle.
2. With 2 fingers on the mass, ask the patient to cough once again ask the
patient to cough and a palpable pulsatile or expansile cough impulse
is felt.
3. If hernia is present attempt to reduce it (only done with the patient lie
supine) or initially ask the patient to reduce it.
4. With the hernia reduced, try pressing over the site of the internal ring
and asking the patient to cough. An indirect hernia will remain
reduced whereas a direct hernia will protrude once more.
Auscultation:
1. Listen over the lump for the presence of bowel sounds which might
indicate the contents of the hernia sac.
Finally:
1. Look at the scrotum for the distension of the hernia, which will make it
more likely to be an indirect hernia.
1
Bader Al-Mukhtar RCSI-MUB SC (2)
2. Femoral hernias
Examination
o Examine with the patient standing up and undressed from the waist down.
o Examine as you would any other hernia and attempt reduction.
o If present, a femoral hernia will appear as a lump just lateral and inferior to
the pubic tubercle, about 2cm medial to the femoral pulse.