Hernia Examination

INTRODUCE & Ask if any pain over the examination area

ON LYING SUPINE
1) Expose properly: Up to knee

2) Inspect: Testes & Groin
    - Testicular swelling/ redness/ loss of wrinkle/ displacement of median raphe/ scar
    - Groin swelling/ redness/ scar

3) Coughing Pulse
    - with b/L groin palpation --> if +ve (EXPANSILE)
    - then without palpation --> see the flow of swelling

4) Demonstrate inguinal ligament line
    - show the swelling above & lateral to the inguinal line

5) Palpation: Testis & Groin
    - Is the Testis separable, can get above the swelling, & feel for the cord
    - Feel for tenderness, temperature, consistency, surface, margin, translumination, compressible
    - Don't forget to measure the size of swelling/ or just estimate

ON STANDING 

    - Ask patient to put the swelling back in (REDUCIBLE) 

    - Upon standing, occlude deep inguinal ring (2FB above midpoint of ing ligament) 

       & ask patient to stand

    - Ask patient to cough & then release your hand

    - See again the flow of swelling ---> sausage shape/ go from inguinal to scrotum

    - Here probably can see the shape more clearly & can measure the size more accurately  

COMPLETE

    - Do Abdominal & PR Examination : Any evidence of Increase Intraabdominal Pressure

    - Examine the Lungs --> any Lung problem, chronic cough 

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Hernia Examination is very tricky, most of the problem student encounter is whether to examine patient on lying supine first or straight away ask patient to stand? the answer is it depends on patient position at the time, if patient is at the time lying supine & you test for coughing pulse & not really demonstrable, I think better you ask patient to stand straight away and start your examination from standing, but if the swelling very obvious o lying supine & coughing pulse is positive, you can just follow the examination flow I recommended here