Hernia Exam

Question 1

Introduction

Answer 1

1. Wash hands
2. Introduce
3. Patient details
4. Permission: Today I have been asked to perform a hernia examination - this will involve me having a look, a feel and a listen to your (hernial orifice). We have our examiner here as chaperone. Does that sound okay?
5. Exposure - groin/abdomen
6. Reposition - 45 degree
7. Any questions? Any pain?

Question 2

General inspection

Answer 2

Around bed - walking aids, stoma bag, surgical drains, catheters
General inspection of abdomen - scars, swelling

Question 3

Hernia inspection

Answer 3

6 S’s - size, site, shape, symmetry, (overlying) skin, scars
Inspect for cough impulse

Question 4

Palpation

Answer 4

Palpate exact location:
If in groin, mark in relation to ASIS + pubic symphysis (midinguinal point) - inguinal = superior and medial; femoral = inferior and lateral.
If incisional, palpate hernial orifice edge.

Question 5

Ilicit

Answer 5

Pain and temp
Consistency
Pulsatility and cough impulse
Relation to structures around it - can you get above/beyond it

Question 6

If reducible?

Answer 6

If suspect to be inguinal, once reduced ask patient to lie flat and occlude deep ring. Now ask patient to cough - if indirect, will stay reduced.

Question 7

Lymphadenopathy?

Answer 7

If not a hernia, palpate for inguinal/femoral lymphadenopathy

Question 8

Auscultation

Answer 8

Auscultate for bowel sounds

Question 9

To conclude

Answer 9

THANK, WASH HANDS AND STETHOSCOPE, OFFER TO HELP DRESS
To complete - full abdo exam and contralateral side, examine scrotum