Groin Hernia Examination Component What to do/rationale Introduce self. Confirm patient’s details. Basics Explain what you will do and why. Wash hands and wear gloves. Ask about pain. Look for any visible protrusions. Look for any scars and swelling. Inspection Look for features of incarcerated and strangulation. Incarcerated -> cannot be pushed back. Strangulated -> discolouration, fever, rapid heart rate etc. Ask the patient to turn their head away from you and cough. Cough impulse Fix eyes at the pubic tubercle and look for visible cough impulse. Ask the patient to do it again, while the patient turns their head the other way. Place the fingers over the region of the pubic tubercle. Ask the patient to cough again and palpate for expansile impulse. Palpation If hernia is present attempt to reduce should not be made when the patient is erect. More difficult and painful. Ask the patient to lie supine on redo the inspection and palpation as above. Determine if is hernia and what type of hernia it is. You cannot get above a hernia but can get about a hydrocele in the inguinal canal. Determine if inguinal or femoral: Inguinal: Above and medial to pubic tubercle. At or above inguinal ligament. Identify type of hernia Femoral: Below and lateral to the pubic tubercle. Below the inguinal ligament. Femoral hernias are more dangerous. Usually smaller and firmer than inguinal hernias. Usually have no cough impulse. Usually irreducible -> hence often mistaken for an enlarged inguinal lymph node. A large hernia may descend through the external ring immediately above the pubic tubercle into the scrotum. Gentle invagination of the scrotum with the tip of the gloved finger in the external ring may be performed to confirm indirect hernia in men. Maldescended testis can be confused with an inguinal hernia. Always confirm or ask to confirm that there are testes in each scrotum. Testes and scrotum Large inguinal may present as a lump in the scrotum. Ascertain whether one can get above the lump: If you can get above the lump -> lump is of a intrascrotal pathology and not a hernia.