Inguinal, Femoral Hernias
- Inspect
- Palpate, cough impulse
- Direct vs. indirect summary
- Inspect
- Palpate
- Is pt. male (predisposing factor).
- Pt's lifting muscles, ascities (predisposing factors).
- Pt. stands, exposed area visible.
- Swellings.
- Swellings: bilateral (direct) or unilateral (indirect).
- Swellings: only appear on standing?
- Swelling location: above or below inguinal ligament. See Inguinal Canal Reference.
- Hernia surgical scars.
- External genitalia, including undescended testicle (DDx).
- Ask pt. to reduce hernia themselves.
- Pt. coughs to highlight hernia.
- Ask pt. about tenderness first.
- See Inguinal Canal Reference for
landmarks.
- Inguinal hernia goes in inguinal canal.
- Palpate mass, scrotal ones can be done up scrotum with little finger.
- Optionally can cough here while little finger up scrotum to feel an impulse on end of
finger (indirect) vs. superior part of finger.
- See whether can reduce it back up through the inguinal ring to reduce it.
- Reduce.
- Hold two fingers on internal ring.
- Pt. coughs while holding fingers on ring.
- See if hernia can extrude around elsewhere (direct) or stays reduced (indirect).
- Bilateral (direct) vs. unilateral (indirect).
- Strangulation concern (indirect) vs. rarely strangulate (direct). Usually obstruction
precedes strangulation (except Richter's).
- Through inguinal ring (indirect) vs. around inguinal ring (direct).
- Is pt female? [predisposing factor].
- Pt. stands, exposed area visible.
- Swellings.
- Swellings: only appear on standing?
- Reddening.
- Hernia surgical scars.
- External genitalia.
- Ask pt. to reduce hernia themselves.
- Pt. coughs to highlight hernia, though may not appear in femorals.
- Whether hernia goes through Hasselbach's triangle. See Inguinal Canal Reference.
- Ask pt. about tenderness first.
- Femoral 'neck' is usually palpated inferior and lateral to pubic tubercle.
- Femorals more likely to be irreducible than inguinals.
- Can have pt. cough while palpating, reducing.
- Don't confuse with firm lymph node, femoral vein.