Groin Examination
Present your self to the patient
Take permission
Wash your hand
Proper exposure and positioning
The patient is examined first in supine position , if the lump is not obvious then on standing position
Ensure privacy of the patient
Patient should be Exposed from the umblicus to mid-thigh
Inspection
.................There is a swelling in
Site (RT or lft inguinal region)
Extend to the scrotum deiation of the penis
size
shape(fusiform in indirect hernia& spherical in direct hernia)
Skin pigmentation
surgical scars
Ask the patient to cough(visiable coughing impulse)
Look to the scrotum anterioly and posteriorly for Surgical scars and ulcers
inspect the perineum
Palpation
"palpable coughing impulse ''It's A groin hernia
ask the patient to reduce the hernia
"It's a reducible groin hernia "
identify the pubic tubercle either from the symphesis pubis then go lateral for the first prominant or the adductor method asking the patient to abduct the thigh because it is the attachment point of the adductor muscles
"if it above and medial "it is a reducible inguinal hernia
"if it is below and lateral"it is a reducible femoral hernia
Ask the patient to reduce the hernia again , localize the pubic tubercle and the anterior superior illiac spine, the line between them is inguinal ligament and the middle of this line is the "mid point of inguinal ligament"measure 1.25cm above it ,it is the deep ring ,occlude the deep ring using the thump and ask the patient to cough and then release your finger and ask the patient to cough again
positive occlusion test-it is a reducible indirect inguinal hernia
negative occlusion test -it is a reducible direct inguinal hernia
Palpate the scrotum for the level of hernia ,testes ,epididymis and cord and the comment will be
"reducible incomplete or complete indirect inguinal hernia"
