Investigations of Hernia

Clinical Examination

Investigations of Hernia

Computer tomography

Ultrasound scan

Examination techniques
If there is hernia in the groin, the examiner must discriminate an inguinal hernia and femoral hernia A hernia in the groin should be examined in the following way:
Inspection Palpation Examination of the other side

Examination can be done:

1. Patient standing 2. Patient lying supine

The features that must be assessed:

Position Tenderness Shape Size Consistency Temperature

Inspection
Expose the patient ensure you can see from umbilicus to knees

Give attention to scars from previous surgery difficult to see

Cant see Ask patient

Look for obvious lump and swelling

Ask patient to look over their shoulder and cough

Examiners eyes should be fixed in the region of pubic tubercle - note the presence of cough impulse - Cough again, inspect opposite side

Inspection helps to determine:

site and shape :
those appearing above and medial to the pubic tubercle are inguinal hernias those appearing below and lateral to the pubic tubercle are femoral hernias

Inspection helps to determine:

whether the lump extends down into the scrotum if there are any other scrotal swellings if there are any swellings on the 'normal' side whether the lump is associated with a scar from previous surgery or trauma

Palpation
Placed fingers over the region of the pubic tubercle Ask patient to cough Palpate the swelling soft, fluctuant, pulsatile etc

 If the inguinal hernia is large:

obscured the pubic tubercle and its position may be less distinct Accurate indication: by comparing the lump with the pubic tubercle on the opposite site

Ultrasound Scan
Initial test Correlation with surgical finding shows it have sensitivity of 33% and specificity of 100% If negative and the clinical suspicion is high CT scan of the groin is indicated.

Computer Tomography
Provides information about hernial orifice: the sacs and its contents Bowel loops are identified & bowel gas delineated Peristaltic movements of herniated bowel loops demonstrated Although a positive CT finding of inguinal hernia is reliable, a negative finding does not exclude the diagnosis