Differential Diagnosis for a presumed Inguinal hernia
- Femoral Hernia
- Vaginal hydrocele
- Hydrocele of cord / canal of Nuck
- Undescended testis
- Lipoma of cord
Differential Diagnosis for a presumed Femoral hernia
- Inguinal hernia
- Enlarged lymph node (of Cloquet)
- saphen0-varix
- ectopic testis
- psoas abscess
- lipoma
Examination of Hernial Orifices
Confirm consent for the examination ± presence of a chaperone.
Ask the patient, once they have stripped below the waist, to stand:
Inspect
- look at both sides groin / scrotum and note any obvious swelling
- ask the patient to cough, while looking for a visible cough impulse at the site of the orifice
Palpate
- Can you get above the swelling?
- Yes: swelling is from scrotal contents
- No: hernia
- Stand to the patient’s side and palpate the orifice. Does the swelling elicit an expansible cough impulse to the palpating fingers?
- determine localisation of swelling to the inguinal ligament and pubic tubercle
- note its: position; size; shape; temperature; tenderness, surface; and edge
- palpate for the swelling’s composition (hernial contents)
- fluctuant and soft: e.g. bowel
- firm / rubbery: e.g. omentum
- shine a torch light for translucency
- Is the swelling reducible?
- after reducing, maintain pressure over deep inguinal ring and ask patient to cough again
- reappears when pressure removed
- may need to repeat after having patient lie down
- Percuss and Auscultate
Repeat for the other side of the patient
Perform an abdominal examination
