Checklist

WIPER

• Patient standing, trousers removed, groin and genitals exposed. Chaperone as required.

Physiological parameters

Inspection

• Evidence of raised intra-abdominal pressure: nicotine stains, barrel chest in COPD, abdominal distension

• Masses: groin lumps

• Scars: laparoscopic port access, groin scars

• Scrotal asymmetry: absent testicle, inguinoscrotal hernias

Ask: ‘ Have you noticed a lump in your groin? Please show me where it is. ’

Ask: ‘ Can you cough please? ’

Palpation

Patient standing:

Ask: ‘ Do you have pain in the groin? ’

• Define anatomy: ASIS, pubic tubercle, inguinal ligament.

• Feel the mass: Tender? Cough reflex? Borborygmi? Pulsatile?

• Locate mass: Finger on pubic tubercle and ask patient to cough.

• Is it superior/medial or inferior/lateral?

• Palpate scrotum: Both testes present? Scrotal masses? Cough impulse?

• Palpate contralateral groin: Bilateral hernias?

Patient supine:

Ask patient to reduce hernia.

• Reduce hernia: reducible or irreducible?

• Control hernia: pressure at midpoint of inguinal ligament.

Ask patient to cough.

•Controlled (indirect hernia) or uncontrolled (direct hernia) by pressure?

Percussion

• Bowel gas present?

Auscultation

• Bowel sounds present in mass?

• Transillumination is optional.

To complete the examination…

• Examine the scrotum, contralateral groin and abdomen (if not done).

• Perform a digital rectal examination.