We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
from Section 2 - General surgery
Published online by Cambridge University Press: 05 July 2015
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.
Examination notes
What are the risk factors for hernia formation that may be elicited in the examination?
Any factor that increases intra-abdominal pressure: smoking, chronic cough, constipation or change in bowel habit, chronic urinary retention, pelvic masses, pregnancy or ascites.
How do you prepare for the examination of the groin?
If examining a patient of the opposite sex ask for a chaperone. The patient needs to be standing so as to allow any hernias to become evident under the effect of gravity. Expose the patient's abdomen, groins and upper thighs.
To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Find out more about the Kindle Personal Document Service.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.
