Examination: Hernias

Hernia examinations are relatively common in clinical assessments as patients with hernias frequently have stable signs over several months whilst awaiting surgery. It is important to know your anatomy and the anatomical landmarks!

• WIPER: wash hands, introduce yourself, permission, expose patient (waist to knees), reposition
• Chaperone - if appropriate
• Pain – ask if patient is in any pain?

• Look around bed – vomit bowls, pain medication
• Look at patient – comfortable? In pain? Distended abdomen?
• Ask the patient to stand – look for any lumps or scars on abdomen or groin
• Lumps – shape, size, site, colour

• Lump – feel for temperature, consistency, size, tenderness
• Cough impulse - ask patient to cough and watch for cough impulse. Ask patient to cough again whilst feeling over lump – if lump expands against your hand, there is a positive cough impulse
• Reduce
  • Ask patient if they are able to reduce the lump themselves
  • Check to see if lump is reducible
  • Inguinal area: once reduced, place fingers over deep inguinal ring – if hernia remains reduced = indirect inguinal hernia
  • If hernia protrudes = direct inguinal hernia

• Auscultate over lump to see if you can hear bowel sounds. You may hear femoral bruits in groin area.

• To complete examination, exam the abdomen – distension or any signs of peritonitis? [Beware of obstructed/strangulated bowel]
• Thank the patient and offer to help them re-dress
• Wash hands

Umbilical:

• These are common, and are often congenital.
• Small ones usually spontaneously close by 2yrs. Larger ones/non-closing ones are usually operated on when the child is around 3-4yrs old.
• Can occur later in life (umbilicus is a 'weak spot') - often appear later in the elderly and women who have given birth.

Incisional:

• Very common post-operatively.

Spigelian:

• Found along edge of rectus abdominus.

Obturator:

• Relatively more common in women esp elderly.
• Hernia sac protrudes through obturator foramen. More likely to be symptomatic rather than cause a visible mass.

Epigastric:

• Occurs between the umbilicus and the xiphisternum (in the midline).
• Often composed of fat/omentum - rarely contain bowel. Can often be painless and easily reduced.

download in pdf