INGUINAL HERNIA

PATIENT NAME:

AGE/SEX:

ADDRESS

OCCUPATION:

RACE:

RELIGION:

SOCIOECONOMIC STATUS:

CHIEF COMPLAINTS:

• SWELLING IN THE RIGHT OR LEFT GROIN………………….DURATION

(OR)
• SWELLING IN THE RIGHT OR LEFT LOWER ABDOMEN…………………….DURATION
• PAIN IN THE SWELLING………………………..DURATION

HISTORY OF PRESENTING ILLNESS:

PATIENT WAS APPARENTLY NORMAL BEFORE……………………….,THEN HE DEVELOPED

• H/O SWELLING IN THE RIGHT OR LEFT GROIN WHICH IS ,

▪ ONSET- SUDDEN / INSIDIOUS ONSET
▪ STARTED FROM GROIN TO SCROTUM,
▪ INITIALLY STARTED AS SMALL SWELLING
▪ GRADUALLY PROGRESSIVE AND ATTAIN THE PRESENT SIZE.
▪ AGGRAVATING BY STRAINING, STANDING, COUGHING
▪ RELIEVED BY BY LYING DOWN, MANUALLY BY HIMSELF

• H/O PAIN IN THE SWELLING………………DURATION

▪ SITE
▪ SIDE
▪ CONTINOUS / INTERMITTENT
▪ MILD/MODERATE/SEVERE
▪ CHARACTER OF PAIN
▪ RADIATING
▪ SHIFTING
▪ AGGRAVATING FACTORS BY
▪ RELIEVING FACTORS BY
▪ DIURNAL /SEASONAL VARIATION

• H/O FEVER
• H/O TRAUMA
• H/O LOSS OF WEIGHT
• H/O LOSS OF APPETITE
 • H/O HEAVY WEIGHT LIFTING
• H/O CHRONIC COUGH
• H/O DIFFICULTY OF MICTURATION.
• H/O URGENCY, FREQUENCY , HESITENCY, PRECIPITANCY OF MICTURATION.
• H/O ABDOMINAL PAIN.
• H/O ABDOMINAL DISTENSION.
• H/O VOMITING.
• H/O DIFFICULTY IN DEFECATION.

PAST HISTORY:

• H/O SIMILAR ILLNESS IN THE PAST.

• NOT K/C OF DM/SHT/TB/EPILEPSY/ HEART DISEASE/KIDNEY DISEASE/ALLERGY.
• H/O PREVIOUS SURGERY IN THE PAST.

PERSONAL HISTORY:

• VEGATARIAN OR NON VEGATARIAN DIET

• SMOKER
• ALCOHOLIC
• BOWEL AND BLADDER HABITS
• SLEEP PATTERN

FAMILY HISTORY:

• TOTAL NUMBER OF FAMILY MEMBERS

• MALE S –
• FEMALES –
• H/O SIMILAR ILLNESS IN THE FAMILY MEMBERS.
• HEALTH STATUS OF FAMILY MEMBERS.

GENERAL EXAMINATION:

• CONSCIOUS
• ORIENTED
• COMFORTABLE
• COPERATIVE
• AFEBRILE
• HYDRATION
• PALLOR
• JAUNDICE
• BUILT
• NOURISHMENT
• CLUBBING
• CYNANOSIS
• PEDAL EDEMA
• GENERALISED LYMPH ADENOPATHY
 • VITAL SIGNS:
➢ BP-
➢ PR-
➢ RR-
➢ T-

LOCAL EXAMINATION:

INSPECTION:

AFTER GETTING CONSENT FROM THE PATIENT IN STANDING POSITION EXAMINAR IN SITTING POSITION, WITH
ADEQUATE EXPOSURE FROM UMBILICUS TO MIDTHIGH, A SINGLE SWELLING PRESENT IN THE RIGHT OR LEFT
INGUINAL REGION

• SITE -
• SIZE -
• SHAPE -
• EXTENT -
• SURFACE -
• SKIN OVER THE SWELLING –
▪ SCAR
▪ SINUS
▪ DILATED VEINS
▪ STRETCHED
▪ SHINY
▪ REDNESS
• MARGIN
• VISIBLE PERISTALSIS
• VISIBLE PULSATION
• REDUCIBILITY
• COUGH IMPULSE
• LYMPH NODES
• PENIS POSITION- MIDLINE/DEVIATED/BURIED
• EXTERNAL URETHRAL MEATUS
• SCROTUM
• OPPOSITE SIDE INGUINAL REGION

PALPATION:

• WARMTH
• TENDERNESS
• SITE
• SIZE
• SHAPE
• EXTENT
• SURFACE
• CONSISTENCY
 • MARGIN
• EXPANSILE COUGH IMPULSE
• REDUCIBILITY
• GET ABOVE THE SWELLING
• CORD STRCTURES PALPABLE OR NOT
• EPIDIDYMIS PALPABLE OR NOT
• EXTERNAL GENETALIA:
▪ SCROTUM
▪ TESTIS
▪ BULBAR URETHRA
▪ PENIS
• DEEP RING OCCLUSION TEST-
➢ SWELLING APPEARS – DIRECT HERNIA
➢ SWELLING NOT APPEARS – INDIRECT HERNIA
• THREE FINGER TEST-
➢ IMPULSE FELT AT INDEX FINGER – INDIRECT HERNIA
➢ IMPULSE FELT AT MIDDLE FINGER – DIRECT HERNIA
➢ IMPULSE FELT AT RING FINGER – FEMORAL HERNIA
• FINGER INVAGINATION TEST-
➢ IMPULSE FELT AT TIP OF LITTLE FINGER – INDIRECT HERNIA
➢ IMPULSE FELT AT BULP OF LITTLE FINGER - DIRECT HERNIA
• LYMPHNODES PALPABLE OR NOT

PERCUSSION:

• RESONANT – ENTEROCELE
• DULL – OMENTOCELE

AUSCULTATION:

• PERISTALIC SOUNDS HEARD – ENTEROCELE

EXAMINATION OF OPPOSITE INGUINAL REGION:

• SWELLING
• COUGHT’ IMPULSE
• REDUCABLE

PER RECTAL EXAMINATION:

• TO BE DONE TO RULE OUT BPH, MALIGNANT OBSTRUCTION, CHRONIC FISSURE IN ANO.

OTHER SYSTEM EXMAINATION:

ABDOMEN:

• SOFT
• BOWEL SOUNDS
• NO DISTENSION
• NO FREE FLUIDS
• ON HEAD RISING TEST- MALGAIGNE’S BULGING PRESENT OR NOT

RESPIRATORY SYSTEM:

• NVBS
• ADDED SOUNDS

CARDIO VASCULAR SYSTEM:

• S1 S2
• MURMUR
• ADDED SOUNDS.

CNS:

• NO FOCAL NEUROLOGICAL DEFICIT.

DIAGNOSIS:

• RIGHT OR LEFT
• CONGENITAL OR ACQUIRED
• DIRECT OR INDIRECT
• REDUCIBLE OR IRREDUCIBLE
• INGUINAL OR FEMORAL
• COMPLETE/INCOMPLETE
• COMPLICATED OR UNCOMPLICATED
• CONTENT-ENTEROCELE/ OMENTOCELE.

DD FOR GROIN SWELLING:

• FEMORAL HERNIA
• ENLARGED INGUINAL LYMPH NODES
• SAPHENA VARIX
• FEMORAL ANEURYSM
• LIPOMA OF THE CORD
• ENCYSTED HYDROCELE OF THE CORD
• UNDESCENDED OR ECTOPIC TESTIS
• PSOAS ABSCESS
• MALGAIGNE’S BULGE.
DD FOR INGUINAL SCROTAL SWELLING:

• CONGENITAL HYDROCELE
• INFANTILE HYDROCELE
• ENCYSTED HYDROCELE OF THE CORD
• HYDROCELE OF CANAL OF NUCK
• LIPOMA OF THE CORD
• VARICOCELE
• FUNICULITIS
• LYMPH VARIX

INVESTIGATIONS:

• HEMOGLOBIN,
• TOTAL COUNT .
• DIFFERENTIAL COUNT
• ERYTHROCYTE SEDIMENTATION RATE
• PLATELET COUNT
• RANDOM BLOOD SUGAR
• SERUM UREA
• SERUM CREATININE
• URINE ROUTINE- ALBUMIN, SUGAR, DEPOISTS
• BLEEDING TIME
• CLOTTING TIME,
• BLOOD GROUPING/TYPING
• HIV-1 AND HIV-2, VDRL, HBSAg, Anti- HCV
• ECG ALL LEADS
• CXR PA VIEW-

SPECIFIC INVESTIGATIONS:

• INVESTIGATION TO CONFIRM THE DIAGNOSIS?

NO INVESTIGATION NEEDED FOR CONFIRMATION OF HERNIA BECAUSE HERNIA IS A CLINICAL DIAGNOSIS

IF EXAMINER SPECIFICALLY ASK TELL THE FOLLOWING INVESTIGATIONS TELL OTHER WISE DON’T
TELL IN EXAM:

• USG ABDOMEN /PELVIS IF OLD AGE WITH BPH SYMPTOMS

➢ IN OLD AGE TO RULE OUT BPH IF ANY URINARY SYMPTOMS PRESENT

➢ TO ASSESS THE PROSTATE SIZE, POST VOIDAL RESIDUAL URINE

• CT ABDOMEN/PELVIS:

➢ IN CASE OF OBSTRUCTED AND STRANGULATED HERNIA

➢ LARGE INCISIONAL HERNIA
 • MRI:
➢ IN CASE OF SPORTS MAN HERNIA- INVESTIGATION OF CHOICE.

• HERNIOGRAM:
➢ IN CASE OF OCCULT HERNIA HERNIOGRAM INVESTIGATION OF CHOICE.

• PULMONARY FUNCTION TEST:

➢ IN CASE SEVERE RESPIRATORY DISORDERS WITH INGUINAL HERNIA.

TREATMENT:

• HERNIOTOMY – CONGENITAL HERNIA

• HERNIORAPPHY – YOUNG ADULTS BUT NOW A DAYS HERNIOPLASTY FOR ALL
• HERNIOPLASTY – BOTH DIRECT AND INDIRECT INGUINAL HENIA.

HERNIOTOMY:

• IDENTIFICATION OF SAC
• SEPARATION OF SAC
• OPENING OF FUNDUS OF THE HERNIAL SAC
• REDUCE THE CONTENTS
• TRANSFIXITIONN OF SAC
• LIGATION OF SAC
• EXCISE THE EXCESSIVE SAC.

HERNIORAPPHY:

• STRENGTHING OF POSTERIOR ABDOMINAL WALL BY ANATOMICAL TISSUE REPAIR

HERNIOPLASTY:

• STRENGTHING OF POSTERIOR ABDOMINAL WALL BY SYNTHETIC MATERIAL LIKE MESH.