Examination for hernia

Examination for hernia

The patient should be examined lying down initially and then standing, as this will usually increase hernia size. Some hernias will only be apparent with the patient standing. The patient may be asked to cough or to perform the Valsalva manoeuvre to make the hernia appear. Divarication is best seen by asking a supine patient to simply lift his/her head o ff the pillow . Finally , it should be remembered that if a patient describes an intermittent swelling but the surgeon finds no hernia on examination, there still may be a hernia present. The overlying skin is usually of normal colour. If there is overlying cellulitis then the hernia content is strangulating and the case should be treated as an emergency . In most cases an expansile cough impulse is felt if gen tle pressure is applied to the lump and the patient is asked to cough; however, there may be no cough impulse when the neck is tight and the hernia irreducible. This is typical of a femoral Adriaan van den Spiegel , 1578–1625, Flemish anatomist who practised in Padua, Italy . Jacob Benignus Winslow , 1669–1764, Danish-born anatomist, Jardin du Roi, Paris, France Antonio Maria Valsalva , 1666–1723, Professor of Anatomy , Bologna, Italy . - agnose a lymph node. A cough impulse can also be appreciated in a saphena varix (see Chapter 62 ). ). If a groin hernia is found on one side, the other side must also be examined as occult contralateral hernias are present in up to 20% of patients . If a hernia does not reduce spontaneously , the surgeon - should ask the patient to attempt reduction because he/she may be w ell practised in this task, and the surgeon might cause unnecessary discomfort. If neither the patient nor the surgeon can reduce the hernia, the trea tment is more urgent. Summary box 64.3 Checks /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF Summary box 64.4 - Examination /uni25CF /uni25CF

Reducibility Cough impulse Tenderness Overlying skin colour changes Multiple defects/contralateral side Signs of previous repair Scrotal content for groin hernia Associated pathology A swelling with a cough impulse is not necessarily a hernia A swelling with no cough impulse may still be a hernia but consider other diagnoses