INGUINAL HERNIA

Sign & symptoms depend on few factors:

i) Exact viscus that is herniating
ii) Location of the herniated bowel (i.e., jejunum or ileum)
iii) Presence of full/ partial strangulation

1. Local symptoms:
a. reducible - irreducible lump
b. groin discomfort, pain on exertion
c. Constipation
d. Lump enlarges during cough
2. Systemic symptoms
Cardinal signs of obstruction
a. Colicky abdominal pain
b. Vomiting
c. Abdominal distention
d. Constipation

Grade Reduct Pain Obstruc Toxic

ion tion
Reducible + - - -
Irreducible - - - -
Incarcerati - Colic + -
on
Strangulati - Steady, + ++ leukocytos
on increas is
e

D(x) tools c) LE
a) HT (Lump of groin) 1. Radiology
1. Location: Unilateral/bilateral - May be useful for in cases in which
2. Onset: Acute/chronic abdominal wall fat layer prevents
3. Size of lump at present accurate d(x)
4. Nature : intermittent/persistent - CT scan is good at detecting
5. Other related symptoms
abdominal & pelvic defect
GI functions: nausea, vomit, bowel syndrome
- USG is rarely helpful
Urinary f(x)
delineate the abdominal wall
Fever
6. Previous history musculature
Similar lump, surgical hernia, trauma
Major illness: chronic cough injury, jaundice

b) PE
1. Inspect color, shape, location & edema
2. Palpate sign of local tenderness, content
3. Trans illumination test
4. Manual reduction of lump
5. Determine position of lump
6. Vital signs & other systems exam
Abdomen:
Inspect respiratory & visible bowel peristalsis movement
Palpate tenderness
Percussion tympanic/dull/ shift
Auscultation Bowel sound
Digital rectal exam (DRE)