Hernia Examination for Medical Students

Welcome to Intractive Podcasting. In this video podcast, Ms. Jill Tierney shows us how to examine an inguinal hernia and then demonstrates the presence of a hydrosil. We hope that you enjoy it. Morning, Mr. Fletcher. Morning. My name's Ms. Tierney. I'm one of the surgeons. Would it be alright if I examined your groin? Yes. Does it hurt at all? Not at present, no. Okay. First of all, could I ask you to stand up please? When inspecting the groin, it's important to stand back. Look for lumps and scars from previous surgery on either side.

Could you turn your head to one side please and cough for me? When the patient coughs, look for the hernia appearing in the groin. This is the visible cough impulse. You're going to have to examine down below. Yeah. I'm just going to examine your testes and your cord. That feels normal. You can examine the testes and the cord on that side. That feels fine. Could I get you to cough again for me please? When the patient coughs, can you feel the hernia against your hand? The cough impulse on this right here.

This is known as a palpable cough impulse. It's important to examine both sides to make sure there's not a hernia on the other side. Does your hernia go away when you lie down? Yeah. Okay. Could I ask you to lie down for me then please? Patients can often reduce the hernia themselves when lying down. Can you make that lump go away yourself? I think it's gone hasn't it? If they are unable to do this, you can gently push the hernia back yourself. Can I ask you to cough again? There it comes out. Now, can you make the lump go

away yourself? Could you do that for me? And that's a nice example, most gentlemen, reduce the lump that way. Okay. Now I'm putting a finger here and a finger here. Could you cough again? Once you've identified the surface marking of the deep ring, put two or three fingers over this point and ask the patient to cough again. If the hernia appears, it is a direct hernia. The hernia has not come through the deep inguinal ring, but has appeared through the back wall of the inguinal canal, medial to the deep inguinal ring.

Okay. The important landmarks here are the anterior superior iliac spine and the pubic tubercle. This line is the surface marking of the inguinal ligament between the anterior superior iliac spine laterally and the pubic tubercle medially. If a groin lump is seen to appear above this line, it is an inguinal hernia, and if it appears below this line, it is more likely to be a femoral hernia. The midpoint of the inguinal ligament is the surface marking for the deep inguinal ring, which is here. The surface marking for the femoral artery is known as the

mid-inguinal point, and this is the midpoint of a line joining the anterior superior iliac spine and the pubic synthesis, not the pubic tubercle. The surface markings shown here are the anterior superior iliac spine and the pubic tubercle. A line drawn between these two points is the surface marking of the inguinal ligament. The midpoint of the inguinal ligament is the surface marking for the deep inguinal ring. Confusingly, the surface marking for the femoral artery is known as the mid-inguinal point, and this is the midpoint of an imaginary line drawn between the anterior superior iliac

spine and the pubic synthesis. This marks the femoral artery. This is therefore medial to the deep inguinal ring. Within the groin, these structures run from medial to lateral as femoral vein, femoral artery and femoral nerve. To check for fluid collection around the testis in the form of a hydroseal, you should attempt to transilluminate any swelling. This involves a pen torch placed behind the scrotum in a darkened room and switched on. There is a small collection of fluid around

the testis and this is the small hydroseal.