Inguinal Hernia

Inspection:

-?mass in groin region - visible cough impulse
-surgical scar - previous hernia surgery, other side, abd surgery (increased intra-abd pressure)

Palpate:

-confirm palpable cough impulse
-reduce hernia (get pt to reduce it first)
-find anatomical landmarks

• pubic tubercle (follow adductor muscle insertion) - above and medial (if below and lat, think femoral hernia)
• Ant Sup Iliac Spine
• 2cm mid point of inguinal ligt = deep ring

-control deep ring - cough again

• controlled = indirect hernia - look for inguinal-scrotal hernia
  
• not controlled = direct hernia
• (to truely establish between indirect vs direct - need surgery to determine position in relation with the inf epigastric vessels)
  

finish with abd examination + groin and PR exam

indirect inguinal hernia:
- mostly children - patent processus vaginalis

direct inguinal hernia:
- acquired abd muscle weakness

Cx:
- incarceration/strangulation
- intestinal obstruction

Mx:
- open mesh repair
- laparoscopic repair - bilateral hernias