8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 130
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Clinical Examination ofInguinal Hernia and
Scrotal Swellings
Valentina Lefemine MD MRCS (Eng)
Specialist Registrar in Surgery
All Wales Training Programme
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 230
wwwdoctorsacademyorg
Introduction
Patient standing up
Patient lying down
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 330
wwwdoctorsacademyorg
Inspection
Scrotum groin crease groinLOOK for
- Scars (manually part the skin fold)- Asymmetry
- Lumpsswelling in both sides
- Skin Changes
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 430
wwwdoctorsacademyorg
Inspection
Look for swelling in both sides
Cough ndashlook (one side)
Cough ndash look (other side)
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 530
wwwdoctorsacademyorg
Palpation
Scrotum groin
Feel mass testicle
cord structures
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 630
wwwdoctorsacademyorg
Lump ( groin scrotum)
Describe lump Introduction (tenderness site size)
Define (shape surface edges)
Composition (consistency fluctuancepulsatility compressibility reducibility)
Layer of origin (fixity tethering) Overlying surrounding skin
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 730
wwwdoctorsacademyorg
Think
Palpate the scrotum first (even if theswelling is in the groin)
If you can feel a mass in the scrotum ask
yourself
bull Can I get above it
bull Can I feel it separate from the testis
bull Does it transilluminate
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 830
wwwdoctorsacademyorg
Palpation
Can you get above it
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 930
wwwdoctorsacademyorg
If nohellip
Hernia
Infantile hydrocele
(rare)
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1030
wwwdoctorsacademyorg
If yeshellip
Testicular mass
EpididymalcystSpermatocoele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1130
wwwdoctorsacademyorg
Palpation
Can you feel the testicle separately
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1230
wwwdoctorsacademyorg
If nohellip
Hydrocelehaematocoele
Testicular neoplasia
Torsion
Orchitis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1330
wwwdoctorsacademyorg
If yeshellip
Hernia
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1430
wwwdoctorsacademyorg
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1530
wwwdoctorsacademyorg
Palpation
Does it transilluminate
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1630
wwwdoctorsacademyorg
If nohellip
Testicular tumour
Hernia
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1730
wwwdoctorsacademyorg
If yeshellip
Hydrocele Epidydimal cyst
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1830
wwwdoctorsacademyorg
If you think the swelling is an herniahellip
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1930
wwwdoctorsacademyorg
Palpation
bull Identify landmarks ASIS pubic tubercle and pubicsymphysis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2030
wwwdoctorsacademyorg
ASIS
PT
PS
M i d - p o i n t
o f t h e i n g
u i n a l l i g a m
e n t D e e p
i n g u i n a l r i n g ndash e
n t r y
p o i n t o f i n d i r e c
t i n g u i n a l
h e r n i a
M i d - i n g
u i n a l p o
i n t ( m i
d - p o i n t b e
t w e e n A
S I S
a n d P S
) - F e m o
r a l a r t e
r y I n g u i n a l
l i g a m e n t
ASIS ndash anterior superior iliac spine
PT ndash pubic tubercle
PS ndash pubic symphysis
The mid-inguinal point is MEDIAL to the mid-
point of the inguinal ligament
Inguinal hernia
Femoral hernia
F e m o r a
l v e
i n
Fem
oralnerve
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2130
wwwdoctorsacademyorg
Very important landmark
Mid-point between the ASIS to the pubic symphyis isMID-INGUINAL POINT ndash the femoral artery lies belowthis
Mid-point between the ASIS to the pubic tubercle isMID-POINT OF THE INGUINAL LIGAMENT ndash the deepinguinal ring lies here
Superficial inguinal ring (through which inguinalhernias emerge ) is above and medial to the pubictubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2230
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2330
wwwdoctorsacademyorg
Type of hernias
Inguinal hernias emergeabove and medial to the pubictubercle
Femoral hernias emergebelow and lateral to the pubic
tubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2430
wwwdoctorsacademyorg
Palpation
bullPosition yourself to the side of the patient
bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the
other supports the small of the back
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 230
wwwdoctorsacademyorg
Introduction
Patient standing up
Patient lying down
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 330
wwwdoctorsacademyorg
Inspection
Scrotum groin crease groinLOOK for
- Scars (manually part the skin fold)- Asymmetry
- Lumpsswelling in both sides
- Skin Changes
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 430
wwwdoctorsacademyorg
Inspection
Look for swelling in both sides
Cough ndashlook (one side)
Cough ndash look (other side)
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 530
wwwdoctorsacademyorg
Palpation
Scrotum groin
Feel mass testicle
cord structures
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 630
wwwdoctorsacademyorg
Lump ( groin scrotum)
Describe lump Introduction (tenderness site size)
Define (shape surface edges)
Composition (consistency fluctuancepulsatility compressibility reducibility)
Layer of origin (fixity tethering) Overlying surrounding skin
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 730
wwwdoctorsacademyorg
Think
Palpate the scrotum first (even if theswelling is in the groin)
If you can feel a mass in the scrotum ask
yourself
bull Can I get above it
bull Can I feel it separate from the testis
bull Does it transilluminate
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 830
wwwdoctorsacademyorg
Palpation
Can you get above it
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 930
wwwdoctorsacademyorg
If nohellip
Hernia
Infantile hydrocele
(rare)
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1030
wwwdoctorsacademyorg
If yeshellip
Testicular mass
EpididymalcystSpermatocoele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1130
wwwdoctorsacademyorg
Palpation
Can you feel the testicle separately
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1230
wwwdoctorsacademyorg
If nohellip
Hydrocelehaematocoele
Testicular neoplasia
Torsion
Orchitis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1330
wwwdoctorsacademyorg
If yeshellip
Hernia
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1430
wwwdoctorsacademyorg
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1530
wwwdoctorsacademyorg
Palpation
Does it transilluminate
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1630
wwwdoctorsacademyorg
If nohellip
Testicular tumour
Hernia
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1730
wwwdoctorsacademyorg
If yeshellip
Hydrocele Epidydimal cyst
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1830
wwwdoctorsacademyorg
If you think the swelling is an herniahellip
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1930
wwwdoctorsacademyorg
Palpation
bull Identify landmarks ASIS pubic tubercle and pubicsymphysis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2030
wwwdoctorsacademyorg
ASIS
PT
PS
M i d - p o i n t
o f t h e i n g
u i n a l l i g a m
e n t D e e p
i n g u i n a l r i n g ndash e
n t r y
p o i n t o f i n d i r e c
t i n g u i n a l
h e r n i a
M i d - i n g
u i n a l p o
i n t ( m i
d - p o i n t b e
t w e e n A
S I S
a n d P S
) - F e m o
r a l a r t e
r y I n g u i n a l
l i g a m e n t
ASIS ndash anterior superior iliac spine
PT ndash pubic tubercle
PS ndash pubic symphysis
The mid-inguinal point is MEDIAL to the mid-
point of the inguinal ligament
Inguinal hernia
Femoral hernia
F e m o r a
l v e
i n
Fem
oralnerve
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2130
wwwdoctorsacademyorg
Very important landmark
Mid-point between the ASIS to the pubic symphyis isMID-INGUINAL POINT ndash the femoral artery lies belowthis
Mid-point between the ASIS to the pubic tubercle isMID-POINT OF THE INGUINAL LIGAMENT ndash the deepinguinal ring lies here
Superficial inguinal ring (through which inguinalhernias emerge ) is above and medial to the pubictubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2230
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2330
wwwdoctorsacademyorg
Type of hernias
Inguinal hernias emergeabove and medial to the pubictubercle
Femoral hernias emergebelow and lateral to the pubic
tubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2430
wwwdoctorsacademyorg
Palpation
bullPosition yourself to the side of the patient
bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the
other supports the small of the back
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 330
wwwdoctorsacademyorg
Inspection
Scrotum groin crease groinLOOK for
- Scars (manually part the skin fold)- Asymmetry
- Lumpsswelling in both sides
- Skin Changes
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 430
wwwdoctorsacademyorg
Inspection
Look for swelling in both sides
Cough ndashlook (one side)
Cough ndash look (other side)
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 530
wwwdoctorsacademyorg
Palpation
Scrotum groin
Feel mass testicle
cord structures
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 630
wwwdoctorsacademyorg
Lump ( groin scrotum)
Describe lump Introduction (tenderness site size)
Define (shape surface edges)
Composition (consistency fluctuancepulsatility compressibility reducibility)
Layer of origin (fixity tethering) Overlying surrounding skin
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 730
wwwdoctorsacademyorg
Think
Palpate the scrotum first (even if theswelling is in the groin)
If you can feel a mass in the scrotum ask
yourself
bull Can I get above it
bull Can I feel it separate from the testis
bull Does it transilluminate
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 830
wwwdoctorsacademyorg
Palpation
Can you get above it
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 930
wwwdoctorsacademyorg
If nohellip
Hernia
Infantile hydrocele
(rare)
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1030
wwwdoctorsacademyorg
If yeshellip
Testicular mass
EpididymalcystSpermatocoele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1130
wwwdoctorsacademyorg
Palpation
Can you feel the testicle separately
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1230
wwwdoctorsacademyorg
If nohellip
Hydrocelehaematocoele
Testicular neoplasia
Torsion
Orchitis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1330
wwwdoctorsacademyorg
If yeshellip
Hernia
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1430
wwwdoctorsacademyorg
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1530
wwwdoctorsacademyorg
Palpation
Does it transilluminate
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1630
wwwdoctorsacademyorg
If nohellip
Testicular tumour
Hernia
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1730
wwwdoctorsacademyorg
If yeshellip
Hydrocele Epidydimal cyst
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1830
wwwdoctorsacademyorg
If you think the swelling is an herniahellip
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1930
wwwdoctorsacademyorg
Palpation
bull Identify landmarks ASIS pubic tubercle and pubicsymphysis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2030
wwwdoctorsacademyorg
ASIS
PT
PS
M i d - p o i n t
o f t h e i n g
u i n a l l i g a m
e n t D e e p
i n g u i n a l r i n g ndash e
n t r y
p o i n t o f i n d i r e c
t i n g u i n a l
h e r n i a
M i d - i n g
u i n a l p o
i n t ( m i
d - p o i n t b e
t w e e n A
S I S
a n d P S
) - F e m o
r a l a r t e
r y I n g u i n a l
l i g a m e n t
ASIS ndash anterior superior iliac spine
PT ndash pubic tubercle
PS ndash pubic symphysis
The mid-inguinal point is MEDIAL to the mid-
point of the inguinal ligament
Inguinal hernia
Femoral hernia
F e m o r a
l v e
i n
Fem
oralnerve
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2130
wwwdoctorsacademyorg
Very important landmark
Mid-point between the ASIS to the pubic symphyis isMID-INGUINAL POINT ndash the femoral artery lies belowthis
Mid-point between the ASIS to the pubic tubercle isMID-POINT OF THE INGUINAL LIGAMENT ndash the deepinguinal ring lies here
Superficial inguinal ring (through which inguinalhernias emerge ) is above and medial to the pubictubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2230
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2330
wwwdoctorsacademyorg
Type of hernias
Inguinal hernias emergeabove and medial to the pubictubercle
Femoral hernias emergebelow and lateral to the pubic
tubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2430
wwwdoctorsacademyorg
Palpation
bullPosition yourself to the side of the patient
bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the
other supports the small of the back
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 430
wwwdoctorsacademyorg
Inspection
Look for swelling in both sides
Cough ndashlook (one side)
Cough ndash look (other side)
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 530
wwwdoctorsacademyorg
Palpation
Scrotum groin
Feel mass testicle
cord structures
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 630
wwwdoctorsacademyorg
Lump ( groin scrotum)
Describe lump Introduction (tenderness site size)
Define (shape surface edges)
Composition (consistency fluctuancepulsatility compressibility reducibility)
Layer of origin (fixity tethering) Overlying surrounding skin
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 730
wwwdoctorsacademyorg
Think
Palpate the scrotum first (even if theswelling is in the groin)
If you can feel a mass in the scrotum ask
yourself
bull Can I get above it
bull Can I feel it separate from the testis
bull Does it transilluminate
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 830
wwwdoctorsacademyorg
Palpation
Can you get above it
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 930
wwwdoctorsacademyorg
If nohellip
Hernia
Infantile hydrocele
(rare)
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1030
wwwdoctorsacademyorg
If yeshellip
Testicular mass
EpididymalcystSpermatocoele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1130
wwwdoctorsacademyorg
Palpation
Can you feel the testicle separately
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1230
wwwdoctorsacademyorg
If nohellip
Hydrocelehaematocoele
Testicular neoplasia
Torsion
Orchitis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1330
wwwdoctorsacademyorg
If yeshellip
Hernia
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1430
wwwdoctorsacademyorg
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1530
wwwdoctorsacademyorg
Palpation
Does it transilluminate
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1630
wwwdoctorsacademyorg
If nohellip
Testicular tumour
Hernia
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1730
wwwdoctorsacademyorg
If yeshellip
Hydrocele Epidydimal cyst
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1830
wwwdoctorsacademyorg
If you think the swelling is an herniahellip
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1930
wwwdoctorsacademyorg
Palpation
bull Identify landmarks ASIS pubic tubercle and pubicsymphysis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2030
wwwdoctorsacademyorg
ASIS
PT
PS
M i d - p o i n t
o f t h e i n g
u i n a l l i g a m
e n t D e e p
i n g u i n a l r i n g ndash e
n t r y
p o i n t o f i n d i r e c
t i n g u i n a l
h e r n i a
M i d - i n g
u i n a l p o
i n t ( m i
d - p o i n t b e
t w e e n A
S I S
a n d P S
) - F e m o
r a l a r t e
r y I n g u i n a l
l i g a m e n t
ASIS ndash anterior superior iliac spine
PT ndash pubic tubercle
PS ndash pubic symphysis
The mid-inguinal point is MEDIAL to the mid-
point of the inguinal ligament
Inguinal hernia
Femoral hernia
F e m o r a
l v e
i n
Fem
oralnerve
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2130
wwwdoctorsacademyorg
Very important landmark
Mid-point between the ASIS to the pubic symphyis isMID-INGUINAL POINT ndash the femoral artery lies belowthis
Mid-point between the ASIS to the pubic tubercle isMID-POINT OF THE INGUINAL LIGAMENT ndash the deepinguinal ring lies here
Superficial inguinal ring (through which inguinalhernias emerge ) is above and medial to the pubictubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2230
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2330
wwwdoctorsacademyorg
Type of hernias
Inguinal hernias emergeabove and medial to the pubictubercle
Femoral hernias emergebelow and lateral to the pubic
tubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2430
wwwdoctorsacademyorg
Palpation
bullPosition yourself to the side of the patient
bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the
other supports the small of the back
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 530
wwwdoctorsacademyorg
Palpation
Scrotum groin
Feel mass testicle
cord structures
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 630
wwwdoctorsacademyorg
Lump ( groin scrotum)
Describe lump Introduction (tenderness site size)
Define (shape surface edges)
Composition (consistency fluctuancepulsatility compressibility reducibility)
Layer of origin (fixity tethering) Overlying surrounding skin
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 730
wwwdoctorsacademyorg
Think
Palpate the scrotum first (even if theswelling is in the groin)
If you can feel a mass in the scrotum ask
yourself
bull Can I get above it
bull Can I feel it separate from the testis
bull Does it transilluminate
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 830
wwwdoctorsacademyorg
Palpation
Can you get above it
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 930
wwwdoctorsacademyorg
If nohellip
Hernia
Infantile hydrocele
(rare)
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1030
wwwdoctorsacademyorg
If yeshellip
Testicular mass
EpididymalcystSpermatocoele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1130
wwwdoctorsacademyorg
Palpation
Can you feel the testicle separately
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1230
wwwdoctorsacademyorg
If nohellip
Hydrocelehaematocoele
Testicular neoplasia
Torsion
Orchitis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1330
wwwdoctorsacademyorg
If yeshellip
Hernia
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1430
wwwdoctorsacademyorg
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1530
wwwdoctorsacademyorg
Palpation
Does it transilluminate
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1630
wwwdoctorsacademyorg
If nohellip
Testicular tumour
Hernia
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1730
wwwdoctorsacademyorg
If yeshellip
Hydrocele Epidydimal cyst
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1830
wwwdoctorsacademyorg
If you think the swelling is an herniahellip
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1930
wwwdoctorsacademyorg
Palpation
bull Identify landmarks ASIS pubic tubercle and pubicsymphysis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2030
wwwdoctorsacademyorg
ASIS
PT
PS
M i d - p o i n t
o f t h e i n g
u i n a l l i g a m
e n t D e e p
i n g u i n a l r i n g ndash e
n t r y
p o i n t o f i n d i r e c
t i n g u i n a l
h e r n i a
M i d - i n g
u i n a l p o
i n t ( m i
d - p o i n t b e
t w e e n A
S I S
a n d P S
) - F e m o
r a l a r t e
r y I n g u i n a l
l i g a m e n t
ASIS ndash anterior superior iliac spine
PT ndash pubic tubercle
PS ndash pubic symphysis
The mid-inguinal point is MEDIAL to the mid-
point of the inguinal ligament
Inguinal hernia
Femoral hernia
F e m o r a
l v e
i n
Fem
oralnerve
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2130
wwwdoctorsacademyorg
Very important landmark
Mid-point between the ASIS to the pubic symphyis isMID-INGUINAL POINT ndash the femoral artery lies belowthis
Mid-point between the ASIS to the pubic tubercle isMID-POINT OF THE INGUINAL LIGAMENT ndash the deepinguinal ring lies here
Superficial inguinal ring (through which inguinalhernias emerge ) is above and medial to the pubictubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2230
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2330
wwwdoctorsacademyorg
Type of hernias
Inguinal hernias emergeabove and medial to the pubictubercle
Femoral hernias emergebelow and lateral to the pubic
tubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2430
wwwdoctorsacademyorg
Palpation
bullPosition yourself to the side of the patient
bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the
other supports the small of the back
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 630
wwwdoctorsacademyorg
Lump ( groin scrotum)
Describe lump Introduction (tenderness site size)
Define (shape surface edges)
Composition (consistency fluctuancepulsatility compressibility reducibility)
Layer of origin (fixity tethering) Overlying surrounding skin
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 730
wwwdoctorsacademyorg
Think
Palpate the scrotum first (even if theswelling is in the groin)
If you can feel a mass in the scrotum ask
yourself
bull Can I get above it
bull Can I feel it separate from the testis
bull Does it transilluminate
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 830
wwwdoctorsacademyorg
Palpation
Can you get above it
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 930
wwwdoctorsacademyorg
If nohellip
Hernia
Infantile hydrocele
(rare)
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1030
wwwdoctorsacademyorg
If yeshellip
Testicular mass
EpididymalcystSpermatocoele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1130
wwwdoctorsacademyorg
Palpation
Can you feel the testicle separately
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1230
wwwdoctorsacademyorg
If nohellip
Hydrocelehaematocoele
Testicular neoplasia
Torsion
Orchitis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1330
wwwdoctorsacademyorg
If yeshellip
Hernia
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1430
wwwdoctorsacademyorg
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1530
wwwdoctorsacademyorg
Palpation
Does it transilluminate
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1630
wwwdoctorsacademyorg
If nohellip
Testicular tumour
Hernia
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1730
wwwdoctorsacademyorg
If yeshellip
Hydrocele Epidydimal cyst
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1830
wwwdoctorsacademyorg
If you think the swelling is an herniahellip
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1930
wwwdoctorsacademyorg
Palpation
bull Identify landmarks ASIS pubic tubercle and pubicsymphysis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2030
wwwdoctorsacademyorg
ASIS
PT
PS
M i d - p o i n t
o f t h e i n g
u i n a l l i g a m
e n t D e e p
i n g u i n a l r i n g ndash e
n t r y
p o i n t o f i n d i r e c
t i n g u i n a l
h e r n i a
M i d - i n g
u i n a l p o
i n t ( m i
d - p o i n t b e
t w e e n A
S I S
a n d P S
) - F e m o
r a l a r t e
r y I n g u i n a l
l i g a m e n t
ASIS ndash anterior superior iliac spine
PT ndash pubic tubercle
PS ndash pubic symphysis
The mid-inguinal point is MEDIAL to the mid-
point of the inguinal ligament
Inguinal hernia
Femoral hernia
F e m o r a
l v e
i n
Fem
oralnerve
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2130
wwwdoctorsacademyorg
Very important landmark
Mid-point between the ASIS to the pubic symphyis isMID-INGUINAL POINT ndash the femoral artery lies belowthis
Mid-point between the ASIS to the pubic tubercle isMID-POINT OF THE INGUINAL LIGAMENT ndash the deepinguinal ring lies here
Superficial inguinal ring (through which inguinalhernias emerge ) is above and medial to the pubictubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2230
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2330
wwwdoctorsacademyorg
Type of hernias
Inguinal hernias emergeabove and medial to the pubictubercle
Femoral hernias emergebelow and lateral to the pubic
tubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2430
wwwdoctorsacademyorg
Palpation
bullPosition yourself to the side of the patient
bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the
other supports the small of the back
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 730
wwwdoctorsacademyorg
Think
Palpate the scrotum first (even if theswelling is in the groin)
If you can feel a mass in the scrotum ask
yourself
bull Can I get above it
bull Can I feel it separate from the testis
bull Does it transilluminate
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 830
wwwdoctorsacademyorg
Palpation
Can you get above it
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 930
wwwdoctorsacademyorg
If nohellip
Hernia
Infantile hydrocele
(rare)
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1030
wwwdoctorsacademyorg
If yeshellip
Testicular mass
EpididymalcystSpermatocoele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1130
wwwdoctorsacademyorg
Palpation
Can you feel the testicle separately
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1230
wwwdoctorsacademyorg
If nohellip
Hydrocelehaematocoele
Testicular neoplasia
Torsion
Orchitis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1330
wwwdoctorsacademyorg
If yeshellip
Hernia
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1430
wwwdoctorsacademyorg
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1530
wwwdoctorsacademyorg
Palpation
Does it transilluminate
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1630
wwwdoctorsacademyorg
If nohellip
Testicular tumour
Hernia
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1730
wwwdoctorsacademyorg
If yeshellip
Hydrocele Epidydimal cyst
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1830
wwwdoctorsacademyorg
If you think the swelling is an herniahellip
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1930
wwwdoctorsacademyorg
Palpation
bull Identify landmarks ASIS pubic tubercle and pubicsymphysis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2030
wwwdoctorsacademyorg
ASIS
PT
PS
M i d - p o i n t
o f t h e i n g
u i n a l l i g a m
e n t D e e p
i n g u i n a l r i n g ndash e
n t r y
p o i n t o f i n d i r e c
t i n g u i n a l
h e r n i a
M i d - i n g
u i n a l p o
i n t ( m i
d - p o i n t b e
t w e e n A
S I S
a n d P S
) - F e m o
r a l a r t e
r y I n g u i n a l
l i g a m e n t
ASIS ndash anterior superior iliac spine
PT ndash pubic tubercle
PS ndash pubic symphysis
The mid-inguinal point is MEDIAL to the mid-
point of the inguinal ligament
Inguinal hernia
Femoral hernia
F e m o r a
l v e
i n
Fem
oralnerve
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2130
wwwdoctorsacademyorg
Very important landmark
Mid-point between the ASIS to the pubic symphyis isMID-INGUINAL POINT ndash the femoral artery lies belowthis
Mid-point between the ASIS to the pubic tubercle isMID-POINT OF THE INGUINAL LIGAMENT ndash the deepinguinal ring lies here
Superficial inguinal ring (through which inguinalhernias emerge ) is above and medial to the pubictubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2230
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2330
wwwdoctorsacademyorg
Type of hernias
Inguinal hernias emergeabove and medial to the pubictubercle
Femoral hernias emergebelow and lateral to the pubic
tubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2430
wwwdoctorsacademyorg
Palpation
bullPosition yourself to the side of the patient
bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the
other supports the small of the back
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 830
wwwdoctorsacademyorg
Palpation
Can you get above it
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 930
wwwdoctorsacademyorg
If nohellip
Hernia
Infantile hydrocele
(rare)
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1030
wwwdoctorsacademyorg
If yeshellip
Testicular mass
EpididymalcystSpermatocoele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1130
wwwdoctorsacademyorg
Palpation
Can you feel the testicle separately
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1230
wwwdoctorsacademyorg
If nohellip
Hydrocelehaematocoele
Testicular neoplasia
Torsion
Orchitis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1330
wwwdoctorsacademyorg
If yeshellip
Hernia
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1430
wwwdoctorsacademyorg
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1530
wwwdoctorsacademyorg
Palpation
Does it transilluminate
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1630
wwwdoctorsacademyorg
If nohellip
Testicular tumour
Hernia
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1730
wwwdoctorsacademyorg
If yeshellip
Hydrocele Epidydimal cyst
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1830
wwwdoctorsacademyorg
If you think the swelling is an herniahellip
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1930
wwwdoctorsacademyorg
Palpation
bull Identify landmarks ASIS pubic tubercle and pubicsymphysis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2030
wwwdoctorsacademyorg
ASIS
PT
PS
M i d - p o i n t
o f t h e i n g
u i n a l l i g a m
e n t D e e p
i n g u i n a l r i n g ndash e
n t r y
p o i n t o f i n d i r e c
t i n g u i n a l
h e r n i a
M i d - i n g
u i n a l p o
i n t ( m i
d - p o i n t b e
t w e e n A
S I S
a n d P S
) - F e m o
r a l a r t e
r y I n g u i n a l
l i g a m e n t
ASIS ndash anterior superior iliac spine
PT ndash pubic tubercle
PS ndash pubic symphysis
The mid-inguinal point is MEDIAL to the mid-
point of the inguinal ligament
Inguinal hernia
Femoral hernia
F e m o r a
l v e
i n
Fem
oralnerve
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2130
wwwdoctorsacademyorg
Very important landmark
Mid-point between the ASIS to the pubic symphyis isMID-INGUINAL POINT ndash the femoral artery lies belowthis
Mid-point between the ASIS to the pubic tubercle isMID-POINT OF THE INGUINAL LIGAMENT ndash the deepinguinal ring lies here
Superficial inguinal ring (through which inguinalhernias emerge ) is above and medial to the pubictubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2230
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2330
wwwdoctorsacademyorg
Type of hernias
Inguinal hernias emergeabove and medial to the pubictubercle
Femoral hernias emergebelow and lateral to the pubic
tubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2430
wwwdoctorsacademyorg
Palpation
bullPosition yourself to the side of the patient
bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the
other supports the small of the back
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 930
wwwdoctorsacademyorg
If nohellip
Hernia
Infantile hydrocele
(rare)
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1030
wwwdoctorsacademyorg
If yeshellip
Testicular mass
EpididymalcystSpermatocoele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1130
wwwdoctorsacademyorg
Palpation
Can you feel the testicle separately
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1230
wwwdoctorsacademyorg
If nohellip
Hydrocelehaematocoele
Testicular neoplasia
Torsion
Orchitis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1330
wwwdoctorsacademyorg
If yeshellip
Hernia
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1430
wwwdoctorsacademyorg
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1530
wwwdoctorsacademyorg
Palpation
Does it transilluminate
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1630
wwwdoctorsacademyorg
If nohellip
Testicular tumour
Hernia
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1730
wwwdoctorsacademyorg
If yeshellip
Hydrocele Epidydimal cyst
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1830
wwwdoctorsacademyorg
If you think the swelling is an herniahellip
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1930
wwwdoctorsacademyorg
Palpation
bull Identify landmarks ASIS pubic tubercle and pubicsymphysis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2030
wwwdoctorsacademyorg
ASIS
PT
PS
M i d - p o i n t
o f t h e i n g
u i n a l l i g a m
e n t D e e p
i n g u i n a l r i n g ndash e
n t r y
p o i n t o f i n d i r e c
t i n g u i n a l
h e r n i a
M i d - i n g
u i n a l p o
i n t ( m i
d - p o i n t b e
t w e e n A
S I S
a n d P S
) - F e m o
r a l a r t e
r y I n g u i n a l
l i g a m e n t
ASIS ndash anterior superior iliac spine
PT ndash pubic tubercle
PS ndash pubic symphysis
The mid-inguinal point is MEDIAL to the mid-
point of the inguinal ligament
Inguinal hernia
Femoral hernia
F e m o r a
l v e
i n
Fem
oralnerve
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2130
wwwdoctorsacademyorg
Very important landmark
Mid-point between the ASIS to the pubic symphyis isMID-INGUINAL POINT ndash the femoral artery lies belowthis
Mid-point between the ASIS to the pubic tubercle isMID-POINT OF THE INGUINAL LIGAMENT ndash the deepinguinal ring lies here
Superficial inguinal ring (through which inguinalhernias emerge ) is above and medial to the pubictubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2230
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2330
wwwdoctorsacademyorg
Type of hernias
Inguinal hernias emergeabove and medial to the pubictubercle
Femoral hernias emergebelow and lateral to the pubic
tubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2430
wwwdoctorsacademyorg
Palpation
bullPosition yourself to the side of the patient
bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the
other supports the small of the back
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1030
wwwdoctorsacademyorg
If yeshellip
Testicular mass
EpididymalcystSpermatocoele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1130
wwwdoctorsacademyorg
Palpation
Can you feel the testicle separately
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1230
wwwdoctorsacademyorg
If nohellip
Hydrocelehaematocoele
Testicular neoplasia
Torsion
Orchitis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1330
wwwdoctorsacademyorg
If yeshellip
Hernia
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1430
wwwdoctorsacademyorg
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1530
wwwdoctorsacademyorg
Palpation
Does it transilluminate
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1630
wwwdoctorsacademyorg
If nohellip
Testicular tumour
Hernia
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1730
wwwdoctorsacademyorg
If yeshellip
Hydrocele Epidydimal cyst
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1830
wwwdoctorsacademyorg
If you think the swelling is an herniahellip
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1930
wwwdoctorsacademyorg
Palpation
bull Identify landmarks ASIS pubic tubercle and pubicsymphysis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2030
wwwdoctorsacademyorg
ASIS
PT
PS
M i d - p o i n t
o f t h e i n g
u i n a l l i g a m
e n t D e e p
i n g u i n a l r i n g ndash e
n t r y
p o i n t o f i n d i r e c
t i n g u i n a l
h e r n i a
M i d - i n g
u i n a l p o
i n t ( m i
d - p o i n t b e
t w e e n A
S I S
a n d P S
) - F e m o
r a l a r t e
r y I n g u i n a l
l i g a m e n t
ASIS ndash anterior superior iliac spine
PT ndash pubic tubercle
PS ndash pubic symphysis
The mid-inguinal point is MEDIAL to the mid-
point of the inguinal ligament
Inguinal hernia
Femoral hernia
F e m o r a
l v e
i n
Fem
oralnerve
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2130
wwwdoctorsacademyorg
Very important landmark
Mid-point between the ASIS to the pubic symphyis isMID-INGUINAL POINT ndash the femoral artery lies belowthis
Mid-point between the ASIS to the pubic tubercle isMID-POINT OF THE INGUINAL LIGAMENT ndash the deepinguinal ring lies here
Superficial inguinal ring (through which inguinalhernias emerge ) is above and medial to the pubictubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2230
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2330
wwwdoctorsacademyorg
Type of hernias
Inguinal hernias emergeabove and medial to the pubictubercle
Femoral hernias emergebelow and lateral to the pubic
tubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2430
wwwdoctorsacademyorg
Palpation
bullPosition yourself to the side of the patient
bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the
other supports the small of the back
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1130
wwwdoctorsacademyorg
Palpation
Can you feel the testicle separately
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1230
wwwdoctorsacademyorg
If nohellip
Hydrocelehaematocoele
Testicular neoplasia
Torsion
Orchitis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1330
wwwdoctorsacademyorg
If yeshellip
Hernia
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1430
wwwdoctorsacademyorg
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1530
wwwdoctorsacademyorg
Palpation
Does it transilluminate
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1630
wwwdoctorsacademyorg
If nohellip
Testicular tumour
Hernia
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1730
wwwdoctorsacademyorg
If yeshellip
Hydrocele Epidydimal cyst
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1830
wwwdoctorsacademyorg
If you think the swelling is an herniahellip
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1930
wwwdoctorsacademyorg
Palpation
bull Identify landmarks ASIS pubic tubercle and pubicsymphysis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2030
wwwdoctorsacademyorg
ASIS
PT
PS
M i d - p o i n t
o f t h e i n g
u i n a l l i g a m
e n t D e e p
i n g u i n a l r i n g ndash e
n t r y
p o i n t o f i n d i r e c
t i n g u i n a l
h e r n i a
M i d - i n g
u i n a l p o
i n t ( m i
d - p o i n t b e
t w e e n A
S I S
a n d P S
) - F e m o
r a l a r t e
r y I n g u i n a l
l i g a m e n t
ASIS ndash anterior superior iliac spine
PT ndash pubic tubercle
PS ndash pubic symphysis
The mid-inguinal point is MEDIAL to the mid-
point of the inguinal ligament
Inguinal hernia
Femoral hernia
F e m o r a
l v e
i n
Fem
oralnerve
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2130
wwwdoctorsacademyorg
Very important landmark
Mid-point between the ASIS to the pubic symphyis isMID-INGUINAL POINT ndash the femoral artery lies belowthis
Mid-point between the ASIS to the pubic tubercle isMID-POINT OF THE INGUINAL LIGAMENT ndash the deepinguinal ring lies here
Superficial inguinal ring (through which inguinalhernias emerge ) is above and medial to the pubictubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2230
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2330
wwwdoctorsacademyorg
Type of hernias
Inguinal hernias emergeabove and medial to the pubictubercle
Femoral hernias emergebelow and lateral to the pubic
tubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2430
wwwdoctorsacademyorg
Palpation
bullPosition yourself to the side of the patient
bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the
other supports the small of the back
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1230
wwwdoctorsacademyorg
If nohellip
Hydrocelehaematocoele
Testicular neoplasia
Torsion
Orchitis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1330
wwwdoctorsacademyorg
If yeshellip
Hernia
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1430
wwwdoctorsacademyorg
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1530
wwwdoctorsacademyorg
Palpation
Does it transilluminate
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1630
wwwdoctorsacademyorg
If nohellip
Testicular tumour
Hernia
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1730
wwwdoctorsacademyorg
If yeshellip
Hydrocele Epidydimal cyst
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1830
wwwdoctorsacademyorg
If you think the swelling is an herniahellip
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1930
wwwdoctorsacademyorg
Palpation
bull Identify landmarks ASIS pubic tubercle and pubicsymphysis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2030
wwwdoctorsacademyorg
ASIS
PT
PS
M i d - p o i n t
o f t h e i n g
u i n a l l i g a m
e n t D e e p
i n g u i n a l r i n g ndash e
n t r y
p o i n t o f i n d i r e c
t i n g u i n a l
h e r n i a
M i d - i n g
u i n a l p o
i n t ( m i
d - p o i n t b e
t w e e n A
S I S
a n d P S
) - F e m o
r a l a r t e
r y I n g u i n a l
l i g a m e n t
ASIS ndash anterior superior iliac spine
PT ndash pubic tubercle
PS ndash pubic symphysis
The mid-inguinal point is MEDIAL to the mid-
point of the inguinal ligament
Inguinal hernia
Femoral hernia
F e m o r a
l v e
i n
Fem
oralnerve
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2130
wwwdoctorsacademyorg
Very important landmark
Mid-point between the ASIS to the pubic symphyis isMID-INGUINAL POINT ndash the femoral artery lies belowthis
Mid-point between the ASIS to the pubic tubercle isMID-POINT OF THE INGUINAL LIGAMENT ndash the deepinguinal ring lies here
Superficial inguinal ring (through which inguinalhernias emerge ) is above and medial to the pubictubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2230
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2330
wwwdoctorsacademyorg
Type of hernias
Inguinal hernias emergeabove and medial to the pubictubercle
Femoral hernias emergebelow and lateral to the pubic
tubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2430
wwwdoctorsacademyorg
Palpation
bullPosition yourself to the side of the patient
bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the
other supports the small of the back
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1330
wwwdoctorsacademyorg
If yeshellip
Hernia
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1430
wwwdoctorsacademyorg
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1530
wwwdoctorsacademyorg
Palpation
Does it transilluminate
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1630
wwwdoctorsacademyorg
If nohellip
Testicular tumour
Hernia
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1730
wwwdoctorsacademyorg
If yeshellip
Hydrocele Epidydimal cyst
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1830
wwwdoctorsacademyorg
If you think the swelling is an herniahellip
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1930
wwwdoctorsacademyorg
Palpation
bull Identify landmarks ASIS pubic tubercle and pubicsymphysis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2030
wwwdoctorsacademyorg
ASIS
PT
PS
M i d - p o i n t
o f t h e i n g
u i n a l l i g a m
e n t D e e p
i n g u i n a l r i n g ndash e
n t r y
p o i n t o f i n d i r e c
t i n g u i n a l
h e r n i a
M i d - i n g
u i n a l p o
i n t ( m i
d - p o i n t b e
t w e e n A
S I S
a n d P S
) - F e m o
r a l a r t e
r y I n g u i n a l
l i g a m e n t
ASIS ndash anterior superior iliac spine
PT ndash pubic tubercle
PS ndash pubic symphysis
The mid-inguinal point is MEDIAL to the mid-
point of the inguinal ligament
Inguinal hernia
Femoral hernia
F e m o r a
l v e
i n
Fem
oralnerve
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2130
wwwdoctorsacademyorg
Very important landmark
Mid-point between the ASIS to the pubic symphyis isMID-INGUINAL POINT ndash the femoral artery lies belowthis
Mid-point between the ASIS to the pubic tubercle isMID-POINT OF THE INGUINAL LIGAMENT ndash the deepinguinal ring lies here
Superficial inguinal ring (through which inguinalhernias emerge ) is above and medial to the pubictubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2230
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2330
wwwdoctorsacademyorg
Type of hernias
Inguinal hernias emergeabove and medial to the pubictubercle
Femoral hernias emergebelow and lateral to the pubic
tubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2430
wwwdoctorsacademyorg
Palpation
bullPosition yourself to the side of the patient
bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the
other supports the small of the back
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1430
wwwdoctorsacademyorg
Varicocele
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1530
wwwdoctorsacademyorg
Palpation
Does it transilluminate
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1630
wwwdoctorsacademyorg
If nohellip
Testicular tumour
Hernia
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1730
wwwdoctorsacademyorg
If yeshellip
Hydrocele Epidydimal cyst
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1830
wwwdoctorsacademyorg
If you think the swelling is an herniahellip
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1930
wwwdoctorsacademyorg
Palpation
bull Identify landmarks ASIS pubic tubercle and pubicsymphysis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2030
wwwdoctorsacademyorg
ASIS
PT
PS
M i d - p o i n t
o f t h e i n g
u i n a l l i g a m
e n t D e e p
i n g u i n a l r i n g ndash e
n t r y
p o i n t o f i n d i r e c
t i n g u i n a l
h e r n i a
M i d - i n g
u i n a l p o
i n t ( m i
d - p o i n t b e
t w e e n A
S I S
a n d P S
) - F e m o
r a l a r t e
r y I n g u i n a l
l i g a m e n t
ASIS ndash anterior superior iliac spine
PT ndash pubic tubercle
PS ndash pubic symphysis
The mid-inguinal point is MEDIAL to the mid-
point of the inguinal ligament
Inguinal hernia
Femoral hernia
F e m o r a
l v e
i n
Fem
oralnerve
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2130
wwwdoctorsacademyorg
Very important landmark
Mid-point between the ASIS to the pubic symphyis isMID-INGUINAL POINT ndash the femoral artery lies belowthis
Mid-point between the ASIS to the pubic tubercle isMID-POINT OF THE INGUINAL LIGAMENT ndash the deepinguinal ring lies here
Superficial inguinal ring (through which inguinalhernias emerge ) is above and medial to the pubictubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2230
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2330
wwwdoctorsacademyorg
Type of hernias
Inguinal hernias emergeabove and medial to the pubictubercle
Femoral hernias emergebelow and lateral to the pubic
tubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2430
wwwdoctorsacademyorg
Palpation
bullPosition yourself to the side of the patient
bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the
other supports the small of the back
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1530
wwwdoctorsacademyorg
Palpation
Does it transilluminate
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1630
wwwdoctorsacademyorg
If nohellip
Testicular tumour
Hernia
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1730
wwwdoctorsacademyorg
If yeshellip
Hydrocele Epidydimal cyst
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1830
wwwdoctorsacademyorg
If you think the swelling is an herniahellip
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1930
wwwdoctorsacademyorg
Palpation
bull Identify landmarks ASIS pubic tubercle and pubicsymphysis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2030
wwwdoctorsacademyorg
ASIS
PT
PS
M i d - p o i n t
o f t h e i n g
u i n a l l i g a m
e n t D e e p
i n g u i n a l r i n g ndash e
n t r y
p o i n t o f i n d i r e c
t i n g u i n a l
h e r n i a
M i d - i n g
u i n a l p o
i n t ( m i
d - p o i n t b e
t w e e n A
S I S
a n d P S
) - F e m o
r a l a r t e
r y I n g u i n a l
l i g a m e n t
ASIS ndash anterior superior iliac spine
PT ndash pubic tubercle
PS ndash pubic symphysis
The mid-inguinal point is MEDIAL to the mid-
point of the inguinal ligament
Inguinal hernia
Femoral hernia
F e m o r a
l v e
i n
Fem
oralnerve
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2130
wwwdoctorsacademyorg
Very important landmark
Mid-point between the ASIS to the pubic symphyis isMID-INGUINAL POINT ndash the femoral artery lies belowthis
Mid-point between the ASIS to the pubic tubercle isMID-POINT OF THE INGUINAL LIGAMENT ndash the deepinguinal ring lies here
Superficial inguinal ring (through which inguinalhernias emerge ) is above and medial to the pubictubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2230
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2330
wwwdoctorsacademyorg
Type of hernias
Inguinal hernias emergeabove and medial to the pubictubercle
Femoral hernias emergebelow and lateral to the pubic
tubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2430
wwwdoctorsacademyorg
Palpation
bullPosition yourself to the side of the patient
bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the
other supports the small of the back
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1630
wwwdoctorsacademyorg
If nohellip
Testicular tumour
Hernia
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1730
wwwdoctorsacademyorg
If yeshellip
Hydrocele Epidydimal cyst
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1830
wwwdoctorsacademyorg
If you think the swelling is an herniahellip
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1930
wwwdoctorsacademyorg
Palpation
bull Identify landmarks ASIS pubic tubercle and pubicsymphysis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2030
wwwdoctorsacademyorg
ASIS
PT
PS
M i d - p o i n t
o f t h e i n g
u i n a l l i g a m
e n t D e e p
i n g u i n a l r i n g ndash e
n t r y
p o i n t o f i n d i r e c
t i n g u i n a l
h e r n i a
M i d - i n g
u i n a l p o
i n t ( m i
d - p o i n t b e
t w e e n A
S I S
a n d P S
) - F e m o
r a l a r t e
r y I n g u i n a l
l i g a m e n t
ASIS ndash anterior superior iliac spine
PT ndash pubic tubercle
PS ndash pubic symphysis
The mid-inguinal point is MEDIAL to the mid-
point of the inguinal ligament
Inguinal hernia
Femoral hernia
F e m o r a
l v e
i n
Fem
oralnerve
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2130
wwwdoctorsacademyorg
Very important landmark
Mid-point between the ASIS to the pubic symphyis isMID-INGUINAL POINT ndash the femoral artery lies belowthis
Mid-point between the ASIS to the pubic tubercle isMID-POINT OF THE INGUINAL LIGAMENT ndash the deepinguinal ring lies here
Superficial inguinal ring (through which inguinalhernias emerge ) is above and medial to the pubictubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2230
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2330
wwwdoctorsacademyorg
Type of hernias
Inguinal hernias emergeabove and medial to the pubictubercle
Femoral hernias emergebelow and lateral to the pubic
tubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2430
wwwdoctorsacademyorg
Palpation
bullPosition yourself to the side of the patient
bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the
other supports the small of the back
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1730
wwwdoctorsacademyorg
If yeshellip
Hydrocele Epidydimal cyst
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1830
wwwdoctorsacademyorg
If you think the swelling is an herniahellip
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1930
wwwdoctorsacademyorg
Palpation
bull Identify landmarks ASIS pubic tubercle and pubicsymphysis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2030
wwwdoctorsacademyorg
ASIS
PT
PS
M i d - p o i n t
o f t h e i n g
u i n a l l i g a m
e n t D e e p
i n g u i n a l r i n g ndash e
n t r y
p o i n t o f i n d i r e c
t i n g u i n a l
h e r n i a
M i d - i n g
u i n a l p o
i n t ( m i
d - p o i n t b e
t w e e n A
S I S
a n d P S
) - F e m o
r a l a r t e
r y I n g u i n a l
l i g a m e n t
ASIS ndash anterior superior iliac spine
PT ndash pubic tubercle
PS ndash pubic symphysis
The mid-inguinal point is MEDIAL to the mid-
point of the inguinal ligament
Inguinal hernia
Femoral hernia
F e m o r a
l v e
i n
Fem
oralnerve
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2130
wwwdoctorsacademyorg
Very important landmark
Mid-point between the ASIS to the pubic symphyis isMID-INGUINAL POINT ndash the femoral artery lies belowthis
Mid-point between the ASIS to the pubic tubercle isMID-POINT OF THE INGUINAL LIGAMENT ndash the deepinguinal ring lies here
Superficial inguinal ring (through which inguinalhernias emerge ) is above and medial to the pubictubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2230
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2330
wwwdoctorsacademyorg
Type of hernias
Inguinal hernias emergeabove and medial to the pubictubercle
Femoral hernias emergebelow and lateral to the pubic
tubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2430
wwwdoctorsacademyorg
Palpation
bullPosition yourself to the side of the patient
bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the
other supports the small of the back
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1830
wwwdoctorsacademyorg
If you think the swelling is an herniahellip
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1930
wwwdoctorsacademyorg
Palpation
bull Identify landmarks ASIS pubic tubercle and pubicsymphysis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2030
wwwdoctorsacademyorg
ASIS
PT
PS
M i d - p o i n t
o f t h e i n g
u i n a l l i g a m
e n t D e e p
i n g u i n a l r i n g ndash e
n t r y
p o i n t o f i n d i r e c
t i n g u i n a l
h e r n i a
M i d - i n g
u i n a l p o
i n t ( m i
d - p o i n t b e
t w e e n A
S I S
a n d P S
) - F e m o
r a l a r t e
r y I n g u i n a l
l i g a m e n t
ASIS ndash anterior superior iliac spine
PT ndash pubic tubercle
PS ndash pubic symphysis
The mid-inguinal point is MEDIAL to the mid-
point of the inguinal ligament
Inguinal hernia
Femoral hernia
F e m o r a
l v e
i n
Fem
oralnerve
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2130
wwwdoctorsacademyorg
Very important landmark
Mid-point between the ASIS to the pubic symphyis isMID-INGUINAL POINT ndash the femoral artery lies belowthis
Mid-point between the ASIS to the pubic tubercle isMID-POINT OF THE INGUINAL LIGAMENT ndash the deepinguinal ring lies here
Superficial inguinal ring (through which inguinalhernias emerge ) is above and medial to the pubictubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2230
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2330
wwwdoctorsacademyorg
Type of hernias
Inguinal hernias emergeabove and medial to the pubictubercle
Femoral hernias emergebelow and lateral to the pubic
tubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2430
wwwdoctorsacademyorg
Palpation
bullPosition yourself to the side of the patient
bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the
other supports the small of the back
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 1930
wwwdoctorsacademyorg
Palpation
bull Identify landmarks ASIS pubic tubercle and pubicsymphysis
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2030
wwwdoctorsacademyorg
ASIS
PT
PS
M i d - p o i n t
o f t h e i n g
u i n a l l i g a m
e n t D e e p
i n g u i n a l r i n g ndash e
n t r y
p o i n t o f i n d i r e c
t i n g u i n a l
h e r n i a
M i d - i n g
u i n a l p o
i n t ( m i
d - p o i n t b e
t w e e n A
S I S
a n d P S
) - F e m o
r a l a r t e
r y I n g u i n a l
l i g a m e n t
ASIS ndash anterior superior iliac spine
PT ndash pubic tubercle
PS ndash pubic symphysis
The mid-inguinal point is MEDIAL to the mid-
point of the inguinal ligament
Inguinal hernia
Femoral hernia
F e m o r a
l v e
i n
Fem
oralnerve
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2130
wwwdoctorsacademyorg
Very important landmark
Mid-point between the ASIS to the pubic symphyis isMID-INGUINAL POINT ndash the femoral artery lies belowthis
Mid-point between the ASIS to the pubic tubercle isMID-POINT OF THE INGUINAL LIGAMENT ndash the deepinguinal ring lies here
Superficial inguinal ring (through which inguinalhernias emerge ) is above and medial to the pubictubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2230
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2330
wwwdoctorsacademyorg
Type of hernias
Inguinal hernias emergeabove and medial to the pubictubercle
Femoral hernias emergebelow and lateral to the pubic
tubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2430
wwwdoctorsacademyorg
Palpation
bullPosition yourself to the side of the patient
bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the
other supports the small of the back
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2030
wwwdoctorsacademyorg
ASIS
PT
PS
M i d - p o i n t
o f t h e i n g
u i n a l l i g a m
e n t D e e p
i n g u i n a l r i n g ndash e
n t r y
p o i n t o f i n d i r e c
t i n g u i n a l
h e r n i a
M i d - i n g
u i n a l p o
i n t ( m i
d - p o i n t b e
t w e e n A
S I S
a n d P S
) - F e m o
r a l a r t e
r y I n g u i n a l
l i g a m e n t
ASIS ndash anterior superior iliac spine
PT ndash pubic tubercle
PS ndash pubic symphysis
The mid-inguinal point is MEDIAL to the mid-
point of the inguinal ligament
Inguinal hernia
Femoral hernia
F e m o r a
l v e
i n
Fem
oralnerve
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2130
wwwdoctorsacademyorg
Very important landmark
Mid-point between the ASIS to the pubic symphyis isMID-INGUINAL POINT ndash the femoral artery lies belowthis
Mid-point between the ASIS to the pubic tubercle isMID-POINT OF THE INGUINAL LIGAMENT ndash the deepinguinal ring lies here
Superficial inguinal ring (through which inguinalhernias emerge ) is above and medial to the pubictubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2230
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2330
wwwdoctorsacademyorg
Type of hernias
Inguinal hernias emergeabove and medial to the pubictubercle
Femoral hernias emergebelow and lateral to the pubic
tubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2430
wwwdoctorsacademyorg
Palpation
bullPosition yourself to the side of the patient
bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the
other supports the small of the back
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2130
wwwdoctorsacademyorg
Very important landmark
Mid-point between the ASIS to the pubic symphyis isMID-INGUINAL POINT ndash the femoral artery lies belowthis
Mid-point between the ASIS to the pubic tubercle isMID-POINT OF THE INGUINAL LIGAMENT ndash the deepinguinal ring lies here
Superficial inguinal ring (through which inguinalhernias emerge ) is above and medial to the pubictubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2230
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2330
wwwdoctorsacademyorg
Type of hernias
Inguinal hernias emergeabove and medial to the pubictubercle
Femoral hernias emergebelow and lateral to the pubic
tubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2430
wwwdoctorsacademyorg
Palpation
bullPosition yourself to the side of the patient
bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the
other supports the small of the back
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2230
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2330
wwwdoctorsacademyorg
Type of hernias
Inguinal hernias emergeabove and medial to the pubictubercle
Femoral hernias emergebelow and lateral to the pubic
tubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2430
wwwdoctorsacademyorg
Palpation
bullPosition yourself to the side of the patient
bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the
other supports the small of the back
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2330
wwwdoctorsacademyorg
Type of hernias
Inguinal hernias emergeabove and medial to the pubictubercle
Femoral hernias emergebelow and lateral to the pubic
tubercle
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2430
wwwdoctorsacademyorg
Palpation
bullPosition yourself to the side of the patient
bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the
other supports the small of the back
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2430
wwwdoctorsacademyorg
Palpation
bullPosition yourself to the side of the patient
bull Use flat of palpating hand on the groin(parallel to the inguinal ligament) while the
other supports the small of the back
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2530
wwwdoctorsacademyorg
Hernia
Cough impulse (not always) Ask patient to reduce it you try if patient
unable
Once reduced Press over external ring ndash cough
Controlled-inguinal hernia
Not controlled ndash femoral hernia
Press over deep ring ndashcough Controlled ndash indirect (80)
Not controlled ndash direct (20)
If you canrsquot reduce it move on
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2630
wwwdoctorsacademyorg
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2730
wwwdoctorsacademyorg
Offer if appropriate
Other groin
Abdominal examination
Per-rectal examination
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2830
wwwdoctorsacademyorg
Finallyhellip
SUMMARY SENTENCE AND
DIAGNOSIS
d t d
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 2930
wwwdoctorsacademyorg
Groin lumpwhat it could be
Hernia Lymphnode
Saphena varix
Ectopic testis
Femoral aneurysm
Hydrocoele
Lipoma of the cord
Psoas abscess
983140 983156 983140
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you
8222019 Hernia and Scrotum
httpslidepdfcomreaderfullhernia-and-scrotum 3030
983159983159983159983086983140983151983139983156983151983154983155983137983139983137983140983141983149983161983086983151983154983143
Thank you