Quantcast Figure 3-10. Palpation of an inguinal hernia. - The Gastrointestinal System

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d. Diagnosis. An inguinal hernia is usually diagnosed by examination rather
than by patient history. Begin by asking the patient to stand while you sit. Perform an
inspection by examination. Look at the inguinal area carefully for bulges. While you
continue looking, ask the patient to strain down. Next, examine by palpation. Use your
right hand when palpating the patient's right side and your left hand when palpating the
patient's left side. Place the index finger of the hand you are using inside the loose
scrotal skin as shown in figure 3-10. Beginning at a point low enough so that your finger
can move with ease, follow the spermatic cord upward to the triangular slit-like opening
of the external inguinal ring. You may be able to put your finger through the inguinal
ring if it is somewhat enlarged. Gently, move your finger, if possible, along the inguinal
canal. Have your finger either at the external ring or in the inguinal canal and ask the
patient to cough or strain down. Feel for any palpable herniating mass as it touches
your finger.
Figure 3-10. Palpation of an inguinal hernia.
e. Treatment. Generally, whether or not an inguinal hernia hurts, it is a
potential hazard and requires surgical correction. A piece of intestine can be trapped in
the bulge. The protruding intestine may swell and/or the hole through which it has
protruded may get smaller making it impossible for the organ to move back into the
abdominal cavity. The hernia is then called an incarcerated hernia. Of a more serious
nature is a strangulated hernia. If the incarcerated hernia does not receive prompt
surgical attention, the hole through which the organ protrudes can become so tight that
the blood supply to the protruding intestine is cut off. This can lead to death of the
tissue and subsequent death of the patient unless emergency surgery is performed
resectioning the entrapped intestine. (The part of the intestine caught in the opening is
removed and the rest of the intestine connected.) It is much better to repair a hernia on
a nonemergency basis, if possible.

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