General Examination
• Patient conscious, cooperative and oriented to time, place and person.
• Examined in a well-lit room after obtaining verbal consent.
• Examination performed in both standing and lying positions.
• Pulse: ___/min.
• Blood Pressure: ___ mmHg.
• Respiratory Rate: ___/min.
• Temperature: ___°C.
• BMI: ___.
• Pallor: Present/Absent.
• Icterus: Present/Absent.
• Cyanosis: Present/Absent.
• Clubbing: Present/Absent.
• Lymphadenopathy: Present/Absent.
• Pedal edema: Present/Absent.
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Inspection
Swelling present in ______ region (right/left inguinal, femoral, umbilical, epigastric, incisional, etc.).
Size approximately _ × _ cm.
Extent: From ______ to ______ (Inguinal region till base of scrotum)
Overlying skin normal/erythematous.
scar/sinus/dilated veins/ulceration.
Any other Positive inspection findings
Swelling becomes more prominent on standing, coughing?
Swelling reduces/disappears on lying down.
Expansile cough impulse present/absent.
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Palpation
Inspection findings confirmed on palpation.
Local rise of temperature: Present/Absent.
Tenderness: Present/Absent.
Size approximately _ × _ cm.
Surface: Smooth/Irregular.
Margins: Well-defined/Ill-defined.
Consistency: Soft/Firm.
Swelling reducible/irreducible.
Expansile cough impulse present/absent.
Get above the swelling :present/absent.
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After Reduction
Hernial defect size approximately ___ cm.
Margins of defect: ______.
Deep Ring Occlusion Test
Positive/negative
Swelling reappears spontaneously/on coughing/on standing.
Direction of reduction: ______.
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Special Tests
Deep Ring Occlusion Test: Positive/Negative.
Ring Invagination Test: Positive/Negative.
Zieman’s Three-Finger Test suggestive of ______ hernia.
Reducibility assessed.
Cough impulse assessed.
Other special tests performed as required.
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Examination of External Genitalia
External genitalia normal.
Both testes palpable separately.
Testes normal in size, position and consistency.
Spermatic cord normal.
No hydrocele.
No varicocele.
No other scrotal pathology.
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Opposite Groin Examination
No visible swelling.
No palpable swelling.
No evidence of hernia.
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Abdominal Examination
No other visible abdominal swelling.
No tenderness.
No guarding.
No rigidity.
Contralateral hernial orifices normal.
No evidence of ascites.
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Regional Lymph Nodes
Inguinal lymph nodes palpable/non-palpable.
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Systemic Examination
Cardiovascular System (CVS)
S1 and S2 heard normally.
No added sounds/murmurs.
Respiratory System (RS)
Bilateral equal air entry present.
No added sounds.
Abdomen
Soft and non-tender.
No organomegaly.
Bowel sounds normal.
📋 Hernia Case Presentation
The patient was conscious and oriented to time, place and person. He/She was examined in a well-lit room, adequately exposed, in standing and lying positions, after taking verbal consent.
General physical examination revealed pulse _/min, blood pressure _ mmHg, respiratory rate _/min, temperature ___°C and BMI _. Pallor/Icterus/Cyanosis/Clubbing/Lymphadenopathy/Pedal edema were present or absent accordingly.
On local examination of the abdomen and groin, a solitary globular swelling of size approximately ___ × ___ cm is present in the ______ region (right/left inguinal, femoral, umbilical, epigastric, incisional, etc.), extending from ______ to ______. The overlying skin is normal/erythematous and showed no scars, sinuses, dilated veins or ulceration.
The swelling became more prominent on standing and coughing and reduced/disappeared on lying down. An expansile cough impulse is present/absent.
My inspection findings are confirmed by palpation. A solitary globular lump of size ___ × ___ cm is present in ______ region, extending from____ to ____, having ______ surface, ______ margins and ______ consistency, non tender, no local rise in temperature. The swelling is reducible/irreducible and an expansile cough impulse is present/absent.
After reducion of Swelling, the swelling reappeared spontaneously/on coughing/on standing. The direction of reduction was ______.
Deep ring occlusion test was positive/negative. Ring invagination test was positive/negative. Zieman’s three-finger test suggested ______ hernia.
The external genitalia were normal. Both testes were palpable separately and normal in size, position and consistency. The spermatic cord was normal. There was no hydrocele, varicocele or other scrotal pathology.
The opposite groin showed no visible or palpable swelling and no evidence of hernia.
Examination of the abdomen revealed no other visible swellings. There was no tenderness, guarding or rigidity. Hernial orifices on the opposite side were normal. No evidence of ascites was present.
Examination of regional lymph nodes revealed palpable/non-palpable inguinal lymph nodes.
On systemic examination, CVS revealed normal S1 and S2. Respiratory system showed bilateral air entry with no added sounds. Abdomen was soft and non-tender with no organomegaly. Bowel sounds were normal.
In summary, this is a case of a ______ hernia on the ______ side, presenting as a reducible/irreducible, uncomplicated/obstructed/strangulated swelling with positive/negative cough impulse and no evidence of complications.
🩺 Common Closing Diagnoses
- Right indirect inguinal hernia, reducible and uncomplicated.
- Left direct inguinal hernia, reducible and uncomplicated.
- Right inguinoscrotal hernia, reducible and uncomplicated.
- Left inguinoscrotal hernia, reducible and uncomplicated.
- Umbilical hernia, reducible and uncomplicated.
- Paraumbilical hernia, reducible and uncomplicated.
- Epigastric hernia, reducible and uncomplicated.
- Femoral hernia.
- Incisional hernia over a previous operative scar.
- Obstructed inguinal hernia requiring urgent surgical management.
- Strangulated inguinal hernia requiring emergency surgery.
🎤 One-Line Exam Case Presentation
“This is a ______ hernia on the ______ side presenting as a swelling measuring approximately _ × _ cm, which is reducible/irreducible with positive/negative cough impulse, clinically suggestive of an uncomplicated/obstructed/strangulated hernia.”
🎓 Special Tests Viva Recall
- Deep Ring Occlusion Test Positive → Indirect Inguinal Hernia
- Deep Ring Occlusion Test Negative → Direct Inguinal Hernia
- Ring Invagination Test Positive → Inguinal Hernia Present
- Zieman’s Three-Finger Test → Helps differentiate Direct, Indirect and Femoral Hernia
- Expansile Cough Impulse Present → Reducible Hernia
- Absent Cough Impulse → Obstructed or Strangulated Hernia
- Reducibility Present → Uncomplicated Hernia
- Irreducibility with Tenderness → Obstructed/Strangulated Hernia
🔍 Differential Diagnosis of Groin Swelling
- Inguinal Hernia
- Femoral Hernia
- Hydrocele of Spermatic Cord
- Undescended Testis
- Lipoma of Spermatic Cord
- Inguinal Lymphadenopathy
- Saphena Varix
- Psoas Abscess
- Femoral Artery Aneurysm
- Encysted Hydrocele of Cord
