Inguinal Hernia Examination

Inguinal Hernia

supine or standing စမ္း ႏိုင္ ေပ မယ့္ Supine နဲ ့ ပဲ စမ္း သင့္ ပါ တယ္ ။
nipple line to mid thigh အထိ ျမင္ ရ ေအာင္ အ ၀တ္ ခြ်တ္ ပါ။

Inspection : Swelling : Site- in inguinoscrotal region ( R / L )
Extent - completely reach to bottom of scrotum / not
Size - ___ x __ x__ cm in greatest dimention
Shape - Pyriform shape ( unilatral ပဲ ျဖစ္ ေလ့ ရ77777ွိ )
Spherical shape ( bilateral ျဖစ္ ေလ့ ရွိ )
Surface - smooth

ေခါင္းဟို ဘက္ လွည့္ ေခ်ာင္ း ဆိုး ပါ ( ၂ ခါ ) : visible cough impulse ( + / -)
On other side has visiblecough impulse ( + / -) -) cough impulse ( + / - )

Skin over swelling : Peristalsis waves
Atrophy
Scar
Signs of inflammation
Dilated veins
Rugaes

Penis : deviated to other side

Palpation : Temperature
Tenderness

Finger cannot get above swelling ( There is sparmatic cord and other structures )
Swelling ( describe and confirm the inspection အတိ အ က် ထပ္ ေျပာ ပါ။ )
Consistancy : soft and cystic ( small intestine မို ့)
Firm and elastic ( intestine )
Doughy ( Omentum )

Reducibility Test - Swelling is reducible with gargling sound
ျပန္ သြင္း လိုက္ ၿပီး ေခ်ာင္း ဆိုး ခိုင္း ၿပီး စမ္း ပါ - Palpable cough impalse ( + )
..........ဒီ ၂ ခု က Superficial Ring ၿဖစ္ ေၾကာင္း ျပ တာပဲ ။..........

Deep ring occulusion test - swelling appear / not
(( DRO ကို Indentify with MARKER ( ASIS , Pubic Symphisis , Pubic Tubercle , Deepring ) လုပ္ ၿပီး မွ စမ္း ျပ ပါ ။ ))

Three fingers Test - Impulse felt at Index finger ( Indirect Inguinal Hernia လို ့ သိ ရ ၿပီ ) or
Middle finger ( Direct Inguinal Hernia လို ့ သိ ရ ၿပီ ) or
Ring finger ( Femoral Inguinal Hernia လို ့ သိ ရ ၿပီ )

Little Finger Invagination Test - impalse felt on Tip of figer ( Indirect Inguinal Hernia ) or
Palp of finger ( direct Inguinal Hernia )


Testes : felt separetly from swelling
Normal size and shape


Percussion : Resonance ( intestine ) or
Dull ( Omentum )

Auscultation : Bowel sound present in hernia

ဘာ ဆက္ စမ္း ခ်င္ ေသး လဲ ေမး ရ င္ Abdomen ( increase intra abdominal pressure by free fluid ,scar , mass သိခ်င္ လို ့ )
PR Examination( benign prostatic hyperplasia ရွိ မ ရွိ သိ ခ်င္လို ့ )
Chest ( cough ရ တတ္ လို ့)
စမ္း သင့္ ပါ တယ္ လို ့ ေျဖ ပါ ။



Diagnosis : R / L Bilateral
complete incomplete
reducible unreducible
*** indirect direct
inguinal hernia of
entrocele type or intestinal type
with nocomplicaton or complicatoin


Point for diagnosis : male
swelling in inguinoscrotal region
painless
pyriform / spherical
cannot get above swelling
reducible and cough impulse present
results of 3 tests


Diferential Diagnosis : indirect inguinal hernia ( pyriform shape )
direct inguinal hernia ( spherical shape)
femoral hernia ( retort shape )
vaginal hernia ( canget above swelling )

spermatocele
varicocele
psoas abscess ( cold abscess , TB )
inguinal lymph node( firm in consistancy and more tha none swelling )

Epididymal cyst ( multiple cystic lesion )

တျခား သိ ထာ း သင့္ တာ ေတြ ကို ဒီမွာ ေရ း ထား တယ္ ။