When hernia is present note the location, size, contents, reducibility and tenderness.
- Inguinal Hernia:
- Indirect: Herniation through Inguinal canal. Large scrotal mass, cannot get fingers above the mass suggesting extension from abdomen. In women the swelling in the labia majora and upward to lateral to the pubic tubercle.
- Femoral Hernia: Swelling over femoral canal.
- Percussion and auscultation helps in determining the contents of hernia. Bowel is resonant. Omentum and organs are dull. Hernial sac often contains both. Bowel sounds can be heard over the mass.
- Apply gentle pressure in the supine position to reduce hernia. The patient himself can reduce the hernia most often. Do not attempt to reduce the hernia that is painful, tender and is associated with vomiting.
- Uncomplicated hernia: Increases in size with any attempt at increase of intra-abdominal pressure like cough or straining. Soft, resonant and usually easily reducible.
- Strangulated hernia. Painful, tender and irreducible.