Hernia

– History Taking
- Dr. Ankit Chandra


1. Patient details
• Name –
• Age – (child/young/old)
• Gender - male/female
• Occupation – sternous labour ? / heavy weight lifter
• Educated up to –
• Hailing from (address) –

2. Chief complain
• Swelling in the Right inguinal region/groin for ____ months
• Pain in Right inguinal swelling for ____ days


3. History of presenting illness (HOPI)
• Patient was apparently well ___ months back , when he noticed a swelling in the
Right/left inguinal region while straining/etc.
• Onset of the swelling - gradual
• It was a small Swelling was started at ____ (groin/scrotum ) ____months back
and now has reached till _____ (groin/scrotum ) to present size.
• Aggravates – on straining/standing/cough/walking
• Swelling is reducible ?? Or initially reducible now its irreducible ?
• Relieves – by lying down/manually by himself
• Associated with pain ?
• History of any swelling on the other side ?

HERNIA HISTORY & EXAMINATION | Dr. Ankit Chandra

 3a) History of Pain
• Onset – sudden/ gradual
• Site –
• Duration
• Nature of pain – dragging/dull aching / colicky
• Radiation –
• Aggravating Factor - pain increases with straining
• Relieving Factor – relieved on lying down.
• Associated with vomiting / fever ?


3b) H/O Complications
1. Irreducibility (adhesions between omentum/sac/contents/ crowding of content)
2. Intestinal Obstruction (Irreducible mass, due to adhesions )
Severe Colicky abd. Pain + Vomiting + Abd. Distension + Obstipation
3. Strangulation (compression of veins - due to odema –constriction of artery - Gangrene)
Irreducible + Inc. in size +sudden, severe pain (tense & tender)

3c) History of precipitating factor
• Chronic cough /bronchitis/asthma /TB / ascites
• Benign Prostatic hyperplasia (BPH) - obstructive Urinary symptoms – dribbling of urine ,
narrowing of stream , feeling of incomplete voiding
• H/o Urine stricture/ retention – dysuria/anuria ?
• Chronic constipation/straining at stools – habitual /left colon ca.
• Weightlifting


4. Past History
• H/O DM/ HTN / CAD _____ for how many years ? On which medications ?
• H/o asthma / bronchitis / TB
• Any history of similar swelling in the same or opposite side.

HERNIA HISTORY & EXAMINATION | Dr. Ankit Chandra

 • Previous h/o of appendix/kidney/LSCS surgery (incision/drain)


5. Family history
• Any Family history of connective tissue disorder ?
• Married ? How many children ? (social history) / Infertile cause

6. Personal History
• History of smoking – how many years? How many cigarette/bidis per day ?
• Any allergy to any drugs ?

7. Summary of History

• ____ old male , a manual laborer, presented with a reducible swelling in Right inguinal
region for past ___months . Swelling aggravates on straining & reduces with rest, With no
Pain and normal bowel & bladder habits. No history of any precipitating factors and No
history suggestive of obstruction or strangulation. Probably it is uncomplicated Hernia

Hernia – Examination
- Ankit Suniyal


1) General Examination
• Comfortable at rest
• Conscious , co-operative
• Oriented to time , Place & Person

HERNIA HISTORY & EXAMINATION | Dr. Ankit Chandra

 • Built (skeletal parameter) - moderate
• Nourishment (BMI based) - average/poor
• BMI = weight (kg) / ht in (mt)2
• Pallor , icterus , cyanosis , clubbing , pedal odema , lymphadenopathy

2. Vitals – BP , Pulse , RR , temp , SPO2

3. Other system examination

Cardio-vascular System (CVS)

• Heart Rate & Rhythm-
• Heart sounds- S1 & S2
• Additional sounds – murmur, rub, gallop

Respiratory system (RS)
• Normal Breath sounds-
• Additional sounds
• Clear to percussion
• Tenderness to palpation


Abdominal Examination
• Generalized guarding (*rupture of strangulated hernia –peritonitis & septicemia)
• Any Mass in abdomen ? Ascites ?
• Any scar of previous surgery ?
• Any umbilical/epigastric/ incisional / ventral hernia ?
• Any organo-megaly ?
• Tone of abdomen muscles – poor / good
• Malgaigne’s bulge ?

HERNIA HISTORY & EXAMINATION | Dr. Ankit Chandra

4) Local examination
4a) Inspection -
• Site – *swelling seen in inguinal / femoral area
• Extend of swelling –
• Size –
• Shape – Pyriform / Globular /Retort
• Surface – smooth / irregular
• Margins – well defined / ill defined
• Cough impulse – expansile (*diagnostic of hernia)
• Skin over the swelling – no change / ulcer /scar/ engorged veins/ pigmentation
• Any visible Peristalsis over the swelling ?
• Inspection of the contralateral side
• Position of penis ? Any deviation ? Buried inside the swelling ?
• Urethral meatus ? Phimosis ?
• Testis seen separately from the swelling or not ?
• Opposite Scrotum


4b) Palpation
• Local Warmth ?
• Tenderness over the swelling
• Site –
• Extend-
• Relation to pubic tubercle – lateral & below / medial & above to pubic tubercle
• Size – Transverse X Longitudinal Diameter , e.g. - 3 X 5 cm
• Shape – pyriform/ Globular /retort
• Surface –
• Margin –
• Consistency – soft & elastic/ Doughy & granular / Tense & Tender
• Cough Impulse on palpation – expansile at the root of scrotum

HERNIA HISTORY & EXAMINATION | Dr. Ankit Chandra

 • Can get above the swelling ?
• Palpation of Spermatic cord ?
• Testis & epididymis can be palpated separately from the swelling or not ?
(complete/Bubonocele/Funicular)
• Lift scrotum & feel for bulbar urethra (Stricture)

Hernia tests
1. Test for Reducibility – reducible? content is intestine or omentum ?
2. Finger invagination test – not done now a days . Impulse felt at the pulp or tip of the
finger? what is the direction of canal ?
3. Deep ring occlusion test – swelling appears or not ?
4. Zieman’s test – impulse felt at which finger ?


4C) Percussion over the hernial swelling
Dull / resonant?


4D) Auscultation over the hernial swelling
• Peristaltic Bowel may sounds heard = Enterocele
• Bowel sounds absent in omentocele / strangulated hernia

Don’t forget to examine & mention the opposite/normal Inguinoscrotal region of the patient,
best is to tabulate all the findings in right & left side column

5) Rectal examination
• To rule out BPH
• Malignant obstruction
• Chronic fissure – constipation

HERNIA HISTORY & EXAMINATION | Dr. Ankit Chandra

6) Diagnosis
1. Right/left sided / Bilateral
2. Inguinal /femoral
3. Direct / Indirect
4. reducible/Irreducible
5. Complete / incomplete
6. Content – intestine / omentum
7. Complicated / uncomplicated
Example –
• This is a case of Right sided reducible complete indirect inguinal hernia containing
Intestine without any features of complications

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HERNIA HISTORY & EXAMINATION | Dr. Ankit Chandra