Name:
Ahern: EES: Video 06-03: Inguinoscrotal Assessment
Description:
Ahern: EES: Video 06-03: Inguinoscrotal Assessment
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Duration:
T00H05M20S
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Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/ede38454-2b04-47bc-84dc-83e1b2133aa0/06-03_ Inguinoscrotal Assessment.mov?sv=2019-02-02&sr=c&sig=3SbOcGlttwcH%2FKIzJ4NME8pGqms3pFt9KtCrWcIscX8%3D&st=2024-12-30T17%3A31%3A02Z&se=2024-12-30T19%3A36%3A02Z&sp=r
Upload Date:
2022-02-27T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
So we-- after the history, we have the patient standing up. That's a very essential part of it. You must examine the patient both standing up and whilst lying down. And like in any other area, we have specific things. We do active tests and more passive tests. For example, for the inguinoscrotal region, we always get the patient to cough because that's a sign of a hernia, a cough impulse.
So we have the patient standing up. We ask him to turn his head the other way so that he won't cough on us or on anybody else in the room. And ask him to cough. And we look at the inguinoscrotal region to see if there's a cough impulse. And we assess that. It may be an obvious descent of a hernia, we may notice that there's a swelling of the scrotum.
So then we can decide if you do see something, is it a hernia or is it a condition of the scrotum or is it a condition of the core, and go through it in a methodical way. We then-- the next thing I would do is with the patient standing still put my hand over the external ring region and get the patient to cough to see if I can feel a cough impulse.
Now with that cough impulse, you can decide if, oh, this feels like a hernia. And if I want to be more sure, I may even invaginate the tip of my finger or little finger in towards the external ring. This is much more important in obese or overweight patients, because remember, no patients are the same. So we've decided well, this looks like a hernia. But there are other conditions.
For example, the hernia may be right down into the scrotum. And you want to know, is this a hernia, is it a hydrocele, is it an epididymal cyst? So what do I do then? I do what I call a pinch test. That means I put my index finger and thumb around the cord and press it gently. Now, if I can feel the cord quite normally and the swelling is above my fingers that's most likely a hernia-- could be something else, but it's most likely a hernia.
If it's below my fingers, then there are a variety of conditions it could be. But then we'd have to go through the process. But the most common cause these days would be a hydrocele. That's typically in older people. But other conditions which it might be, testicular tumor, it may be an encysted hydrocele with a cord, it may be an epididymal cyst. But our processes with help us define the difference between these conditions.
Once we've completed our assessment of the patient whilst he's standing up. We then ask the patient to lie down. What we may have done actually is reduced the hernia whilst the patient was standing. And then with our hand over the inguinal canal having lied down again, it should come out again and get him to cough or vise versa. Now, with the patient incumbent, we examine him again.
We assess whether the swelling that was present has disappeared. For example, if it's a varicocele, which feels like we describe as a bag of worms, soft and compressible, and a bit knotty looking, if you have a look at it. It will disappear when the patient lies down. That's a varicocele. A communicating hydrocele will disappear, but that's a differentiation from a hernia.
So we then examine the patient for a hernia. We get the patient to cough and strain. And even sometimes, a difficulty with hernia when the patient is standing can be felt with what I call the squelch test. When I get them to cough and strain, lifting the head off the abdominal wall, sometimes it pushes out a small hernia and you can feel the squelch under your fingers as you palpate it.
Another condition to consider is an epididymal cyst. This is usually quite separate from the testis. It can be felt by putting your fingers above the testis and above the swelling. And it's a smooth swelling, which is quite typical of an epididymal cyst. The other condition is a hydrocele. Now, the classic test for a hydrocele, apart from the examination, is to transilluminate this.
That's with a torch in a dark room. You can actually see the fluid. It's a good clinical test, and it's been replaced a lot by technology and an ultrasound is often wanted for that. Now, the other condition of course, is testicular tumors and when we're examining the scrotum consider where the testis is, because occasionally you can have what's called an anteverted testis, or retroverted testis.
That's where the epididymus is actually in front of the testis. So there are other problems which occur in the area such as an undescended testis in children, an ectopic testis. So you must always identify the correct position of the testis when you examine a patient. The other very, very important aspect is to always examine both sides.
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