Inguinal swelling: History

History in Inguinal swelling  

1.       Age, occupation

2.       Presenting complaints

·         Swelling in groin (inguino-scotral) region

·         Dragging pain (dragging over mesentery)

·         Sense of weight/heaviness

3.       History of Present Illness

·         Swelling –Mode of onset

·         How did the swelling appear first (with strain or not)

·         Site of first onset

Ø  Groin/scrotum àinguinal hernia 

Ø  Below groin crease àfemoral hernia

·         Reducibility 

Ø  Immediate (direct inguinal)

Ø  Self (indirect inguinal)

Ø  Overnight (varicocele, congenital hydrocele)

·         Progress of the swelling—size and extent of the swelling at onset—whether the swelling descended from groin to the scrotum or from scrotum to the groin

·         Pain

Ø  Dragging, dull aching (Usually)

Ø  Very painful (strangulation)

Ø  Colicky pain- obstructed hernia

Ø  Acute pain without symptoms of obstruction – Richter’s Hernia (Browse)

4.       Precipitating factors

·         Chronic cough, asthma, bronchitis

·         Heavy weight lifting( occupation)

·         Constipation (straining to pass motion)

·         Urinary complaints: night frequency, hesitancy and urgency

·         History of appendectomy (damage to ilioinguinal nerve- Direct hernia)

5.       Any systemic symptoms

·         Colicky abdominal pain, vomiting, distension, absolute constipation (Obstructed hernia)

6.       Past history

·         Previous hernia repair