Although hernias may be defined as any protrusion of a viscus, or part of it, through a normal or abnormal opening, 90% of all hernias are located in the inguinal area. Commonly, a hernial impulse is better seen than felt.
Instruct the patient to turn his head to the side and to cough or strain. Inspect the inguinal and femoral areas for any sudden swelling during coughing, which may indicate a hernia. If a sudden bulge is seen, ask the patient to cough again, and compare the impulse with that of the other side. If the patient complains of pain while coughing, determine the location of the pain, and reevaluate the area.
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