Synopsis
Perform a focused, respectful abdominal and groin examination, explain the anatomical meaning and limitations of the findings, and use them to decide urgency and the next investigation.
- Obtain consent for the intended examination, offer a chaperone for intimate exposure and preserve the patient’s control throughout.
- Check observations and overall appearance before concentrating on an abdominal region or a visible lump.
- Inspect and palpate systematically, beginning away from pain and using the patient’s response to guide the examination.
Key red flags
Generalised guarding, circulatory compromise or an acutely tender irreducible groin swelling requires urgent surgical assessment rather than a prolonged examination routine.
Begin gentle palpation away from the painful area, observe the face and ask about discomfort. Voluntary tension can lessen with explanation and relaxation; persistent involuntary guarding suggests peritoneal irritation. Describe location and extent. Avoid repeatedly provoking rebound when gentle percussion or movement already demonstrates pain. Marked guarding in an unwell patient should shorten the examination and accelerate escalation.
Reasoning priorities
Produce reproducible findings that localise disease and identify urgency.
After inspection and gentle palpation, assess masses, organ enlargement and percussion or auscultation when they answer the clinical question. Describe a mass by location, size, surface, consistency, movement and tenderness. Bowel sounds vary and their presence does not establish bowel viability or exclude obstruction; integrate them with symptoms and the rest of the examination.
Worked reasoning
A 72-year-old develops vomiting and a painful right groin lump that was previously intermittent. They are tachycardic, the swelling is tender and does not disappear when lying down, and abdominal palpation causes guarding.
- Explain that the examination needs to be brief because the combination of symptoms may be urgent. Obtain consent, offer a chaperone and assess observations and perfusion while organising surgical review.
- Identify and document the side, relationship to landmarks, tenderness and abdominal findings without repeatedly squeezing the lump or testing reducibility. The new persistent swelling and obstruction symptoms raise concern for compromised herniated bowel.
- Communicate an acutely irreducible groin hernia with possible strangulation as the working assessment, while acknowledging any uncertainty about exact anatomical type. The urgency depends on the clinical threat, not on winning an inguinal-versus-femoral naming exercise.
- The decision is urgent senior surgical management with physiological support and an intervention plan. Arrange appropriate blood tests and discuss imaging only insofar as it helps that plan without unsafe delay.
- Confirm that a senior clinician has accepted the referral, reassess discomfort and physiology, and check the patient understands why repeated reduction or outpatient observation would be inappropriate in this scenario.
A haemodynamically stable patient agrees to examination for localised abdominal pain without immediate evidence of systemic deterioration.