1. Jenelle Beadle 5/20/2015  Inguinal/Femoral

2.  Type  Based on location of defect  Contents  Fat, fluid, bowel  Movement through defect (valsalva)  Reducibility (compression)  Completely reducible  Partial reducible  Non-reducible (incarcerated)  Size/Extent  Diameter of neck/defect  Inguinal hernias (e.g. extends into the scrotum)

3.  Incarcerated hernias can result in bowel obstruction and/or stragulation  Bowel involvement is a surgical emergency  Strangulation = Ischemia  Ultrasound Findings  Dilated, fluid filled bowel loops  Bowel wall thickening  Non-peristalsing  Free fluid within hernia sac

4.  Inguinal  Indirect  Direct  Femoral

5.  Entire canal is screened in short axis (w/ valsalva)  Images are captured in long and short axis  Transducer is oriented with the indicator as shown below  This can get confusing when in an oblique plane Trans Rt Ing CanalLong Rt Ing Canal

6.  Entire canal is screened in short axis (w/ valsalva)  Images are captured in long and short axis  Transducer is oriented with the indicator as shown below  This can get confusing when in an oblique plane Trans Lt Ing CanalLong Lt Ing Canal

7.  Proximal and Distal Inguinal Canal:  Long and short axis  Long and short axis w/ valsalva  Long and short axis w/ valsalva cine

11. Cine w/ Valsalva Long Inguinal Canal Prox

14. Cine w/ Valsalva Trans Inguinal Canal Prox

17. Cine w/ Valsalva Long Inguinal Canal Dist

20. Cine w/ Valsalva Trans Inguinal Canal Dist

21.  Proximal and Distal Inguinal Canal:  Long and short axis  Long and short axis w/ valsalva  Long and short axis w/ valsalva cine  Femoral Canal  Short axis  Short axis w/ valsalva  Short axis w/ valsalva cine

24. Cine w/ Valsalva Long Femoral

27. Cine w/ Valsalva Trans Femoral

28.  Additional documentation will be necessary if a hernia is present.  Documentation should describe the following:  Hernia type (based on origin)  Contents (fat, fluid, bowel)  Reducibility (with transducer compression)  Extent (using sonographic landmarks)  The sonographer’s findings may read something like this:  Fat-containing, indirect, right inguinal hernia. Not completely reducible. With valsalva, it extends 1.5cm distal to the lateral pubic tubercle.

29.  Direct  Medial  Sagittal  Canal side wall  Indirect  Lateral  Oblique  Deep inguinal ring

30.  Direct & Indirect  Can extend through the superficial inguinal ring and into the scrotum