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Monday, July 19, 2010

1-Begin by simply looking at the area in question, which is on either side of the crease separating the leg from the groin region. Make note of any discrete swellings, which might represent adenopathy or a femoral hernia.
2-Palpate the area, feeling carefully for the femoral pulses as well as for inguinal/femoral adenopathy (nodes which surround the femoral artery and vein.... up to one cm in size are considered non-pathologic). If you feel any lymph nodes, note if they are firm or soft, fixed in position or freely mobile (fixed, firm nodes are more worrisome for pathologic states).
3-The femoral pulse should be easily identifiable, located along the crease midway between the pubic bone and the anterior iliac crest. Use the tips of your 2nd, 3rd and 4th fingers. If there is a lot of subcutaneous fat, you will need to push firmly.
4-A femoral hernia, if present, is located on the anterior thigh, medial to the femoral artery. As it can be transient (i.e. the patient reports its presence yet you find nothing on examination), investigation should include observation as well as palpation while the patient performs a valsalva maneuver, which may make a hernia more prominent.





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