Question-132

A 35 year-old male had splenectomy a year ago. He now presents with reducible epigastric swelling. There is no pain. Which of the following is the best position to examine him?



A Standing erect and asking him to cough
B Standing erect
C Lying down and asking him to cough
D Lying down and asking him to raise his hand
E Lying down and asking him to raise his leg

The diagnosis is clinical. Because the hernia may be apparent only when abdominal pressure is increased, the patient should be examined in a standing position. If no hernia is palpable, the patient should cough or perform a Valsalva maneuver as the examiner palpates the abdominal wall.

http://www.merckmanuals.com/professional/gastrointestinal_disorders/acute_abdomen_and_surgical_gastroenterology/hernias_of_the_abdominal_wall.html
B Standing erect