History & Examination of a lump

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Presentation transcript:

History & Examination of a lump M K ALAM MS; FRCS Professor of Surgery

History of a lump When did you noticed it? How did you noticed it? Is the lump symptomatic? Pain, pressure effect Any change in size since first noticed? Does the lump ever disappear/ reduce in size? Hernia Aggravating / relieving factors ? Any other lump ? Any cause- Trauma? Heavy wt. lifting?

History Remaining history- as usual Systemic inquiry Past medical/ surgical history Medications Allergies Social

General examination Patient permission A nurse present Vital signs Adequate exposure

Examination of a lump- Inspection: Site: Lipoma- limbs, trunk, Ganglion- hand, Sebaceous cyst- scalp, back Size Shape: spherical- lipoma, sebaceous cyst Surface: lobulated- lipoma, punctum- sebaceous cyst

Examination of a lump- Inspection Colour: Red- inflammatory swellings , capillary haemangioma Blue- haemangioma, hematoma Pulsation: aneurysm Cough impulse: hernia Any other lump?

Examination of a lump- Palpation Site Size Shape Surface Edge- well-defined/ ill-defined

Pulsation: True vs transmitted - 2 finger technique

Examination of a lump- Palpation Temperature Tenderness Consistency- hard, firm, soft

Soft swelling- palpation Fluctuation Transillumination Reducibility Compressibility Cough impulse

Examination of a lump- FLUCTUATION TRANSMISSION OF IMPULSE IN TWO DIRECTIONS AT RIGHT ANGLES TO EACH OTHER. IMPLIES PRSENCE OF FLUID IN THE SWELLING. Fluctuation- for fixed & mobile lump, tested in 2 axis

Examination of a lump- palpation Transillumination Compressibility: Sustained pressure empties swelling which refills on release of pressure- haemangioma

Examination of a lump- palpation Reducibility: reduced into another space. Does not return spontaneously Attachments- overlying skin, underlying muscle/bone Regional lymph nodes

Examination of a lump Percussion: Auscultation: Dull (solid, fluid) Resonant (gas) Auscultation: Bruit (vascular) Bowel sounds(hernia)

Systemic examination Complete examination of the patient

Thank you!