Local lump examination

Local lump examinationCreated OnApril 15, 2020Last Updated OnApril 15, 2020byadmin You are here: Main Clinical Examination Local lump examination < All Topics Table of Contents Examination of a swelling/lump (neoplasm) History taking: During history taking other than routine history we must include some specific points like- Mode of onset (following trauma, spontaneous) Duration of the swelling Progression ( rapid-malignant/slow-benign), Numbers (single/multiple) Associated symptoms (pain/fever etc.), Known underlying disease (Diabetes/Hypertension/ TB/HIV etc.), Previous treatment history for the similar swelling/recurrence Local examination: includes inspection, palpation, percussion and auscultation as described below. Inspection DESCRIPTION SOLITARY/MULTIPLE Point towards specific diagnosis SITE Accurately measure to a fixed landmarks, using bony prominence as reference point if possible SIZE Measure the dimension in centimetre using measuring tape for a lump SHAPE Variable, Specific lump has specific characteristics SKIN CHANGES Trophic changes- skin texture, hair distribution, colour (reddened in inflammation, gangrenous, grey or bluish discolouration in impairment of circulation) SCAR Incisional hernia or recurrence/unsolved disease Palpation Before palpation, ask for any tenderness and try to leave it as last part of examination. SURFACE Smooth/irregular EDGE Well / poorly defined CONSISTENCY Soft-comparable with flesh of nostrils Firm- comparable with nasal septum Hard- comparable with woody table TEMPERATURE Feel with dorsum of the hand comparing both similar site or surrounding TENDERNESS Indicate underlying inflammation TRANSILLUMINABLITY Using a bright pen-torch on side of lump and looking through an opaque tube in a dark room. PULSATILITY Use your both hand index finger and place it on opposite side of lump. 2 types: I. Expansile- distances between each finger increase with pulsation (true pulsation from vascular origin) II. Transmitted- distances between each finger is the same (pseudo-pulsation from lump transmitting pulsation of vascular) COMPRESSIBILITY/ REDUCIBILITY Compressibility: Lump disappear from pressure but reappear on release e.g. Haemangioma Reducibility: Lump disappear from pressure but reappear only when only another force is supplied e.g. hernia FLUCTUATION (SMALL LUMP)/ FLUID THRILL (BIG LUMP) Fluctuation: rest two fingers of one hand on opposite side of the lump and press the middle of the lump with index finger of another hand, if the two fingers move apart, the lump is fluctuant True fluctuant: cystic content Pseudo-fluctuant: lipoma FIXATION Skin: pinch skin over the lump to see fixity Muscle: move the lump in two planes perpendicular to each other. Tense the muscle and see if the lump moveable Percussion Dull/resonance Auscultation Bruits or bowel sound Completion Examine the draining lymph nodes and access the neurovascular status of the area or limbs. Doctrina Perpetua Clinical Surgery 2nd edition*Taken from Doctrina Perpetua Clinical Surgery 2nd...

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