History & Examination of a lump
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Transcript of History & Examination of a lump
History &
Examination of a lump
M K ALAM MS; FRCSProfessor of Surgery
History of a lump• When did you noticed it?• How did you noticed it?• Is the lump symptomatic? Pain, pressure• Any change in size since first noticed?• Does the lump ever disappear or reduce
in size? Hernia• Any other lump on the body?• 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• Size• Shape• Surface• Colour• Pulsation• Cough impulse• Any other lump in the area or on the body
Examination of a lump
Palpation:• Site• Size• Shape• Surface• Colour• Pulsation (true or transmitted)- 2 finger technique• Cough impulse
Examination of a lump
• Temperature
• Tenderness
• Consistency- hard, firm, soft
• Edge
Examination of a lump
• Fluctuation- for fixed & mobile lump, tested in 2 axis
• Transillumination
• Compressibility: Sustained pressure empties swelling which refills on release of
pressure- hemangioma
• Reducibility: reduced into another space. Does not return spontaneously
• Attachments- overlying skin, underlying muscle/bone
• Regional lymph nodes
Examination of a lump
• Percussion: Dull (solid, fluid) Resonant (gas)
• Auscultation: Bruit (vascular) Bowel sounds(hernia)
Systemic examination
• Complete examination of the patient
Thank you!