History & Examination of a lump

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

3. 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?

4. History • Remaining history as usual • Systemic inquiry • Past medical/ surgical history • Medications • Allergies • Social

5. General examination • Patient permission • A nurse present • Vital signs • Adequate exposure

6. Examination of a lump Inspection: • Site • Size • Shape • Surface • Colour • Pulsation • Cough impulse • Any other lump in the area or on the body

9. Examination of a lump Palpation: • Site • Size • Shape • Surface • Colour • Pulsation (true or transmitted)- 2 finger technique • Cough impulse

10. Examination of a lump • Temperature • Tenderness • Consistency- hard, firm, soft • Edge

11. 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

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

13. Systemic examination • Complete examination of the patient

14. Thank you!