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Clinical Examination of Groin Lump

Division of Digestive Surgery Medical School, Padjadjaran University

Specific learning objectives :
At the end of training session, student will be able to :
– perform history taking of groin lump correctly. (P5) – perform physical examination on groin lump correctly. (P5)

Definition : Groin lump

• A lump which arises from the groin/inguinal region and it may be due to various diseases or disorders

Causes of groin lump: • Inguinal hernias: Direct. Indirect • Femoral hernia • Vaginal hydrocele • Hydrocele of testis/cord / canal of Nuck • Ectopic testicle • Lipoma of the cord .

Causes of groin lump: • Lymphadenitis • Lymphadenopathy • Abscess • Hematoma • Varicocele • Seroma .

Causes of groin lump: • Testicular mass • Testicular torsion • Epididymitis • Femoral aneurysm or pseudoaneurysm • Cyst .

Anatomy of the inguinal region .

Types of Inguinal Hernia : .

Femoral Hernia .

Clinical Grading Reduction Grade • reponible • irreponible • incarceration + colic + pain Obstruction toxic • strangulation - steady increase + ++ leucocytosis .

and develop a warm and helpful environment – Introduce yourself to the patient .History taking: • Introduction: – Greet the patient.

History taking: • Patient Identity – Ask the patient politely concerning his/her: • Name • Age – Record the gender: • Male • Female: – Number of children – parity .

chronic (>2 weeks). • Size of the lump at present . – Lump on the groin: • Location: unilateral/bilateral • Onset: acute (< 2 weeks).History taking: • Chief complaint: – Ask the patient regarding why the patient comes to you.

what are the aggravating factors? Or relieving factors? – Is the lump reducible? – Feeling discomfort? • Persistent? – If yes. determine the lump progression – Accompanying pain: continuous? Intermittent? Colicky abdominal pain? .History taking: The nature of the lump: • Intermittent? – If yes.

• • Vomiting Bowel habit: obstipation? .History taking: Other related symptoms: • Ask the patient concerning related/concomitant symptoms of : – Gastro-intestinal function: • Nausea.

History taking: • Urinary function: – Micturition: amount of urine. – Lower urinary tract symptoms: obstructive and irritative symptoms. .

History taking: Fever: • • Onset of fever: before or after the appearance of the lump? Type of fever: – Continuous? – Intermittent? • Accompanying night sweating? .

jaundice.History taking: • Previous history of : – Previous similar lump – Previous hernia surgery – Previous major illness: incl. . injury. chronic coughing. fever.

. – Wash your hands with antiseptic soap.Physical Examination: Preparation • Check all the equipment required and have a good light: – Examination couch – Stethoscope – Explain the procedure and its goals to the patient. – Dry and warm your hands with tissue towels and put on hand gloves.

General Examination: • General appearance: – Consciousness – Mood: distressed? Anxious? – Immobile – Colour: Pallor? Flushing? .

• Ask the patient politely to expose his/her inguinal region. the patient is asked to stand up in front of you. .• If the patient’s general condition looks normal.

allow the patient to strain and watch for any visible lump from both inguinal and femoral regions. and blow air through the mouth. . While doing this. and scrotal regions for male patients. Ask the patient to cover his/her mouth with one of hands. you ask the patient to perform Valsava manoeuvre: • Ask the patient’s head to turn one side.• If there is no lump.

Groin Examination • • • • • • • • Position Temperature Pain Size Shape Tensile strength Composition (solid. liquid) Changes with cough X . gas.

Inspect the lump and determine: – The colour of the lump: Redness? – The shape and location of the lump – Skin edema b.If there is a lump on the inguinal or femoral region. determine : – Sign of local tenderness – The content . a. Palpate the lump.

• If it fails.• Try to reduce the lump manually by using your fingers. starting from the external ring or the most lower part of the lump. pubic tubercle). . do not continue. going up to internal ring (Anatomical landmark: Anterior Superior Iliac Spine. The success procedure is indicated when the lump disappears with or without gurgle sounds.

• Put your right index finger above the inguinal canal or place your right/left fingers on the external ring and the opposite fingers on the internal ring or on top of any noticeable lump. watch if there is lump coming out from the rings. • Determine the position of the lump in relation with inguinal ligament: . • Ask the patient to repeat the valsava manoeuvre.

Finger test .

• Direct inguinal hernia (Round Lump above inguinal ligament) • Femoral hernia (Lump below the inguinal ligament/pubic tubercle). if the fingers compression released. the lump will reappear). .Differential Diagnosis • Indirect inguinal hernia (no lump.

. determine whether there is any trans-illumination. grasp the swelling between fingers and thumb. • Using flash light. • Determine its continuity with the inguinal canal.• If a scrotal lump presents. and ascertain whether it is possible to get above the swelling.

• Ask the patient to lie down on the couch in supine position. • Examine the vital signs: – Temperature – Pulse rate – Blood Pressure – Respiratory rate .

• Perform other systems examination. . • Ask the patient politely to expose his/her abdomen and inguinal region. including cardio-pulmonary system.

Abdominal Examination: Inspection : • Inspect the movement: – Respiratory movement – Visible bowel peristaltis • Is there any abdominal distention? .

Abdominal Examination: Palpation: • Using the palmar surface of your fingers. look to the face expression of the patient. and look for any signs of : – – – – – Tenderness Rebound tenderness Muscle guarding Rigidity Hernial orifices . gently palpate the abdomen. • While palpating.

moving all around the abdominal region: – – – – Is it tymphanitic? Is it Dull ? Is there any shifting dullness? Site of liver dullness ? and is it disappeared ? .Abdominal Examination: Percussion: • Place the palmar aspect of your left hand on the abdomen. and gently percuss its dorsal aspect with the tip of the middle finger of the right hand.

Abdominal Examination: Auscultation • Using stethoscope. and place it gently on the abdomen. listen to the bowel sounds and bruit at least for a minute: – Normal – Absent? – High pitched and hyperactive? – Metallic sound? .

which can be useful information if you are unsure as to the nature of an inguinal bulge. .Groin Examination: • Perform the groin examination as you perform on standing position. • Auscultation on top of a hernia may allow the detection of bowel sounds.

perform digital rectal examination to look for signs of enlarged prostate gland.Digital Rectal Examination • In old male patient with the suspicion of lower urinary tract symptoms. .

Write up • Write up all significant findings in the medical record. and order any necessary special investigations . • Conclude your diagnosis and differential diagnosis.

Demonstration:Video .