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!