Approach to Groin Swelling

Question 1

What are the questions to ask when approaching inguinal hernia?

Answer 1

1. Inguinal scrotal swelling or groin lump
2. Inguinal/femoral hernia
3. Reducible or irreducible
4. Direct or indirect
5. Presdisposing factors
   CHECK BOTH SIDES

Question 2

What is the PE approach for groin swelling? (Inspection)

Answer 2

Inspect

• Lump
• Above or below inguinal ligament
• Involves scrotum?
• Dimensions
• Skin changes/scars (recurrent hernia)
• Lump on other side

Question 3

What is the PE approach for groin swelling? (Palpation)

Answer 3

Palpate

• Above the lump?
• Feel testis
• Lump - consitency, fluctuant, size, temp, tenderness
• Landmark pubic tubercle and show that it is above and medial to pubic tubercle compared to femoral hernia (lateral to pubic tubercle)
• Check cough impulse

Ask pt reduce lump
Reducible vs strangulated - point of reduction will be above and medial to PT

Patient lie down
- Reduce hernia if not done
- Locate deep inguinal ring and hold pressure, ask patient to stand up
-Cough impulse
Auscultate bowel sounds

Question 4

What is the PE approach for groin swelling? (Wishlist)

Answer 4

Wishlist:

1. Abdo exam
2. DRE for BPH
3. Respi exam for COPD
4. History of risk factors

Question 5

What are the differentials for groin lump?

Answer 5

Hernia: Inguinal/femoral hernia

Vascular: Femoral artery aneurysm, saphenous varix, hematoma

Lymphatics: Lymphadenopathy, lymphoma

Soft tissue/bone: Lipoma, abscess, tumour of muscle/bone, hidradenitis suppurativa

Nerves - Femoral neuroma

Others: Varicocele, cord lipoma, undescended/ectopic testes, hydrocele

Question 6

Differentials for inguinal lymphadenopathy

Answer 6

Per vaginal/per rectal exam sincethey drain to superficial lymph nodes

Legs

Perineum

Abdominal wall

Back below iliac crest

Systemic causes - contralateral inguinal nodes, cervical nodes, axillary nodes, hepatosplenomegaly