Groin Lump Flashcards
What anatomy can be helpful to determine differential diagnosis for going lump?
- Psoas sheath
- Femoral nerve
- Femoral artery
- Femoral vein/long saphenous vein
- Lymph nodes
- Hernial orifices
- Skin/subcutis
What differential diagnosis for going lump are related to the psoas sheath?
- Psoas abscess
2. Psoas bursa
What differential diagnosis for going lump are related to the femoral nerve?
neuroma
What differential diagnosis for going lump are related to the femoral artery?
- femoral aneurysm
2. psuedoaneurysm
What differential diagnosis for going lump are related to the femoral vein/ long saphenous vein?
saphena varix (dilated great saphenous vein due to incompetence at the saphenofemoral junction)
What differential diagnosis for going lump are related to the lymph nodes?
lymphadenopathy (infectious or malignant)
What differential diagnosis for going lump are related to the hernial orifces?
- ectopic testis
- undescended testis
- hydrocele of cord
What differential diagnosis for going lump are related to the skin/subcutis?
- lipoma
- infected abscess (e.g. from IV drug use)
- sebaceous cyst
What are the common reasons for going lump in order of prevelance?
- Indirect inguinal hernia
- Direct inguinal hernia
- Femoral hernia
- Saphena varix
- Psoas abcess/bursa
- Lipoma
- Sebaceous cyst
- Neuroma
- Femoral aneurysm/pseudoaneurysm
- Ectopic testis
- Undescended testis
- Hydrocele of cord
What questions do you ask about the groin lump?
- How long has the lump been there
- Is the lump always there? does it reduce when patient lies down?
- Has lump got bigger or smaller or stayed the same
- Is lump painful
- Any other lump?
When would a femoral arterty pseudoaneurysm show up?
after angiography
When would a direct inguinal hernia show up?
period of heavy lifting
When might inguinal lyphadenopathy show up?
lower limb infection
When would ectopic + undescended testis present? How is it fixed?
present from birth + fixed by orchidopexy and orchidectomy
Why do you ask if the lump was always there or if it reduces when patient lies down?
hernias and saphena varix
What can increase hernia size?
coughing and straining stool
How does the size of a saphena varix change?
increase if stand long time but disappears as soon as patient lies down
Do most lumps change in size over time?
yes
What would a rapid change in groin lump size suggest?
infective process e.g. psoas abscess, or lympahdeopathy
Are reducible and incarcerated hernias painful?
can be or not
Is a strangulated hernia painful?
yes
Which other groin lumps can sometimes be painful?
- groin abscess
- infected sebaceous cyst
- infected pseudoaneurysm
Why do you ask if any other lump?
20% of inguinal hernias bilateral
In what conditions can inguinal lymphadenopathy also happen in?
- lymphoma
- primary HIV
- SLE
- Metastatic spread from anal cancer, scrotal cancer or mealanoma
What questions should you ask if you suspect a hernia?
- Any abdominal pain
- Has patient been straining stool, struggling to pass urine, suffering from chronic cough? Does job involve heavy lifting?
- Has patient had prior operations to groin?
What are abdominal conditions that are risk for hernia?
- bowel obstruction
2. bowel strangulation
Why would you ask if patient been straining stool, struggling to pass urine, suffering from chronic cough? Does job involve heavy lifting?
all increase intra-abdominal pressure and increase liklihood of hernias
Why do you ask about prior operations to the groin?
- Previous surgery predisposes to incisional hernias
- History of of inguinal or femoral hernias makes them more likely
What questions do you ask if you suspect an infective process or malignancy?
- trauma or infection in lower limbs or groin?
- any indications of anal, scrotal or cutaneous malignancy
- any fever
- any weight loss, night sweats or pruritus
How do you check if trauma or infection in lower limbs or groin?
- e.g. injecting drug use
- ask about insect bites or infected toe nails
- sexual history questions about genital rash and discharge as STI
What are some indications of anal, scrotal or cutaenous malignancy?
new or changing lumps/bumps or marks in surrounding region
What would febrile symptoms suggest?
- infective pathology e.g. psoas abcess or lymphadenopathy
- fever also part of FLAWS
Why would weight loss and night sweats suggest?
malignancy
What may pruritus suggest?
symptom of lymphoma
What is the exposure for examination of a groin lump?
- examine abdomen, groin and external genitalia: keep covered until need be
lying down and repeat groin with standing up - both sides of groin for any masses or scars from previous surgery
When you palpate a groin lump what characteristics are you looking for?
- Site
- How big
- Lump tender and/or warm
- Lump solid or fluctuant
- Lump pulsatile
- Lump have a cough impulse
- Lump reducible? If so in which direction?
What would a lump in saphenofemoral junction suggest?
saphenia varix
For a hernia what do you look for to determine site?
neck of swelling
If the neck of swelling in a hernia is superior and medial to pubic tubercle what does it suggest?
inguinal hernia
If the neck of swelling in a hernia is inferior and lateral to pubic tubercle what does it suggest?
femoral hernia
For site which possible tissue laters could the groin lump lie in?
- cutaenous
- subcutaenous
- associated with deeper tissues
What would a lump extending into scrotum suggest?
indirect inguinal hernia (rarely a direct one)
For size what should you determine?
how big is the lump
Is a strangulated hernia tender and warm?
skin red and inflamed and some signs of systemic inflammatory response and bowel obstruction
Which type of hernia is tender to palpitation?
reducible hernias
Which types of groin lumps might be warm and tender on palpitation and overlying erythema?
- groin abscesses
- reactive lymph nodes
- infected pseuodaneurysm
What type of groin lump is solid?
swollen lymph nodes
What type of groin lumps is softer and fluctuant?
- Hernia
- saphenia varix
- femoral aneurysm/pseudoaneurysm
- psoas bursa
- hydrocele of cord
What would a pulsatile groin lump suggest?
femoral aneurysm (true or pseduoaneurysm)
When might there be a transmitted pulse in a groin lump?
if swollen lymph node overlies femoral artery
