Groin lump

Question 1

What are the ddx for groin lump

Answer 1

Indirect inguinal hernia
Direct inguinal hernia
Femoral hernia
Inguinal lymphadenopathy
Saphena varix
Psoas abscess/bursa

Question 2

A period of heavy lifting might precipitate what?

Answer 2

Direct inguinal hernia

Question 3

A saphena varix may increase if?

Answer 3

Patients stand for a long period of time - saphena varix disappears completely when patient lies down

Question 4

Rapid increases in size of the lump may indicate?

Answer 4

Psoas abscess or lymphadenopathy

Question 5

Why is it important to ask about if the lump is painful

Answer 5

Reducible/incarcerated hernias =not painful (more uncomfortable). Strangulated hernias are acutely painful.

Groin abscess, infected sebaceous cysts, or pseudo aneurysm is painful

Question 6

What are the main risks of hernia formation?

Answer 6

Bowel obstruction and bowel strangulation - so ask about abdominal pain

Question 7

Straining at stool, struggling to pass urine, suffering from a chronic cough all increase the likelihood of?

Answer 7

Hernia due to the intraabdominal pressure increasing

Question 8

Febrile symptoms make infective pathologies more likely, e.g. which infective pathologies?

Answer 8

Psoas abscess or lymphadenopathy

Question 9

Describe the locations of an inguinal hernia vs femoral hernia

Answer 9

Inguinal hernia = superior and medial to pubic tubercle

Femoral hernia = inferior and lateral to pubic tubercle

Question 10

Describe the appearance of skin overlaying a strangulated hernia

Answer 10

Red and inflamed

Groin abscess, reactive lymph nodes, infected pseudoaneurysms may have the same warmth and tenderness

Question 11

If a groin lump expands and increases in tension during coughing - what is this diagnostic of

Answer 11

Hernias (as coughing increases intraabdominal hernia)

Direct hernias will expand outwards whereas indirect hernias will expand along the path of the inguinal canal (inferomedial direction)

Question 12

If a lump is reducible what could it be

Answer 12

Hernia or saphena varix (rare)

Saphena varix = rare, soft, bluish swelling that is only seen when patient standing

Question 13

A groin lump with audible bowel sounds is likely to be?

Answer 13

Herniated bowel

Question 14

A fluctuant mass, with a cough impulse, originating superomedially to the pubic tubercle is suggestive of?

Answer 14

Reducible inguinal hernia

Can tell if it is indirect hernia if the lump doesn’t reappear following placing your hand over the deep inguinal ring and asking them to cough