Groin Lump Flashcards
List the causes of groin lumps by considering the anatomical structures in the groin.
Psoas sheath – psoas abscess, psoas bursa
Femoral nerve – femoral neuroma
Femoral artery – aneurysm, pseudoaneurysm
Femoral vein – saphena varix
Lymph nodes – inguinal lymphadenopathy (infectious or malignant)
Hernial orifices – inguinal hernia, femoral hernia
Testicular apparatus – ectopic testis, undescended testis, hydrocoele of the cord
Skin/subcutis – lipoma, infected abscess, sebaceous cyst
List the most common causes of groin lump.
Indirect inguinal hernia Direct inguinal hernia Inguinal lymphadenopathy Femoral hernia Saphena varix
List some important questions you should ask about the history of presenting complaint.
How long has the lump been there? Is the lump always there? Does it go away when you lie down? Has the lump changed in size? Is the lump painful? Have you noticed any other lumps?
Which causes of groin lump would have been present since birth?
Undescended testis
Ectopic testis
Which causes of groin lump are reducible?
Hernias
Saphena varix
What can make a saphena varix increase in size?
Standing up for a long time
What does a rapid increase in the size of a groin lump suggest about the underlying cause?
Infective process
List some causes of painful groin lumps.
Strangulated hernia
Groin abscess
Infected sebaceous cyst
Infected pseudoaneurysm
What is the difference between incarcerated hernias and strangulated hernias?
Incarcerated – the hernia is stuck in one place and cannot be reduced
Strangulated – the blood supply to the loop of bowel has been cut off leading to ischaemia and infarction
Why is it important to ask the patient about any other lumps that they may have noticed?
The presence of inguinal lymphadenopathy in the context of more widespread lymphadenopathy may increase suspicion of a systemic disease (e.g. SLE, lymphoma, HIV)
List some important questions you should ask if the groin lump is thought to be a hernia.
Has there been any abdominal pain?
Have you been straining at the stool or to pass urine? Have you been suffering from a chronic cough? Do you do a lot of heavy lifting?
Have you had any prior operations in the groin?
What are the two main risks of hernias?
Bowel obstruction
Bowel strangulation
Why is it important to ask about prior operations in the groin/abdomen?
Prior operations will increase the risk of incisional hernias
List some important questions you should ask if the groin lump is thought to be caused by an infective process or malignancy.
Has there been any trauma or infection in the groin or lower limbs?
Have you had a fever?
Have you noticed any weight loss, night sweats or itchiness (pruritus)?
NOTE: pruritus is a feature of lymphoma
Describe how the site of inguinal hernias differs from femoral hernias.
Inguinal – superior and medial to the pubic tubercle
Femoral – inferior and lateral to the pubic tubercle