Lumps and Bumps Flashcards
What is a hernia?
A protrusion of a viscus through an abnormal opening
Where is the defect?
The neck of the hernia
What sort of defects may a hernia occur at?
Congenital or acquired wall weaknesses IN ABDOMINAL WALL
What are the common hernias?
Epigastric Umbilical Incisional Inguinal Femoral
What is abdominal wound dehiscence?
When an incision does not close properly and bowel protrudes through
Where is the internal and external inguinal ring?
The two openings to the inguinal canal are known as rings. The deep (internal) ring is found above the midpoint of the inguinal ligament.
The superficial (external) ring marks the end of the inguinal canal, and lies just superior to the pubic tubercle.
Where do femoral and inguinal hernias come out?
Femoral- herniation into femoral canal
Direct inguinal- herniation through wall of abdomen
Indirect inguinal- herniation into inguinal canal through the deep inguinal ring
Where is the inguinal ligament?
ASIS to pubic tubercle
Where do femoral and inguinal hernias get moved back into?
Femoral- under inguinal ligament
Inguinal- over the top
What are hernias like?
Often reducible
Often has an expansile cough impulse
How do you examine a patient with a hernia?
Ask patient to stand up Look for a lump in the front Palpate from the front Palpate from the side Palpate from the other side Examine testicles and abdomen
What can be in the hernia?
Omentum
Bowel
Bladder
Appendicitis
What is a stragnulated hernia?
Ischaemic, necrotic bowel where blood has been cut off from the hernia
What are the rare hernia?
Spigelian
Lumbar
Gluteal
Obturator
What is the difference between a lump and a bump?
Lump: compact, shapeless or unshapely mass
Mass: large body of matter
The diagnosis of a lump is made from history, examination and investigations
What do you ask in a lump history?
When did they first notice
Why did they notice
What symptoms (pain? Interference with movement? wallowing? breathing?)
Has the lump changed
Does it diappear
Has there been other similar lumps
What does the patient think caused the lump
How do you examine a lump?
> Note the position in location to anatomical points (e.g. dermoid lumps occur at lines of embrylogical fusion) > Colour and texture of overlying skin > Temperature > Tenderness > Shaoe > Size > Surface: smooth, irregular, bosselated > Edge: clear or vague > Composition: hard or soft, fluctuance, fluid thrill, translucency, resonance > Pulsatile > Compressibility > Reducible > Mobility: superficial, deep or in both directions > Regional nodes > General examination
What does an ulcerated lump suggest?
Friable (Ulcerated) points to neoplasia
E.g. Basal cell carcinoma, rodent ulcers
What is an easy way to remember how to examine lumps?
Site Size Shape Surface Surroundings Temperature Tenderness Transillumination Tethering Colour Contour Consistency Pulsatility Auscultation
