Lumps, Bumps, Hernias and Abdo masses Flashcards
Describe a cavernous haemangioma
(strawberry naevus)
benign tumour of a blood vessel, cavity
involutes, no scar
usually regresses spontaneously
How can a cavernous haemangioma be treated if intervention is required?
propranolol
what name is given to the benign tumour of a capillary that appears flat, and is also known as port-wine stain?
capillary haemangioma
how is a capillary haemangioma treated?
laser treatment
what name is given to the benign red skin lesions seen in middle to older age, which are very common and of no concern?
Campbell de Morgan spots
in what are the presence of spider naevi not pathological?
pregnancy
Give 3 signs of liver cirrhosis in males which are due to excess oestrogens and explain why this occurs?
spider naevi
gynaecomastia
testicular atrophy
liver normally breaks down oestrogens so in liver cirrhosis, its function is lost and oestrogens accumulate.
oestrogens produced in male from dehydroepiandrosterone (DHEA), which is converted to oestrogens in adipose tissue, so overweight males often have a more feminine appearance.
why does a spider naevus blanch?
central feeding arteriole compressed
on release, it rapidly refills from central arteriole
what is a papilloma and what different types are there?
also known as a skin tag, benign tumour of skin epithelial cells
lump in the skin, so moves with it
may be smooth and pedunculated, sessile or pigmented- may have similar appearance to a malignant melanoma, although not all malignant melanomas appear pigmented!
what is a neurofibroma?
a benign tumour of the peripheral nerve sheath
may be in skin or SC tissues
type 1 neurofibromatosis has an autosomal dominant inheritence pattern and results in the presence of dermal neurofibromas. what are the diagnostic criteria?
if 2 of following found: 6 or more cafe au lait macules 2 or more neurofibromas of any type or 1 plexiform (involve multiple fascicles along nerve) axillary or inguinal freckling optic glioma 2 or more Lisch nodules= brown/translucent mounds on iris osseous lesion 1st degree relative with type 1 NF
in what condition are bilateral vestibular schwannomas characteristic, producing sensorineural hearing loss at around 20 yrs old?
type 2 neurofibromatosis
characteristics of a hystiocytoma (dermatofibroma)?
benign neoplasm of fibroblasts of dermis itchy lump in an exposed area of skin history= occurs following insect bite, has become itchy firm lump typically asymptomatic remains same size after initial growth generally no tment required
characteristics of lipomas (lipomata) ?
can be very large
soft
found beneath skin, so don’t move with skin when skin moved
no fluctuancy= on pressing the middle, if your fingers are at either side they are not pushed outwards. This would however be seen with cysts.
? semi fluctutant
most lobulated-on surface and at edges as fat in body=lobules
don’t reduce, pulsate or transilluminate
characteristics of ganglia?
myxomatous degeneration of joint capsules (pathologic degeneration of CT), so found in areas of multiple joints= wrist and ankle
soft, not painful, smooth and under skin, jelly like
contain synovial fluid
tment= can be left, may disappear on their own
can aspirate to remove synovial fluid if cyst causes pain or interferes with joint movement.
types of skin cysts?
epidermal (sebaceous)/pilar= contain keratin as blocked hair follicle, 50% have a punctum= a sharp point, not found on palms or soles of feet.
dermoid= skin beneath skin, found in midline, behind ear and just above eye (lateral canthus). Arise from cystic changes in epithelial remnants left behind at lines of embryological fusion. Contain keratin, hair, sebaceous glands.
implantation dermoid= occur in manual workers- push skin under skin. commonest in fingers.
how can a midline dermoid cyst in the neck be distinguished from a thyroglossal cyst?
on protrusion of tongue, a thyroglossal cyst would move up in the neck due to origin of thyroid= foramen cecum= found on dorsum of posterior aspect of tongue.
why are teratomas of benign in the female, but malignant in the male?
female= oocytes= very low turnover male= spermatozoa= very high turnover
2 most common tumours of testes?
seminoma= malignant germ cell tumour
teratoma
what is a dermoid cyst of the ovary also known as?
an ovarian teratoma
what is a pilonidal sinus?
an infected tract under the skin, between the buttocks, fills with pus. hair underneath. hair contained from neck.
name given to the common benign skin growths originating from keratinocytes which are usually pigmented, and are harmless?
seborrheic keratoses
characteristics of a pyogenic granuloma?
pus filled, collection of epitheliod histiocytes (modified macrophages)
history of injury
tment= excision
define a sinus
a blind ended epithelial lined tract
what is a keratoacanthoma?
squamoproliferative lesion, keratin contained in middle, thought to originate from neck of hair follicle-but unknown reason as to why originate from hair follicle skin cells, go away within a few yrs.
but variant of squamous cell carcinoma, and cannot be distinguished from skin Ca reliably clinically, so usually treated surgically.
why is it important to observe scars from any previous surgery prior to carrying out surgery?
check for keloid scars= keloid will occur everytime a scar occurs, there is continued growth of scar tissue around a wound and ptnt must be aware of this prior to surgery.
often afro-caribbean origin
in what patients is erytheme ab igna common?
those with chronic abdominal pain e.g. chronic pancreatitis, ptnt may frequently use a hot water bottle to relieve pain.
define an ulcer
area of discontinuity of epithelium
what a sloping ulcer characteristic of?
a healing venous ulcer
what is a punched out ulcer (trophic- related to nutrition) characteristic of?
peripheral vascular disease or peripheral neuropathy, as may occur in diabetic ptnts
what is an undermined ulcer characteristic of?
buttock pressure sore
appearance of a basal cell carcinoma?
rolled
appearance of a squamous cell carcinoma?
everted
what is hidradenitis suppurativa?
(sometimes known as acne inversa) is a painful, long-term skin disease that causes abscesses and scarring on the skin.
inflammation of apocrine sweat gland–axillae, groin, under breats, pus produced
what is a carbuncle?
red, swollen, and painful cluster of boils that coalesce under the skin
what is often mistaken for a squamous cell carcinoma due to its rapid growth?
a keratoacanthoma
the area in which spider naevi appear is drained by what blood vessel?
SVC
usual content of a femoral hernia?
omentum
bowel may be contained- frequently in form of Richter’s hernia- only antimesenteric border of bowel protrudes, occurs most frquently on R, doesn’t cause bowel obstruction.
femoral hernias frequently have no cough impulse, what is this?
no increase in swelling palpable on coughing-becomes more tense and expansile
basic pathology of a femoral hernia?
defect in transversalis fascia and overlying muscle, allowing peritoneal protrusion to occur.
differentials for femoral hernia?
inguinal hernia- neck felt superior and medial to pubic tubercle, points towards groin rather than down leg psoas abscess/bursa femoral aneurysm enlarged LN ectopic testis
contrast features of direct and indirect inguinal hernias
indirect= can and often does descend into scrotum
reduces upwards, then laterally and backwards
controlled by pressure over internal (deep) inguinal ring after reduction
bulge reappears in middle of inguinal region and flows medially and obliquely towards scrotum after reduction
found in all age groups
direct= don’t go down into scrotum
reduces upwards and then straight backwards
bulge comes directly forwards after reduction
rare in children and young adults
causes of RIF masses?
appendix mass/abscess caecal carcinoma crohn's disease pelvic mass intussusception TB mass transplanted kidney tumour in undescended testis
causes of LUQ masses?
splenomegaly
enlarged stomach, colon, kidney or pancreas?
cysts- true or pseudocyst- acute panceatitis
what is an incarcerated hernia?
contents of hernial sac are stuck inside it by adhesions, but are alive and functioning normally
contents of femoral canal?
fat and Cloquet’s node
RFs for inguinal hernias?
male chronic cough heavy lifting ascites previous abdo surgery e.g. damage to iliohypogastric nerve during appendicectomy which innervates internal and transverse abdo muscles constipation urinary obstruction
where is the superficial inguinal ring found?
it’s a split in the EO aponeurosis, just superior and medial to the pubic tubercle
gold standard for determining if inguinal hernia direct or indirect?
at surgery with reference to inferior epigastric vessels
best way on exam.= to reduce hernia and occlude deep inguinal ring with 2 fingers, ask ptnt to cough or stand and if hernia restrained, it is indirect.
