The examination of a lump Dr AbdulQader Said Murshed Consultant General, G.I., & Laparoscoic Surgeon FRCS Glasg, FRCSI, Jordanian Board Monday, 9/7/2018

The examination of a lump Local examination General examination

The examination of a lump or Local examination: Site/position: exact anatomical terms Size: measure dimensions, width, length and height or depth. Shape: spherical, elliptical or hemispherical, asymmetrical, dumb-bell shaped, pear shaped or kidney shaped. sometimes a diagram will clarify Surface: smooth, irregular or irregular. mixture of surfaces. Depth

The examination of a lump or Local examination: Local examination (cont.): Colour and texture of the overlying skin Temperature: hot, cold or of normal temperature Tenderness: Always try to feel the non-tender part before feeling the tender area, and watch the patient’s face to ensure that you are not causing discomfort as you palpate. Edge: clearly defined or indistinct

The examination of a lump or Local examination: Local examination (cont.): Composition: -Consistency: very soft to very hard. Stony hard, Firm, Rubbery, Spongy:, Soft. Some fluid-filled lumps feel hard, some solid lumps are soft; -Fluctuation: Pressure on one side of a fluid-filled cavity makes all the other surfaces protrude -Fluid thrill: A percussion wave is easily conducted across a large fluid collection or cyst -Translucency: (transillumination) -Resonance: -Pulsatility: transmitted pulsation, expansile pulsation. -Compressibility: (should not be confused with reducibility) vascular malformations and fluid collections that can be pushed back into a cavity, a joint or a cistern -Bruit: listen to a lump, A systolic bruit or a machinery murmur (throughout both systole and diastole)

The examination of a lump or Local examination: Reducibility: A reducible lump becomes smaller and then moves, may disappear, lump may return, when you ask the patient to cough cough impulse. to another place as it is compresse Relations to surrounding structures – mobility/fixity. overlying and deeper tissues. The underlying muscles must be tensed. Regional lymph glands

The examination of a lump or Local examination: State of local tissues: Arteries Nerves Bones and joints

The examination of a lump or General examination: You must always examine the whole patient.