Download THE GROIN

THE GROIN
1.
2.
Where is it?
-
Leg ?
-
Thigh ?
-
Crease ?
-
Hip ?
-
Abdomen ?
-
Genitalia ?
-
Inguinal hernia - Direct
- Indirect
-
Femoral hernia
-
Lymph nodes
-
Sapheno varix
-
Skin/subcutaneous lesions
What are we looking for?
Examination of “groin”
-
Many different techniques
-
Pick one that suits you
-
This is the version I use
1.
Patient lying down - comfortably
- lower abdomen & “crease” exposed
- dignity preserved
2.
Scott’s Lumps Law #1
3.
Look - describe
4.
Cough and look - describe
5.
Palpate - describe finding
6.
Define anatomy I (pubic tubercle) – describe position of swelling
in relation to anatomy:
If above (and ? medial) to pubic tubercle = inguinal hernia
If below and lateral to pubic tubercle
= femoral hernia
If inguinal hernia
7.
Reduce swelling
8.
Define anatomy II – deep ring (half way between symphysis pubis
and anterior superior iliac spine and one finger above).
9.
Finger in deep ring - cough
-
? control
? no control
= indirect
= direct
(very inaccurate test)
10. Then tell the examiner that:
“I always examine: The other side (20% bilateral)
The genitalia”
And stand patient up
? Why
-
sapheno varix
varicocele
hydrocele of cord
SCROTAL SWELLINGS
What are we going to find?
 Tumour
 Orchitis
-
Testicular lesions
-
 Cyst
Epididymal lesions  Granuloma
 Epididymitis
-
Cord lesions
-
Fluid
-
Skin lesions
-
Inguinal hernia (inguino-scrotal hernia)
 Varicocele
 Hydrocele cord
 Hydrocele
 Epididymal cysts
 Sebaceous
cysts
EXAMINATION
1.
Lie patient down.
2.
Scott’s Lumps Law #1
3.
LOOK
4.
Palpation
-
Shape
Size
Colour
**1ST PRIORITY**
Can you get above swelling?
NO =
YES =
Hernia
True intra scrotal pathology
5.
Hernia
-
Convert to hernia pathway
6.
Scrotal
-
Can you feel testicle
-
Yes -
? normal (compare with other side)
position of testis compared with lump
Transilluminate swelling to show if fluid. If it is:Testicle not palpable or behind swelling =
hydrocele
Testicle below swelling
=
epididymal cyst
=
varicocele (usually left
and feel for left kidney).
Stand patient up
? bag of worms
REMEMBER TO EXAMINE OTHER SIDE
LOOK
? VISIBLE
LUMP
YES
NO (don’t panic!)
COUGH
COUGH
VISIBLE LUMP
NO (still don’t panic)
YES
INCREASE IN SIZE
YES
NO
PALPATE
PALPATE
CONFIRM COUGH
IMPULSE
DESCRIBE
NODES
SKIN LESIONS
? PALPABLE LUMP/IMPULSE
YES
DEFINE
PUBIC TUBERCLE
ARISING
ABOVE
INGUINAL
HERNIA
REDUCE, INSERT
FINGER INTO DEEP
RING (1/2 WAY BETWEEN
ASIS AND SYMPHYSIS)
CONTROL
YES
NO
INDIRECT
PALPATE& COUGH
ABOVE
ARISING
BELOW &
LATERAL
FEMORAL
HERNIA
CHECK
OTHER
SIDE
LIST
NO
STAND PATIENT
UP
VISIBLE/PALPABLE LUMP
YES
NO
RELATION
TO
INGUINAL
LIGAMENT
PANIC!
BELOW
PROBABLY
SAPHENO
VARIX
PROBABLY
MISSED
HERNIA
DIRECT
EXAMINE LEG & DOPPLER