Approach to examining a lump

INSPECTION – assess the following:

1. ▪ Site

2. ▪ Size (width, length and depth)

3. ▪ Shape (e.g. spherical)

4. ▪ Surface (irregular vs. smooth)

5. ▪ Skin changes (including discolouration, ulceration and tethering)

6. ▪ Scars (indicating previous surgery).

PALPATION

1. ▪ Edge (well-defined vs. diffuse)

2. ▪ Consistency (soft, firm, hard)

3. ▪ Fluctuance (if two areas on the opposite end of a lump bulge when a third area is compressed). This is best elicited by placing thumb and index finger either side of lump and compressing it with the index finger of the other hand)

4. ▪ Compressability (if the lump disappears and then reforms)

5. ▪ Reducibility (a characteristic of hernia)

6. ▪ Cough impulse (a key characteristic of hernia)

7. ▪ Pulsatility (implies that the lump lies adjacent to an artery). If it is expansile (can be felt by placing a hand either side of the lump), this suggests the presence of an aneurysm

8. ▪ Layer of origin (e.g. skin, fat, muscle, bone)

9. ▪ Tethering

10. ▪ Fixity (whether it is attached to a deeper structure. Fixity to muscle can be demonstrated by contracting the underlying muscle and seeing the effect this has on its mobility)

11. ▪ Regional lymph nodes.

AUSCULTATION

1. ▪ Bruits

2. ▪ Bowel sounds.

OTHER

1. ▪ Transillumination (transmission of light through the swelling suggests a fluid content).