003 Swellings - Introduction to Clinical Surgery Lectures

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Lecture on swellings from a series of lectures on an introduction to clinical surgery. It has been devised with medical students in mind.

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003 Swellings - Introduction to Clinical Surgery Lectures

  1. 1. Swellings Nick Harvey
  2. 2. History of a Swelling <ul><li>Onset, Course, Duration? </li></ul><ul><li>Painful or Painless? </li></ul><ul><li>Other Lumps? </li></ul><ul><li>Effect on General Condition? </li></ul><ul><li>Cause? </li></ul><ul><li>Does the lump disappear? </li></ul>
  3. 3. Examination of a swelling: Inspection <ul><li>Site </li></ul><ul><li>Size </li></ul><ul><li>Shape </li></ul><ul><li>Symmetry </li></ul><ul><li>Surface </li></ul><ul><li>Skin overlying </li></ul><ul><li>Scars </li></ul><ul><li>Special signs </li></ul><ul><ul><li>Pulsations, cough impulse, movement on swallowing, etc. </li></ul></ul>
  4. 4. Examination of a swelling: Palpation <ul><li>Tenderness </li></ul><ul><li>Skin temperature </li></ul><ul><li>Size </li></ul><ul><li>Surface </li></ul><ul><ul><li>Smooth, irregular </li></ul></ul><ul><li>Edge </li></ul><ul><ul><li>Well-defined, ill-defined </li></ul></ul><ul><li>Consistency </li></ul><ul><ul><li>Cystic/solid, soft/firm/hard </li></ul></ul><ul><li>Relation to surrounding structures </li></ul><ul><ul><li>Skin, muscles, arteries, nerves… </li></ul></ul><ul><li>Draining lymph nodes </li></ul><ul><li>Special signs </li></ul>
  5. 5. Examination of a swelling: Consistency <ul><li>Cystic </li></ul><ul><ul><li>Fluctuation </li></ul></ul><ul><ul><li>Paget’s Test </li></ul></ul><ul><li>Solid </li></ul><ul><ul><li>Soft </li></ul></ul><ul><ul><li>Firm </li></ul></ul><ul><ul><li>(Indurated) </li></ul></ul><ul><ul><li>Hard </li></ul></ul>
  6. 6. Examination of a swelling: Relation to Skin <ul><li>Is the lump separate from the surrounding skin? </li></ul><ul><ul><li>Pinch the skin over the lump </li></ul></ul><ul><li>Is the lump tethered or fixed to the skin? </li></ul><ul><ul><li>Move the lump and see what happens to the skin </li></ul></ul>
  7. 7. Examination of a swelling: Relation to Muscle <ul><li>Feel the swelling before and after muscle contraction </li></ul><ul><li>Is the swelling: </li></ul><ul><ul><li>Superficial </li></ul></ul><ul><ul><li>Within </li></ul></ul><ul><ul><li>Deep to the muscles? </li></ul></ul>
  8. 8. Examination of a swelling: Pulsations <ul><li>Expansile </li></ul><ul><li>Transmitted </li></ul>
  9. 9. Examination of a swelling: Transillumination <ul><li>Hydrocoele </li></ul><ul><li>Cystic hygroma </li></ul><ul><li>… </li></ul>
  10. 10. Examination of a swelling: Neck Lumps <ul><li>Thyroid </li></ul><ul><li>Thyroglossal Cyst </li></ul>
  11. 11. Examination of a swelling: Hernias <ul><li>Cough impulse </li></ul><ul><li>Reduction </li></ul>
  12. 12. Examination of a swelling: Percussion & Auscultation <ul><li>Percussion </li></ul><ul><ul><li>Retrosternal goitre </li></ul></ul><ul><li>Ausultation </li></ul><ul><ul><li>Esp over arteries/pulsating masses </li></ul></ul>

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