Clinical

Examination
of Groin Lump
Division
Division of
of Digestive
Digestive Surgery
Surgery
Medical
Medical School,
School, Padjadjaran
Padjadjaran
University
University

Specific learning
objectives :
At the end of training session, student
will be able to :
perform history taking of groin lump
correctly. (P5)
perform physical examination on groin
lump correctly. (P5)

Definition : Groin lump

A lump which arises from the
groin/inguinal region and it may be
due to various diseases or disorders

Causes of groin lump:

Inguinal hernias: Direct, Indirect
Femoral hernia
Vaginal hydrocele
Hydrocele of testis/cord / canal of Nuck
Ectopic testicle
Lipoma of the cord

Causes of groin lump:

Lymphadenitis
Lymphadenopathy
Abscess
Hematoma
Varicocele
Seroma

Causes of groin lump:

Testicular mass
Testicular torsion
Epididymitis
Femoral aneurysm or
pseudoaneurysm
Cyst

Anatomy of the inguinal

region

Types of Inguinal Hernia :

Femoral Hernia

Clinical Grading
Reduction

pain Obstruction toxic

Grade
reponible

irreponible

incarceration -

colic

strangulation increase
leucocytosis

steady

++

History taking:
Introduction:
Greet the patient, and develop a warm
and helpful environment
Introduce yourself to the patient

History taking:
Patient Identity
Ask the patient politely concerning
his/her:
Name
Age

Record the gender:

Male
Female:
Number of children
parity

History taking:
Chief complaint:
Ask the patient regarding why the
patient comes to you.
Lump on the groin:
Location: unilateral/bilateral
Onset: acute (< 2 weeks), chronic (>2
weeks).
Size of the lump at present

History taking:
The nature of the lump:
Intermittent?
If yes, what are the aggravating factors? Or
relieving factors?
Is the lump reducible?
Feeling discomfort?

Persistent?
If yes, determine the lump progression
Accompanying pain: continuous? Intermittent?
Colicky abdominal pain?

History taking:
Other related symptoms:

Ask the patient concerning

related/concomitant symptoms of
:
Gastro-intestinal function:

Nausea.

Vomiting

Bowel habit: obstipation?

History taking:

Urinary function:
Micturition: amount of urine,
Lower urinary tract symptoms:
obstructive and irritative symptoms.

History taking:
Fever:

Onset of fever: before or after the

appearance of the lump?

Type of fever:
Continuous?
Intermittent?

Accompanying night sweating?

History taking:
Previous history of :
Previous similar lump
Previous hernia surgery
Previous major illness: incl. fever,
chronic coughing, injury, jaundice.

Physical Examination:
Preparation
Check all the equipment required
and have a good light:
Examination couch
Stethoscope
Explain the procedure and its goals to
the patient.
Wash your hands with antiseptic soap.
Dry and warm your hands with tissue
towels and put on hand gloves.

General Examination:
General appearance:
Consciousness
Mood: distressed? Anxious?
Immobile
Colour: Pallor? Flushing?

 If the patients general condition

looks normal, the patient is asked to
stand up in front of you.
Ask the patient politely to expose
his/her inguinal region.

 If there is no lump, you ask the patient to

perform Valsava manoeuvre:
Ask the patients head to turn one side.
Ask the patient to cover his/her mouth
with one of hands, and blow air through
the mouth. While doing this, allow the
patient to strain and watch for any visible
lump from both inguinal and femoral
regions, and scrotal regions for male
patients.

Groin Examination

Position
Temperature
Pain
Size
Shape
Tensile strength
Composition (solid, gas, liquid)
Changes with cough

If there is a lump on the inguinal or femoral

region,
a. Inspect the lump and determine:
The colour of the lump: Redness?
The shape and location of the lump
Skin edema
b. Palpate the lump, determine :
Sign of local tenderness
The content

 Try to reduce the lump manually by using

your fingers, starting from the external
ring or the most lower part of the lump,
going up to internal ring (Anatomical
landmark: Anterior Superior Iliac Spine,
pubic tubercle).
If it fails, do not continue. The success
procedure is indicated when the lump
disappears with or without gurgle sounds.

 Put your right index finger above the

inguinal canal or place your right/left
fingers on the external ring and the
opposite fingers on the internal ring or on
top of any noticeable lump.
Ask the patient to repeat the valsava
manoeuvre, watch if there is lump coming
out from the rings.
Determine the position of the lump in
relation with inguinal ligament:

Finger test

Differential Diagnosis
Indirect inguinal hernia (no lump, if
the fingers compression released,
the lump will reappear).
Direct inguinal hernia (Round Lump
above inguinal ligament)
Femoral hernia (Lump below the
inguinal ligament/pubic tubercle).

 If a scrotal lump presents, grasp the

swelling between fingers and
thumb, and ascertain whether it is
possible to get above the swelling.
Determine its continuity with the
inguinal canal.
Using flash light, determine whether
there is any trans-illumination.

 Ask the patient to lie down on the couch

in supine position.
Examine the vital signs:
Temperature
Pulse rate
Blood Pressure
Respiratory rate

 Perform other systems examination,

including cardio-pulmonary system.
Ask the patient politely to expose
his/her abdomen and inguinal
region.

Abdominal Examination:
Inspection :
Inspect the movement:
Respiratory movement
Visible bowel peristaltis

Is there any abdominal distention?

Abdominal Examination:
Palpation:
Using the palmar surface of your fingers,
gently palpate the abdomen.
While palpating, look to the face
expression of the patient, and look for
any signs of :

Tenderness
Rebound tenderness
Muscle guarding
Rigidity
Hernial orifices

Abdominal Examination:
Percussion:
Place the palmar aspect of your left hand
on the abdomen, and gently percuss its
dorsal aspect with the tip of the middle
finger of the right hand, moving all
around the abdominal region:

Is it tymphanitic?
Is it Dull ?
Is there any shifting dullness?
Site of liver dullness ? and is it disappeared ?

Abdominal Examination:
Auscultation
Using stethoscope, and place it gently on
the abdomen, listen to the bowel sounds
and bruit at least for a minute:

Normal
Absent?
High pitched and hyperactive?
Metallic sound?

Groin Examination:
Perform the groin examination as
you perform on standing position.
Auscultation on top of a hernia may
allow the detection of bowel sounds,
which can be useful information if
you are unsure as to the nature of
an inguinal bulge.

Digital Rectal
Examination
In old male patient with the
suspicion of lower urinary tract
symptoms, perform digital rectal
examination to look for signs of
enlarged prostate gland.

Write up
Write up all significant findings in
the medical record.
Conclude your diagnosis and
differential diagnosis, and order any
necessary special investigations

Demonstration:Video