24. Groin Lump

Question 1

Where can groin lumps occur?

Answer 1

Psoas sheath- psoas abscess, psoas bursa
Femoral nerve- neuroma
Femoral artery- femoral aneurysm, pseudoaneurysm
Femoral vein/ saphenous- saphena varix
Lymph nodes- lymphadenopathy (infectious or malignant)
Hernial orifices- hernia
Testicular apparatus- ectopic testis, undescended testis, hydrocele
skin- lipoma, infected abcess, sebaceous cyst

Question 2

The most common causes of groin lumps are?

Answer 2

Indirect inguinal hernia, direct inguinal hernia

Question 3

What are the key features of HPC of groin lump?

Answer 3

How long has it been there, does it reduce when lying down, has it changed in size, is the lump painful, are there any other lumps

Question 4

What are important Qs if a hernia is suspected?

Answer 4

Has there been abdominal pain?
Have you been straining at stool, struggling to pass urine or suffering chronic cough?
Does your job involve heavy lifting? (all increase intra abdo pressure)Have you had any prior operations in groin? (presidposes to incisional hernias)

Question 5

What are the main risks of hernias?

Answer 5

Bowel obstruction and bowel strangulation

Question 6

What are important questions if infective process or malignancy are suspected?

Answer 6

Has there been trauma/ infection in lower limb? (drug use, minor injuries, STIs can cause inguinal lymphadenopathy)Has there been indicators of anal, scrotal, cutaneous malignancy?
Do you have a fever?
FLAWS

Question 7

What are the key features on examination of a groin lump?

Answer 7

Site, tenderness/ warmth, solid/ fluctuant, pulsatile, cough impulse, reducible, percussion and auscultation

Question 8

Where is an inguinal and femoral hernia?

Answer 8

INGUINAL - superior and medial to pubic tubercle

FEMORAL - inferior and lateral to the pubic tubercle

Question 9

What will you notice with tenderness and warmth with hernias?

Answer 9

Skin on strangulated hernias might be red/inflamedReducible hernias may be tender Groin abscesses, reactive lymph nodes and infected pseudoaneurysms may be warm and tender

Question 10

What happens with the cough impulse?

Answer 10

Lumps expands during coughing in this impulse. This is diagnostic of hernias because they will expand in response to increased intra-abdominal pressure
o The cough impulse may be slightly different in different types of hernias:
Direct Inguinal - expand outwards
Indirect Inguinal - expand along the path of the inguinal canal (inferomedial direction)
Reducible
o ONLY reducible groin lumps: Hernias, Saphena varix (rare)

The direction of reducibility is most useful for distinguishing direct and indirect inguinal hernias: Direct - superolaterally and posteriorly
Indirect - along the inguinal canal