Groin swelling

ICD 10. Code R19.09

• Other intra-abdominal and pelvic swelling, mass and lump

• Adnexal mass
• Inguinal mass
• Inguinal swelling
• Mass of uterine adnexa
• Pelvic mass in pregnancy
• Retroperitoneal mass
• Swelling of inguinal region
Introduction

• Introduce yourself to the patient

• Wash your hands
• Explain the examination to the patient
• Reassure them that you will stop immediately if it becomes too painful at any point
• Ensure verbal consent is adequately obtained
• Offer the patient a chaperone if required
• Always work through a structured approach as below unless instructed
otherwise; be prepared to be instructed to move on quickly to certain
sections by any examiner.
• Cysts
• Swollen glands
• Hernia
• Sexually transmitted infections (STIs) due to swollen lymph nodes
• Saphena varix
This occurs when the valve of the saphenous vein fails to open
correctly to let blood flow through, causing the blood to collect inside
the vein. Saphena varix causes golf-ball sized lumps that have a blue
tinge.
• Allergic reaction
• Cancer
• Drug reaction
• Harmless (benign) cyst
• Hernia (a soft, large bulge in the groin on one or both sides)
• Infections in the legs
• Injury to the groin area
• Lipomas (harmless fatty growths)
• Sexually transmitted diseases such as genital herpes, chlamydia, and
gonorrhea
• Swollen lymph glands in the groin area
Anamnesis

• When did the lump first appear?

• How big is the lump?
• Has the lump grown?
• Did the lump develop suddenly or over a few days?
• Does the lump change in size or shape when you cough?
• Historical deasease?
Observation

• Examine them standing first and ask them to lower their underwear
• Assess the patient from in front and from the side, on both sides,
checking for:
• Obvious lumps or swellings
• Asymmetry
• Scars or skin changes
• Ask the patient to cough, to accentuate any hernia
Examination of the Lump

• If there is an obvious lump, examine that side first; remember to tell the patient exactly
what are you doing throughout.
• Important points to note are:
• One lump or multiple lumps
• Multiple lumps may suggest lymph nodes or possibly superficial lesions
• Consistency (hard or soft)
• Cough impulse*
• Reducible
• Pulsatile
• Able to palpate above it
• If able to get above it, likely to be scrotal swelling; if not able to get above it, likely groin swelling
• *Remember that an incarcerated hernia will most likely not have a cough impulse (as by
definition the hernia is trapped and immovable)
Examination of a Hernia

• If you suspect a hernia, clarify the relation to the pubic tubercle:

• Above and medial = inguinal hernia
• Below and lateral = femoral hernia*
• Repeat the examination for the other side of the groin (around 20% of
inguinal hernias are bilateral)
• Ask the patient to lie down; look to see if the lump reduces spontaneously
at this point, as this will indicate a likely hernia
• *Look for a small “pea-sized” lump in the groin, indicative of a femoral
hernia. These are difficult to find because they are small, but have high
rates of obstruction thus essential to look carefully for; they are often
incarcerated and so rarely have a cough impulse
Completing the Examination
• To finish the examination, thank the patient and state to the examiner
that to complete your examination, you would like to examine the
external genitalia.
• Examination of the external genitalia will assess for scrotal extension
of the hernia and any genital lesions which may spread to the inguinal
lymph nodes. Testicular lesions will drain to the para-aortic nodes, so
will not be palpable