Swelling
Swelling is a vague term which denotes any enlargement or protuberance in the body due to any cause.
Tumour is a growth of new cells which proliferate independent of the need of the body.
History
· Duration –
o How long is the lump present there?
· Mode of onset –
o How did the swelling start?
· Other symptoms associated with the lump –
o Pain, difficulty in respiration, difficulty in swallowing, interfering with any movement, disfiguring etc.?
· Pain –
o Whether pain appeared before the swelling or after it,
o Nature of pain –
§ Throbbing (which suggests inflammation leading to suppuration)
§ Burning
§ Stabbing (pain is sudden, sharp, severe and of short duration)
§ Distending
§ Aching
o Site – same site, referred, radiation,
· Progress of the swelling –
o Has the lump changed its size since it was first noticed?
· Exact site –
o From which structure the swelling appeared?
· Fever –
· Presence of other lumps –
· Secondary changes –
· Impairment of function –
· Recurrence of swelling –
o E.g.- Paget’s recurrent fibroid , cystic swelling may recur if the cyst wall is not completely removed.
· Loss of body weight –
· Past history –
· Personal history – habit of eating betel leaf, betel nut, slaked lime or tobacco.
· Family history – tuberculosis, Von Recklinghausen’s disease
General Survey –
Local examination –
INSPECTION –
· Situation –
· Colour –
· Shape –
· Size –
· Surface –On inspection, it may be difficult to have a clear idea about the surface of the swelling. But in certain swellngs, the surface may be very much obvious and diagnostic, eg. cauliflower surface of squamous cell carcinoma, irregular numerous branched surface of a papilloma etc.
· Edge – The edge of the swelling may be clearly defined or indistinct. The swelling may be pedunculated or sessile.
· Number –
· Pulsation –
· Peristalsis –
· Movement with respiration –
· Impulse on coughing –
· Movement on deglutition – e.g.- thyroid swelling, thyroglossal cyst, subhyoid bursitis and pre-or paratracheal lymph node enlargement
· Movement with protrusion of the tongue – thyroglossal cyst
· Skin over the swelling –
o This will be red and oedematous, where the swelling is an inflammatory one.
o The skin becomes tense, glossy with venous prominence, where the swelling is a sarcoma with rapid growth.
o Presence of a black punctum over a cutaneous swelling indicates sebaceous cyst.
o Pigmentation of the skin is seen in moles, naevi or after repeated exposures to deep X-rays.
o Presence of scar indicates either previous operation (when the scar is a linear one with suture marks), injury (a regular scar) or previous suppuration (when the scar is puckered, broad and irregular).
· Any pressure effect –
PALPATION –
· Temperature –
· Tenderness –
· Size, Shape & Extent –
· Surface – the surface of a swelling may be smooth(cyst), lobular with smooth bumps(lipoma), nodular( a mass of matted lymph nodes) or irregular & rough(Carcinoma).
Edge-
Consistency-
Fluctuation-
Fluid thrill-
Translucency-
Impulse on coughing-
Reducibility-
Compressibility-
Pulsatility-
Fixity to the overlying skin-
Relations to surrounding structures-
C. State of the Regional Lymph nodes-
D. Percussion-
E. Auscultation-
F. Measurements-
G. Movements-
H. Examination for Pressure effect-
General examination-