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| Abdominal swelling (Umbilical hernia) |
Swelling:
Any enlargement or protuberance in the body is called swelling. It may be congenital, traumatic, inflammatory, neoplastic or miscellaneous.
Examination:
General Survey:
Patient with swelling should be looked at as a whole. Observe the patient for cachexia or malnutrition and his/her attitude.This general survey is important and may lead to the diagnosis.
Inspection:
Following points should be preciselt noriced:
1- Site: (dermoid cyst commonly seen in midline of the body, pre or post auricular areas)
2- Size: (vertical and horizontal dimensions)
3- Shape: (ovoid, spherical or pear-shaped --- never say circular swelling)
4- Surface: (cauliflower surface in squamous cell carcinoma, irregular numerous branched surface of a papilloma)
5- colour: black(benign nevus, melanoma), red or purple(arterial hemangioma), bluish(ranula)
6- Number: solitary(lipoma, dermoid cyst), multiple(neurofibromatosis, diaphyseal aclasis)
7- Edge: (clearly defined or indistinct, pedunculated or sessile)
8- Pulsation: (vascular swelling)
9- Impulse on coughing: (the swellings which are in continuity with the abdominal, pleural, cranial cavity or spinal canal show positive cough impulse)
10- Peristalsis: (congenital hypertrophic pyloric stenosis)
11- Movement with respiration: (swelling arising from liver, spleen, stomach, gallbladder, hepatic and splenic flexures of colon move with respiration)
12- Movement with deglutition: (thyroid swelling, thyroglossal cysts, subhyoid bursitis, pre or paratracheal lymph node enlagement)
13- Movement with protrusion of tongue: (thyroglossal cyst)
14- Skin over the swelling: red and oedematous(inflammatory), tense glossy with venous prominence(sarcoma), black punctum( sebaceous cyst), pigmentation(moles, naevi), scar(previous operation, injury or suppuration), peau d' orange(CA beast)
15- Any pressure effect: (axillary swelling may cause oedema of upper limb, venous engorgement in neck due to retrostrnal prolongation of swelling.
