26.1.12

Clinical- Inguinoscrotal examination


Scrotal & Inguinoscrotal swellings (Standing)

Groin Hernia (Inguinal / Femoral)  Answer 3 questions
Introduce yourself                                                        - Can I get above it?          
Exposure: upto groin                                                     - Is it separate from testis?    
1-        Inspection (from the Front - Patient Standing)    - Does it transilluminate?
a-     Swelling 5S ☺”I can see a (Rt./Lt./Bilateral) groin/ Inguinoscrotal swelling,  
OR fullness at (Rt./Lt./Bilateral) scrotal neck”
b-    Cough كح → expansile impulse on cough (becomes more prominent)
c-   Scrotum & back scrotum → 2 full compartments, symmetrical, with median raphe. No dilated veins, no scars (ask) or sinuses)
 d-    Penis → No Hypospadius, Episapdius, Meatal stenosis
2-        Palpation Ask about pain   2T
·      from the Front - Patient Standing
a-    2 testes: Size (average size/small), Consistency (N/soft).
b-    Scrotal Neck test & cord كح → I cannot get above swelling → inguinoscrotal
                                                       → Swelling above my hands → inguinal
+ expansile impulse on cough
·      From the Side -Patient Standing (for Hernia)
a-    Hand on swelling (if groin swelling only) كح → expansile impulse on cough
b-    Other side: hand on groin كح → NO expansile impulse on cough = no hernia
3-    Special test     ·   Standing (for time) OR Supine (better)
a-       Relation to P.T. (better supine): above& med.PT= Inguinal/ below& lat.PT= femoral
b-      Reducibility (ask pt. if reducible).   If reducible → try reduce standing.
 If fail → try reduce supine.
 If fail → ask pt. reduce it
c-      Internal ring test (better supine): Pubic tubercle - ASIS → mid-point ing.canal (int.ring). close by 2 fingers. If controlled → Indirect / If not controlled→ Direct

Auscultation (if suspect strangulation)

I would like to finish my examination by:
1-       Examination other side
2-       Examine Abd. & Ask about ppf:  Chest problems: chr.bronchitis.
                                                             Bowel problems: constipation.
                                                             Urinary problems: BPH.
                                                             Occupation: wt lefting.

Varicocele
Introduce yourself
Exposure: upto groin   
1-   Inspection (from the Front - Patient Standing)
a-     Swelling 5S  ☺”I can see a (Rt./Lt./Bilateral) Inguinoscrotal swelling/fullness”
b-    Cough كح → expansile impulse on cough
c-    Scrotum & back scrotum → 2 full compartments, Asymmetrical, with median raphe. multiple dilated veins on Lt scrotum, no scars (ask) or sinuses.)
d-    Penis → No Hypospadius, Episapdius, Meatal stenosis

2-     Palpation Ask about pain   2T
·    from the Front - Patient Standing
a-    2 testes: Size (average sie/small), Consistency (N/soft).
b-    Scrotal Neck test & cord كح → I cannot get above swelling → inguinoscrotal & sensation bag warms & cough → thrill
·    From the Side -Patient Standing (for Hernia)
 a-      Both sides : hand on groin كح → NO expansile impulse on cough = intact hernial orifices
3-    Special test        ·   Supine
Elevate scrotum (to evacuate veins). If ↓ →1ry varicocele
I would like to finish my examination by:
1- Examination other side

Scrotal Swelling (Hydrocele, Spermatocele, Encysted H cord)

Introduce yourself
Exposure: upto groin   
1-   Inspection (from the Front - Patient Standing)
a-     Swelling 5S ☺”I can see a (Rt./Lt./Bilateral) scrotal swelling”
b-    Cough  كح☺”→ NO expansile impulse on cough
c-    Scrotum & back scrotum (2 full compartments, symmetrical, with median raphe, no scars(ask) or sinuses.)
d-    Penis → No Hypospadius, Episapdius, Meatal stenosis
2-     Palpation Ask about pain   2T
·    from the Front - Patient Standing
a-    2 testes: Size (average sie/small), Consistency (N/soft).
b-    Scrotal Neck test → I can get above swelling → purely scrotal
c-    relation to testis: can be separated from testis → encysted H - Spermatocele
                                  / cannot be separated from testis → vaginal hydrocele
·    From the Side -Patient Standing (for Hernia)
 c-      Both sides : hand on groin كح → NO expansile impulse on cough = intact hernial orifices
3-    Special test        ·   Standing
a- Bipolar fluctuation: +ve → cystic swelling
b- Transillumination test (torsh laterally & light off or opaque tube by examiner) →
 if +ve → hydrocele
 if –ve → may be complicated hydrocele (common) or solid swell. (rare in exam)

Contents of Spermatic Cord
  3 Arteries
3 Nerves
3 Tubes
·  Testicular artery (Aorta)
·  Artery to vas (Inferior Vesical a.)
·  Cremasteric artery (Inf. Epigasteric a.)
·  Ilioinguinal nerve   (infront cord)
·  Cremasteric nerve
(branch genitofemoral n.)
·  Sympathetic fibers
·  Vas deferens
·  Pampiniform plexus of vs
·  Lymphatic vessels


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