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