History & Examination of Swelling,Ulcer,Sinus and Fistula

History & Examination of swelling,ulcer,sinus and FistulaLump vs. Swelling Lump-Vague mass of body tissue Swelling-A vague term which denote any enlargement or protuberance in the body & may include tumors History           Duration Mode of Onset Other symptoms associated with the lump Pain Progress of the swelling Exact site Fever Presence of other lump Secondary changes Impairment of the function History contd.      Recurrence of the swelling Loss of body weight Past History Personal History Family History Inspection              Local Examination situation color Shape Edge Number pulsation Peristalsis Movement with respiration Impulse on coughing Movement on deglutition Movement with protrusion of tongue skin over the swelling any pressure effect Palpation             Temperature Tenderness Size, Shape & Extent Surface Edge Consistency Fluctuation Fluid thrill Translucency Impulse on coughing Reducibility Compressibility      Pulsability Fixed to the overlying skin Relation to surrounding structures Skin, subcutaneous tissue, deep fascia, muscle,tendon,bone Sate of regional Lymph nodes Fungating bleeding mass -  Breast lump  Inguinal swelling -Thyroglossal cyst  Congenital dermoid -     Percussion-Hydratid thrill Auscultation Measurement Movement Examination of Pressure effect General Examination malignancy  syphilitic stigma  tuberculosis History for Ulcer Ulcer is a break in the continuity of covering epithelium  Mode of onset  Duration  Pain  Discharge  Associated Disease Examination Inspection         Size Shape number Position Edge Discharge Surrounding area Whole limbs Palpation        Tenderness Edge& Margin Base Depth Bleeding Related with deeper structure Surrounding skin -      Undermined Punched out sloping Raised &pearly white beaded rolled out(everted) Venous ulcer  -     Examination of Lymph node Examination for vascular insufficiency Examination for nerve lesions General Examinationtuberculosis syphilitic stigma trophic ischemic History for sinus/ fistula   Sinus-A sinus is a blind track leading from the surface down to the tissue Fistula-It is a communicating track between two epithelial surfaces commonly between a hollow viscus & the skin or between two hollow viscera Causes of persistence of a sinus      Presence of foreign body or necrotic tissue in the depth Absence of the rest Nondependent drainage or inadequate drainage of an abscess Chronic infections Dense fibrosis History     Pain Fever & redness of the surrounding skin Past history Family history Local Examination Inspection  Number  Position  Opening of the sinus  Discharge  Surrounding skin Palpation  Tenderness  Wall of the sinus  Mobility  Lump Examination of Lymph nodes General Examination Examination with Probe  Direction/ depth of sinus  Presence of any f.b/sequestrum  Communication with hollow viscera  Fresh discharge on with drawl of probe -  Sinus at left inguinal region Thyroglossal fistula -