“LUMPS & BUMPS”
I recently presented a power point webinar on “LUMPS &BUMPS”
The importance of the history and examination in arriving at a clinical diagnoses is stressed.The brain acts like a computer – matching a list of physical signs, pathological processes and anatomical location to arrive at a precise diagnoses.
The session started with head and neck lumps.
Some points discussed included:
- With oropharangeal lumps and thus neck secondaries an increasing incidence of carcinoma is due to sexually transmitted diseases rather than just smoking or alcohol.Thus a younger age group is presenting.
- With neck lumps aspiration cytology or core biopsy is usually used to exclude or confirm malignancy and to help plan appropriate surgery. Of course the primary source should be sought.
There were a series of images illustrating how each can be assessed, for example by swallowing for a thyroid or poking out the tongue for a thyroglossal cyst.
Similarly,in other regions we should first ask the breast patient to first elevate the arms to inspect for skin retraction or tethering. The hernia patient should be asked to cough.Around a joint active movement is assess
Particular physical signs such as mobility can help differentiate a lipoma from a less common soft tissue tumour.A lipoma will move in all directions whilst a neurofibroma, leiomyoma or any tumour attached to a tendon or longitudinally running structure such as a vessel or nerve will only move in a transverse direction. Thus a simple clinical sign can be diagnostic and suggest caution.
Another hint in diagnosing the unusual or what could be termed an outlier is that malignancies can show overlying erythema as exemplified by a secondary melanoma or a large liposarcoma..
Surgery to remove a sebaceous cyst and lipoma were demonstrated step by step.The surgery is displayed on the MELBOURNE HERNI CLINIC WEBSITE.
The case of a lacerated finger with a digital nerve injury was discussed.
THE IMPORTANCE OF APPROPRIATE ASSESSMENT BEFORE USING LOCAL WAS STRESSED. In the fingers the digital nerves are superficial to the arteries .Thus severe bleeding suggests a nerve may be divided.
A case of torsion of the testis which had been diagnosed as a strangulated hernia was was demonstrated and discussed.
We also presented work from THE MELBOURNE HERNIA CLINIC.
I WORK WITH COLLEAGUES INCLUDING MR CHARLES LEINKRAM who specializes in hernia repair under local as a day case and incisional hernia repair.He also performs abdominoplasty.
We specialize in day care surgery. Tel 0395259077. Fax. 0395271519 www.hernia.net au