Lipoma , Sebaceous Cyst and Dermoid CystExamination

ထိုင္ ခိုင္း ပါ ။

General : well and alert
no dyspnoeic

Local : INSPECTION
swelling : number
site
size
shape
surface
skin over swelling - sign of inflammation ( + / - )
margin
Puntum
swelling in other part - normal or not
( ေခ်ာင္း ဆိုး ၾကည့္ ပါ။ ) - cough impulse ( + / - )
distal to that swelling - oedema ,sensation , wasting of limb

PALPATION
temperature
tenderness
site
size
shape
surface
skin over swelling - sign of inflammation ( + / - )
margin
consistancy - hard
firm
doughy
soft / cystic - fluctuation test
transillumination test
Other tests -PINCH test
puntumရွိရင္- skin attachment ရွိမယ္--puntum ရွိေၾကာင္းအရင္ေျပာ
အလယ္ နဲ ့ ေဘး ၂ ဘက္ ဆြဲ ၾကည့္ -skin attachment ရွိမ ရွိ ေျပာ

SLIPPING sign
margin ကို အေပၚ က ေန index finger နဲ ့ ဖိ- slip ျဖစ္ရင္ ( + )
( It means subcutaneous lipoma )
( if there is bone defect it is congenital dermoid cyst and there is also cough impulse )
LOBULATION test
thumb and index fingers နဲ ့ ေဘး ၂ ဖက္ က ေန ဖိ ကိုင္ လိုက္ရင္ - အခ်ိဳင့္ ေလး ေတြ ေပၚလာ ရင္ ( + )
(Pinch test and lobulation positive mean it is LIPOMA )

MOULDING sign
index and thumb နဲ ့ ဖိ ဖိ ၾကည့္ လို ့ တန္းျပန္ မ ေပ်ာက္တဲ့ အခ်ိဳင့္ေတြေပၚ ရ င္ ( + ) ပံုသြင္းလို ့ရ တဲ့သေဘာ ကို ေျပာခ်င္တာ ။
( If positive it mean SEBACEOUS CYST )

EMPTYING sign
အေပၚ က ေန index fingerနဲ ့ ဖိ ၾကည့္ လို ့ ေပ်ာက္သြား ၿပီး ခဏေန မွ ေပၚ လာ ရင္ ( + )



Others : lymphnode
regional lymphnode ေတြ စမ္း ေပး ပါ ။

DIFFERENTIAL DIAGNOSIS :
LIPOMA ( universal common ) - lobulation sign ( + )
slipping sign ( + )
fluctuation test ( + )
transillumination test ( - )
SEBACEOUS CYST - Puntum present ( purplish black spot in middle of swelling )
moulding sign ( + )
emptying sign (+ )
slipping sign ( - )
fluctuation test (- )
transillumination test ( - )

DERMOID CYST - i t occured after injury
fluctuation test ( + )
transillumination test ( - )

Treatment : Excision under Local Anasthetic - complete removal
Avulsion under Local Anasthetic - better scar but recurrent present