General Physical Examination

Appearance: Anemic, jaundiced or emaciated, Lymph nodes, especially supraclavicular.

Local Examination

Inspection:

• Overlying skin
• Position, size, shape and surface of the swelling
• Movement of swelling  on respiration
• Check sites of hernia
• Observe scrotum for any fullness

Palpation:

• Note the local temperature
• Is swelling tender?
• Muscular rigidity
• Confirming positive findings of inspection
• Note margins on palpation. Can you get around the margin? Well or ill-defined.
• Consistency: Soft, firm or hard. Hard swellings are usually malignant, soft swelling may be cystic.
• Mobility: This should be determined by hand in all directions, i.e. from side to side and above downward.
• Is swelling parietal or intra-abdominal?
  This can be found out by making the abdominal muscles taut by raising the shoulders or the legs.
  If the lump becomes less prominent is intra-abdominal. If it becomes more prominent it is partial.
  If the lump is mobile over the contracted muscles it is superficial to the muscles and if it is fixed, it is adherent to the muscle.
• Hernial sites for expansile impulse on coughing
• Pulsations if present: expansile (aortic) or transmitted (lump over aorta)

Percussion:

• Dull or resonant

Auscultation:

For rub (perisplenitis and perihepatitis)