3. Abdominal mass/distension

Question 1

causes of abdominal swelling

Answer 1

6 Fs
flatus
fat
fluid
feces
fatal growth

Question 2

what is flatus made up of

Answer 2

increased intestinal gas
nitrogen and oxygen are swallowed while CO2, hydrogen and methane are produced intraluminally by bacterial fermentation

Question 3

aerophagia is

Answer 3

the swelling of air - can result in an increased amount of oxygen and nitrogen in the small intestine (flatus) and lead to abdominal swelling

Question 4

aerophagia results from

Answer 4

gulping food, chewing gum, smoking, or as a response to anxiety which can lead to repetitive belching.

Question 5

increase in production of intestinal gas is caused by

Answer 5

bacterial metabolism of excess fermentable substances such as lactose and other oligosaccharides, which can lead to production of hydrogen, carbon dioxide, or methane.

Question 6

impaired transit of gas

Answer 6

In some persons, particularly those with irritable bowel syndrome and bloating, the subjective sense of abdominal pressure is attributable to impaired intestinal transit of gas rather than increased gas volume.

Question 7

fat

Answer 7

Abdominal fat may be caused by an imbalance between caloric intake and energy expenditure associated with a poor diet and sedentary lifestyle; it also can be a manifestation of certain diseases, such as Cushing’s syndrome.

Question 8

fluid

Answer 8

The accumulation of fluid within the abdominal cavity (ascites) often results in abdominal distention

Question 9

grades of ascites

Answer 9

Grade 1 ascites is detectable only by ultrasonography; grade 2 ascites is detectable by physical examination; and grade 3 ascites results in marked abdominal distention.

Question 10

fetus

Answer 10

Typically, an increase in abdominal size is first noted at 12–14 weeks of gestation, when the uterus moves from the pelvis into the abdomen. Abdominal distention may be seen before this point as a result of fluid retention and relaxation of the abdominal muscles.

Question 11

feces

Answer 11

In the setting of severe constipation or intestinal obstruction, increased stool in the colon leads to increased abdominal girth. These conditions are often accompanied by abdominal discomfort or pain, nausea, and vomiting and can be diagnosed by imaging studies.

Question 12

fatal growth

Answer 12

Neoplasms, abscesses, or cysts can grow to sizes that lead to increased abdominal girth. Enlargement of the intraabdominal organs, specifically the liver (hepatomegaly) or spleen (splenomegaly), or an abdominal aortic aneurysm can result in abdominal distention. Bladder distention also may result in abdominal swelling.

Question 13

excessive alcohol and jaundice suggests

Answer 13

ascites

Question 14

Hx of heart failure or TB suggests

Answer 14

ascites

Question 15

increased eructation and flatus suggests

Answer 15

aerophagia or increased intestinal production of gas

Question 16

inability to pass stool or flatus together with nausea and vomiting suggests

Answer 16

bowel obstruction

Question 17

weight loss, night sweat and anorexia indicates

Answer 17

neoplastic

Question 18

presence of lymphadenopathy, especially supraclavicular (Virchow’s node) suggests

Answer 18

metastatic abdominal malignancy

Question 19

kussmaul’s sign is

Answer 19

elevation of JVP during inspiration

Question 20

elevated JVP, kussmauls sign, a murmur of tricuspid regurgitation or pericardial knock indicate

Answer 20

ascites

Question 21

spider angiomas, palmar erythema, caput medusae or gynecomastia indicate

Answer 21

liver disease

Question 22

caput medusae

Answer 22

dilated superficial veins around the umbilicus

Question 23

absence of bowel sounds or presence of localised high pitched bowel sounds indicates

Answer 23

ileus or intestinal obstruction

Question 24

umbilical venous hum suggests

Answer 24

portal hypertension

Question 25

harsh bruit over the liver suggests

Answer 25

heard rarely in patients with hepatocellular carcinoma or alcohol-associated hepatitis

Question 26

abdo swelling by fluid/gas/solid mass can be differentiated by

Answer 26

percussion

Question 27

abdomen filled with gas on percussion

Answer 27

tympanic

Question 28

abdomen containing mass or fluid on percussion

Answer 28

dull

Question 29

absence of abdominal dullness on percussion

Answer 29

cannot exclude ascites

minimum of 1500ml of ascitic fluid is required for detection on physical examination

Question 30

nodular liver suggests

Answer 30

cirrhosis or tumour

Question 31

pulsations on palpation of the liver

Answer 31

Light palpation of the liver may detect pulsations suggesting retrograde vascular flow from the heart in patients with right-sided heart failure, particularly tricuspid regurgitation.

Question 32

abdo x-ray in intestinal obstruction of ileus

Answer 32

dilated loops of bowel

Question 33

abdo US can detect

Answer 33

as little as 100 mL of ascitic fluid, hepatosplenomegaly, a nodular liver, or a mass.

often inadequate to detect retroperitoneal lymphadenopathy or a pancreatic lesion because of overlying bowel gas.

Question 34

if malignancy or pancreatic disease is suspected

Answer 34

If malignancy or pancreatic disease is suspected, CT can be performed. CT may also detect changes associated with advanced cirrhosis and portal hypertension

Question 35

laboratory evaluation

Answer 35

should include (to assess hepatic function):

• liver biochemical testing
• serum albumin level measurement
• prothrombin time determination (international normalized ratio)
  and:
• complete blood count to evaluate for the presence of cytopenias that may result from portal hypertension or of leukocytosis, anemia, and thrombocytosis that may result from systemic infection.
• Serum amylase and lipase levels should be checked to evaluate the patient for acute pancreatitis.
• Urinary protein quantitation is indicated when nephrotic syndrome, which may cause ascites, is suspected.

Question 36

if liver cirrhosis is suspected

Answer 36

In selected cases, the hepatic venous pressure gradient (pressure across the liver between the portal and hepatic veins) can be measured via cannulation of the hepatic vein to confirm that ascites is caused by cirrhosis. In some cases, a liver biopsy may be necessary to confirm cirrhosis.