3. Abdominal mass/distension Flashcards
causes of abdominal swelling
6 Fs
flatus
fat
fluid
feces
fatal growth
what is flatus made up of
increased intestinal gas
nitrogen and oxygen are swallowed while CO2, hydrogen and methane are produced intraluminally by bacterial fermentation
aerophagia is
the swelling of air - can result in an increased amount of oxygen and nitrogen in the small intestine (flatus) and lead to abdominal swelling
aerophagia results from
gulping food, chewing gum, smoking, or as a response to anxiety which can lead to repetitive belching.
increase in production of intestinal gas is caused by
bacterial metabolism of excess fermentable substances such as lactose and other oligosaccharides, which can lead to production of hydrogen, carbon dioxide, or methane.
impaired transit of gas
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.
fat
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.
fluid
The accumulation of fluid within the abdominal cavity (ascites) often results in abdominal distention
grades of ascites
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.
fetus
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.
feces
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.
fatal growth
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.
excessive alcohol and jaundice suggests
ascites
Hx of heart failure or TB suggests
ascites
increased eructation and flatus suggests
aerophagia or increased intestinal production of gas
inability to pass stool or flatus together with nausea and vomiting suggests
bowel obstruction
weight loss, night sweat and anorexia indicates
neoplastic
presence of lymphadenopathy, especially supraclavicular (Virchow’s node) suggests
metastatic abdominal malignancy
kussmaul’s sign is
elevation of JVP during inspiration
elevated JVP, kussmauls sign, a murmur of tricuspid regurgitation or pericardial knock indicate
ascites
spider angiomas, palmar erythema, caput medusae or gynecomastia indicate
liver disease
caput medusae
dilated superficial veins around the umbilicus
absence of bowel sounds or presence of localised high pitched bowel sounds indicates
ileus or intestinal obstruction
umbilical venous hum suggests
portal hypertension
harsh bruit over the liver suggests
heard rarely in patients with hepatocellular carcinoma or alcohol-associated hepatitis
abdo swelling by fluid/gas/solid mass can be differentiated by
percussion
abdomen filled with gas on percussion
tympanic
abdomen containing mass or fluid on percussion
dull
absence of abdominal dullness on percussion
cannot exclude ascites
minimum of 1500ml of ascitic fluid is required for detection on physical examination
nodular liver suggests
cirrhosis or tumour
pulsations on palpation of the liver
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.
abdo x-ray in intestinal obstruction of ileus
dilated loops of bowel
abdo US can detect
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.
if malignancy or pancreatic disease is suspected
If malignancy or pancreatic disease is suspected, CT can be performed. CT may also detect changes associated with advanced cirrhosis and portal hypertension
laboratory evaluation
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.
if liver cirrhosis is suspected
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.
