4. Approach to a Mass arising from the Pelvis Flashcards
Categories of mass arising from the pelvis
physiological
gynaecological
non- gynaecological
Physioloigcal mass arising from the pelvis
- Pregnancy
- Distended bladder
- Impacted faeces
Non- gynaecological mass arising from the pelvis
- Diverticular disease
- Appendix abscess
- Hydatid disease
- Pelvic kidney
- Cancer of colon, bladder, appendix etc
Pregnancy related mass arising from the pelvis
- Intrauterine
- Ectopic
- GTD
Non- pregnancy related mass arising from the pelvis
- Congenital anomaly
- Functional ovarian cysts
- Inflammatory masses
- Endometriosis
- Neoplasia (ovary, tube, uterus, cervix, vulva and vagina – benign or malignant/ primary or secondary)
What is the general approach to a mass arising from the pelvis?
- Conduct a thorough clinical history and physical examination.
- Evaluate the characteristics of the mass, such as size, mobility, and tenderness.
- Identify associated symptoms like bleeding, urinary, or bowel issues.
- Determine if the mass has gynecological or non-gynecological origins.
- Use investigations to confirm the diagnosis and guide management.
What routine investigations should be performed for a pelvic mass?
- Hemoglobin (Hb)
- Urine tests:
- Microscopy
- Dipstick
- Pregnancy test
- VDRL (syphilis test) and - HIV screening
- Pap smear
What special investigations may be considered for a pelvic mass?
- White Cell Count + ESR: Useful for diagnosing inflammatory causes.
- Gynecological Ultrasound:
- Helps with early pregnancy complications, polycystic ovaries, ascites, and defining mass characteristics.
- Should not replace vaginal examination.
- Avoid performing ultrasound as a routine or reflexive investigation; always consider its value for management. - Bowel Investigations: Indicated for gastrointestinal symptoms (e.g., dyspepsia, constipation, altered bowel habits).
- Endometrial Sampling: Recommended for women with a pelvic mass and abnormal bleeding, especially over 45 years.
- Tumor Markers (CA 125, CEA): For suspected gynecological cancer with a metastatic workup.
- CT Scan and MRI:
- CT: When a retroperitoneal mass is suspected.
- MRI: For suspected congenital anomalies or when additional soft tissue detail is needed. - Laparoscopy and Hysteroscopy: If the diagnosis is unclear after other investigations.
What is the role of ultrasound in evaluating a pelvic mass?
Essential for diagnosing:
- Early pregnancy complications
- Polycystic ovaries
- Ascites
- Mass characteristics in specific situations (e.g., young women, obesity, unclear clinical signs).
Should be performed with a clear purpose to improve patient management.
Should NOT replace a vaginal examination.
Avoid performing ultrasound reflexively without understanding its diagnostic value.
When are bowel investigations indicated for a pelvic mass?
When the patient has symptoms related to the gastrointestinal tract, such as:
- Dyspepsia
- Constipation
- Altered bowel habits
When the presentation is not suggestive of a gynecological origin.
When should endometrial sampling be performed in women with a pelvic mass?
In women with abnormal uterine bleeding, particularly those over 45 years of age.
What should be included in the workup if a gynecological cancer is suspected?
Tumor markers such as CA 125 and CEA.
A metastatic workup appropriate to the suspected cancer.
When should CT and MRI scans be considered in the evaluation of a pelvic mass?
CT Scan: When a retroperitoneal mass is suspected.
MRI: Useful for suspected congenital anomalies or when further soft tissue characterization is required.
What is the role of laparoscopy and hysteroscopy in evaluating a pelvic mass?
They are considered when the diagnosis remains unclear after all other investigations have been performed.
Why is hemoglobin (Hb) measured in a patient with a pelvic mass?
To assess for anemia, which may indicate chronic blood loss or malignancy-related blood loss.
