60. Abdominal mass Flashcards
RUQ mass.
a) Differentials
b) What is Courvoisier’s sign?
a) - Hepatomegaly
- Cholecystitis - very tender mass (Murphy’s)
- Cholangiocarcinoma - moderately tender, irregularly shaped mass
- Head of pancreas malignancy (painless jaundice)
- Liver cyst
- Liver abscess/ subphrenic abscess (pyrexial, tender)
- Liver cancer - firm, craggy mass
b) A palpable gallbladder that is non-tender and accompanied with mild painless jaundice is unlikely to be due to gallstones (likely pancreatic/gallbladder Ca)
Epigastric mass
- Hepatomegaly - (also in right costal margin)
- Pancreatic abscess or pseudocyst
- Pancreatic Ca
- Gastric Ca
LUQ mass.
- Splenomegaly
- Gastric carcinoma
- Pancreatic abscess or pseudocyst
- Disorders of kidney and colon
- Subphrenic abscess (eg. post-splenectomy)
Right/left flank mass.
a) Differentials
b) Triad of renal cell Ca
a) - Hydronephrosis - smooth spongy mass
- Renal cell carcinoma (smooth, firm, non-tender mass)
- Polycystic kidney disease
- Psoas abscess (rare; fever)
b) Loin pain, loin mass, haematuria
Periumbilical mass.
- Abdominal aortic aneurysm (pulsating mass)
- Tumour somewhere in the gastrointestinal tract
- Umbilical hernia
RIF mass.
- Crohn’s disease (multiple tender, sausage-shaped masses)
- Appendix mass or abscess
- Caecal/colon cancer or distension
- Hernia
- Ileocaecal mass caused by tuberculosis
- Kidney abnormality (transplanted kidney)
- Ovarian tumour
LIF mass.
- Diverticulitis (abscess)
- Hernia
- Impacted faeces (constipation, ?obstruction)
- Colorectal cancer
- Kidney abnormality
- Ovarian tumour
Suprapubic/pelvic
- Distended bladder (firm mass can extend up to the umbilicus in extreme cases
- Ovarian cyst - smooth, round, rubbery mass
- Ovarian tumour
- Pregnancy
- Uterine fibroids (round, lumpy mass) or malignancy
Abdominal mass + pyrexia - differentials
- Abscess (swinging pyrexia)
- Appendicitis (with mass/abscess)
- Mass causing perforation + peritonitis
- Diverticulitis + obstruction
- IBD
