Abdominal mass Flashcards
What is an abdominal mass?
Abnormal growth in the abdomen (from diaphragm to pelvis). May be visible or invisable (obesity)
What are the 6 F’s that can cause an abdominal mass?
Fat Faeces Flatus, Foetus Fluid Fatal growth
Mass in the Right hypochondrium?
Liver
Gall bladder
Mass in the left hypochondrium?
Spleen
Mass in the epigastric region?
Stomach
Pancreas
Mass in the Right or Left lumbar region?
Kidney
Colon
Mass in the umbilical region?
Aorta
Small bowel
Mass in the RIF?
Appendix, ovaries, kidneys
Bowel
Mass in LIF?
Sigmoid
Mass in Supra pubic?
Uterus
Bladder
What are the retroperitoneal structures of the abdomen?
Aorta, Kidneys
Pancreas
Duodenum
Important associated symptoms with abdominal mass?
1) Blood loss: haematemesis, haemopysis, metena, vaginal bleeding, haematuria
2) Gynae: Menopause, last period (irregular, heavy, missed, painful) Pain on sex.
3) Jaundice
4) Operations: abdo ops. What for? How many? History of cancer
5) Vomiting: How much, acute or chronic, what colour, dysphagia
6) Urinary symptoms: Reduced output, pain, urgency, frequency, incomplete evacuation.
7) Change in bowel habit: colour, consistency, blood, frequency.
8) Weight loss or loss of appetite.
What are important examinations in abdominal masses?
Anaemia, cyanosis, jaundice, blood pressure. Lymph nodes Peripheral pulses Chest Abdomen Hernia PR
How can you check for hernias?
Ask the patient to stand up and cough- this will make the hernia more obvious
When examining the mass what are you feeling for?
Tender?
Fixed?
Size?
Hard/soft?
Smooth or rough?
Movements on respiration (involved with abdominal wall muscles?
Pulsitile? (put fingers either side and see if the fingers move) = vascular
Should you percuss over an abdominal mass?
Yes if its not too painful.
Helps you to identify fluid or solid.
What are the investigations you should request for abdominal mass?
Erect chest X ray (air under diaphragm, lung mets)
AXR (small or large bowel obstruction or calcification of aorta)
USS (mass dependant- good for pelvic organs and differentiating solids and fluids)
CT = GOLD STANDARD
What organs are well visualised with USS?
Liver Gall bladder CBD Kidneys (hydronephrosis) Appendix (useful in children and females. Ovaries Uterus and Bladder
What is the gold standard test for abdominal mass?
CT scan +/- CT guided biopsy.
Determines next steps eg. endoscopy, ERCP, laparscopy and biopsy
What is the life threatening cause of abdominal mass, how does it present and how is it treated?
AAA (ruptured or not)
Presentation= Pain radiating to the back and collapse. Pulsatile epigastric mass +/- peripheral pulses.
Treatment: urgent CT and then Interventional radiology or theatre
What are the common causes of abdominal mass?
Hepatic mass (Liver metastasis)
Splenic mass (trauma- motorbike, horse, rugby)
Renal mass (renal carcinoma, cysts, hydronephritis (stones, cancer of bladder or enlarged prostate)
Pancreatic mass (Carcinoma, pancreatitis)
Colorectal cancer
Gynaecological mass (cyst, cancer)
Hernias
What are the signs of pancreatic cancer?
Painless jaundice- need to do an ERCP for brushings and cytology.
What are the signs of ovarian cancer?
Often associated with ascites
What is an incisional hernia?
Hernia as a result of previous surgery- hard to operate due to scaring
What is a paraumbilical hernia?
Not associated with a scar and around the umbilicus (area of weakness). Easier to surgically treat.
What is an inguinal hernia?
A hernia in the inguinal region. Either: direct (medial to epigastric artery) or indirect hernia (lateral to epigastric artery).
