Abdominal mass

Question 1

What is an abdominal mass?

Answer 1

Abnormal growth in the abdomen (from diaphragm to pelvis). May be visible or invisable (obesity)

Question 2

What are the 6 F’s that can cause an abdominal mass?

Answer 2

Fat
Faeces
Flatus, Foetus
Fluid
Fatal growth

Question 3

Mass in the Right hypochondrium?

Answer 3

Liver

Gall bladder

Question 4

Mass in the left hypochondrium?

Answer 4

Spleen

Question 5

Mass in the epigastric region?

Answer 5

Stomach

Pancreas

Question 6

Mass in the Right or Left lumbar region?

Answer 6

Kidney

Colon

Question 7

Mass in the umbilical region?

Answer 7

Aorta

Small bowel

Question 8

Mass in the RIF?

Answer 8

Appendix, ovaries, kidneys

Bowel

Question 9

Mass in LIF?

Answer 9

Sigmoid

Question 10

Mass in Supra pubic?

Answer 10

Uterus

Bladder

Question 11

What are the retroperitoneal structures of the abdomen?

Answer 11

Aorta, Kidneys
Pancreas
Duodenum

Question 12

Important associated symptoms with abdominal mass?

Answer 12

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.

Question 13

What are important examinations in abdominal masses?

Answer 13

Anaemia, cyanosis, jaundice, blood pressure.
Lymph nodes
Peripheral pulses
Chest
Abdomen
Hernia
PR

Question 14

How can you check for hernias?

Answer 14

Ask the patient to stand up and cough- this will make the hernia more obvious

Question 15

When examining the mass what are you feeling for?

Answer 15

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

Question 16

Should you percuss over an abdominal mass?

Answer 16

Yes if its not too painful.

Helps you to identify fluid or solid.

Question 17

What are the investigations you should request for abdominal mass?

Answer 17

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

Question 18

What organs are well visualised with USS?

Answer 18

Liver
Gall bladder
CBD
Kidneys (hydronephrosis)
Appendix (useful in children and females.
Ovaries
Uterus and Bladder

Question 19

What is the gold standard test for abdominal mass?

Answer 19

CT scan +/- CT guided biopsy.

Determines next steps eg. endoscopy, ERCP, laparscopy and biopsy

Question 20

What is the life threatening cause of abdominal mass, how does it present and how is it treated?

Answer 20

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

Question 21

What are the common causes of abdominal mass?

Answer 21

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

Question 22

What are the signs of pancreatic cancer?

Answer 22

Painless jaundice- need to do an ERCP for brushings and cytology.

Question 23

What are the signs of ovarian cancer?

Answer 23

Often associated with ascites

Question 24

What is an incisional hernia?

Answer 24

Hernia as a result of previous surgery- hard to operate due to scaring

Question 25

What is a paraumbilical hernia?

Answer 25

Not associated with a scar and around the umbilicus (area of weakness). Easier to surgically treat.

Question 26

What is an inguinal hernia?

Answer 26

A hernia in the inguinal region. Either: direct (medial to epigastric artery) or indirect hernia (lateral to epigastric artery).