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GI > Abdominal Mass and Hernias > Flashcards

Abdominal Mass and Hernias Flashcards

1
Q

What is meant by an abdominal mass?

A
  • Abnormal growth in the abdomen.
  • causes visible swelling
  • may change the shape of the abdomen
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2
Q

What are the 6Fs which can cause an abdominal mass?

A
  • fat
  • faeces
  • flatus
  • foetus
  • fluid
  • fatal growth
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3
Q

Describe how an abdominal mass can be referred to by location?

A
  • either by quadrant location (RUQ, LUQ, RLQ, LLQ)

- By region (epigastric, R/L hypochondrium, Umbilical, R/L lumbar, Suprapubic, R/L iliac)

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4
Q

What should you ask a patient in a history about their abdominal mass?

A
  • Size (increase/decrease, change lying down/exercise)
  • Tender?
  • Duration?
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5
Q

What associated symptoms may occur with an abdominal mass?

A
  • anorexia/ weight loss
  • blood loss
  • gynae symptoms
  • urinary symptoms
  • vomiting
  • change in bowel habit
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6
Q

What should you look for on inspection of an abdominal mass?

A
  • Contour/ Shape
  • Pulsations
  • Prominent Veins
  • Scars: previous ops, injuries
  • rash
  • Colour (jaundice)
  • Breathing
  • ASK TO COUGH AND STAND UP
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7
Q

What characteristics of an abdominal mass should you be aiming to palpate on examination?

A
  • Tender
  • Fixed
  • Hard
  • Smooth edge
  • Moves on respiration
  • Pulsatile
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8
Q

How would a patient present with an AAA and how would you investigate?

A
  • Pulsatile, epigastric mass
  • O/E = feel for distal pulses
  • Ix = urgent CT
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9
Q

How do patients present with a hepatic mass and how would you investigate?

A
  • wt loss and jaundice
  • O/E = jaundice, hepatomegaly
  • Ix = US, CT, liver biopsy
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10
Q

How would patients present with a splenic mass and how would you investigate for this?

A
  • Hx of trauma, wt loss
  • O/E = Splenomegaly
  • Ix = CT, MRI, PET CT
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11
Q

How does a renal mass usually present and how is it investigated?

A
  • Renal failure, wt loss
  • O/E = May be ballotable, BUT may be difficult to feel
  • Ix = USS, CT
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12
Q

How do patients normally present with a pancreatic mass?

A
  • wt loss
  • Hx of alcohol
  • O/E = epigastric mass, non tender
  • Ix = ERCP, CT, biopsy
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13
Q

How do patients normally present with a mass indicative of colorectal cancer? What investigations could be used to confirm this diagnosis?

A
  • altered bowel habit, PR bleeding, wt loss
  • O/E = small bowel obstruction, localised mass
  • Ix = CT, Colonoscopy
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14
Q

HOw do patients normally present with a gynaecological mass and what investigations can be used for this?

A
  • wt loss, non tender mass, mass is often large as lots of space in pelvis to grow without being noticed
  • O/E - associated ascites
  • Ix = US, TVUS, CT, laparoscopy
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15
Q

Describe what happens in an inguinal hernia

A

inguinal ring is weakened

=> bit of bowel is able to protrude through this hole and appears as a mass beneath the skin of the inguinal region

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16
Q

What can cause a hole in the abdominal wall which precipitates a hernia forming?

A
  • certain anatomical sites are designed this way (e.g. inguinal ring)
  • Collagen disorders cause wall to be weak
  • Sites where surgical incisions are made
17
Q

Give examples of types of abdominal hernia

A 
Epigastric
Umbilical/Paraumbilical               
Inguinal Hernia
Femoral Hernia
Lumbar Hernia
Incisional Hernia
Parastomal Hernia
18
Q

What is the difference between a “reducible hernia” and an “incarcerated hernia”?

A

“Reducible” - Hernia can be pushed back into abdomen

“Incarcerated” or “Irreducible” hernia - cannot be manipulated back into abdomen

19
Q

What is a strangulated hernia?

A
  • Vascular supply to the contents contained within the hernia is compromise
    => ischaemic and gangrenous tissue
20
Q

What causes an epigastric hernia?

A
  • fascial defect in the linea alba

- between the xiphoid process and the umbilicus.

21
Q

How does an epigastric hernia normally present?

A
  • Main presentation = midline lump.

- Asymptomatic (75%) or can present with pain.

22
Q

Who normally gets a paraumbilical hernia and what can cause it?

A
  • can occur in all age groups
  • caused by stretching of the abdominal wall
    => obesity, multiple pregnancy and ascites
23
Q

Describe how paraumbilical hernias normally present?

A
  • pain
  • do not resolve spontaneously
  • high incidence of incarceration and strangulation
24
Q

How are paraumbilical hernias managed?

A
  • Nearly always surgical
25
Q

What usually causes an adult umbilical hernia?

A
  • persistent elevation of intra-abdominal pressure
26
Q

What are the 2 main types of inguinal hernia?

A
  • Direct or Indirect
27
Q

Describe the anatomical difference between a direct and indirect inguinal hernia

A

Direct - bowel does NOT enter inguinal canal/ rings. Instead it pushes through a weak area in floor of inguinal canal called “Hesselbach’s Triangle”

Indirect - bowel passes through deep inguinal ring and inguinal canal and pushes outwards via superficial inguinal ring

28
Q

Who is more likely to get an inguinal hernia, which type is more common and which side is it most likely to appear on?

A

M>F
Indirect > direct (3:2)
Right side more common than left

29
Q

How do patients present with an inguinal hernia?

A
  • Groin swelling
  • this usually disappears when lying down.
  • located above and medial to the pubic tubercle
  • Palpable cough impulse on examination
30
Q

Which gender is most likely to develop a femoral hernia?

A

20% of hernias in women and 5% in men

=> F>M

31
Q

Strangulated femoral hernias are common at presentation. TRUE/FALSE?

A

TRUE - Strangulation initial presentation in 40%.

32
Q

Incidence of femoral hernia increases with age. TRUE/FALSE?

A

TRUE

33
Q

How are femoral hernias treated?

A

Surgically

- especially if strangulated at presentation

34
Q

How is an incisional hernia caused?

A
  • Iatrogenic

- Commonest complication of a laparotomy (Exploration of the abdomen)

35
Q

What can predispose a patient to an incisional hernia?

A
  • Wound Complications
  • Collagen abnormalities
  • Advanced Age
  • Smoking
  • Obesity
  • Malignancy
  • Surgical Technique

GI (33 decks)

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