Abdominal Mass and Hernias Flashcards
What is meant by an abdominal mass?
- Abnormal growth in the abdomen.
- causes visible swelling
- may change the shape of the abdomen
What are the 6Fs which can cause an abdominal mass?
- fat
- faeces
- flatus
- foetus
- fluid
- fatal growth
Describe how an abdominal mass can be referred to by location?
- either by quadrant location (RUQ, LUQ, RLQ, LLQ)
- By region (epigastric, R/L hypochondrium, Umbilical, R/L lumbar, Suprapubic, R/L iliac)
What should you ask a patient in a history about their abdominal mass?
- Size (increase/decrease, change lying down/exercise)
- Tender?
- Duration?
What associated symptoms may occur with an abdominal mass?
- anorexia/ weight loss
- blood loss
- gynae symptoms
- urinary symptoms
- vomiting
- change in bowel habit
What should you look for on inspection of an abdominal mass?
- Contour/ Shape
- Pulsations
- Prominent Veins
- Scars: previous ops, injuries
- rash
- Colour (jaundice)
- Breathing
- ASK TO COUGH AND STAND UP
What characteristics of an abdominal mass should you be aiming to palpate on examination?
- Tender
- Fixed
- Hard
- Smooth edge
- Moves on respiration
- Pulsatile
How would a patient present with an AAA and how would you investigate?
- Pulsatile, epigastric mass
- O/E = feel for distal pulses
- Ix = urgent CT
How do patients present with a hepatic mass and how would you investigate?
- wt loss and jaundice
- O/E = jaundice, hepatomegaly
- Ix = US, CT, liver biopsy
How would patients present with a splenic mass and how would you investigate for this?
- Hx of trauma, wt loss
- O/E = Splenomegaly
- Ix = CT, MRI, PET CT
How does a renal mass usually present and how is it investigated?
- Renal failure, wt loss
- O/E = May be ballotable, BUT may be difficult to feel
- Ix = USS, CT
How do patients normally present with a pancreatic mass?
- wt loss
- Hx of alcohol
- O/E = epigastric mass, non tender
- Ix = ERCP, CT, biopsy
How do patients normally present with a mass indicative of colorectal cancer? What investigations could be used to confirm this diagnosis?
- altered bowel habit, PR bleeding, wt loss
- O/E = small bowel obstruction, localised mass
- Ix = CT, Colonoscopy
HOw do patients normally present with a gynaecological mass and what investigations can be used for this?
- 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
Describe what happens in an inguinal hernia
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
What can cause a hole in the abdominal wall which precipitates a hernia forming?
- certain anatomical sites are designed this way (e.g. inguinal ring)
- Collagen disorders cause wall to be weak
- Sites where surgical incisions are made
Give examples of types of abdominal hernia
Epigastric Umbilical/Paraumbilical Inguinal Hernia Femoral Hernia Lumbar Hernia Incisional Hernia Parastomal Hernia
What is the difference between a “reducible hernia” and an “incarcerated hernia”?
“Reducible” - Hernia can be pushed back into abdomen
“Incarcerated” or “Irreducible” hernia - cannot be manipulated back into abdomen
What is a strangulated hernia?
- Vascular supply to the contents contained within the hernia is compromise
=> ischaemic and gangrenous tissue
What causes an epigastric hernia?
- fascial defect in the linea alba
- between the xiphoid process and the umbilicus.
How does an epigastric hernia normally present?
- Main presentation = midline lump.
- Asymptomatic (75%) or can present with pain.
Who normally gets a paraumbilical hernia and what can cause it?
- can occur in all age groups
- caused by stretching of the abdominal wall
=> obesity, multiple pregnancy and ascites
Describe how paraumbilical hernias normally present?
- pain
- do not resolve spontaneously
- high incidence of incarceration and strangulation
How are paraumbilical hernias managed?
- Nearly always surgical
