Abdominal Masses Flashcards
Causes of abdominal distension
Flatus Fat Faeces Fluid Foetus Flipping big tumour
Right Iliac Fossa Masses
Appendix mass/abscess Caecal carcinoma Crohn's disease Pelvic mass (fibroid, foetus, bladder, ovarian cyst/malignancy) Intussusception TB mass Amoebic abscess Transplanted kidney Kidney malformation Tumour in undecended testis
Causes of ascites
Malignancy Infections - esp TB Decreased albumin (eg nephrosis) CCF; pericarditis Pancreatitis Myxoedema
Ascites with portal HTN
Cirrhosis
Budd-Chiari syndrome
IVC or portal vein thrombosis
Portal nodes
Ddx for left upper quadrant mass
Spleen Stomach Kidney Colon Pancreas Neurofibromatoma Pancreatic cyst Pseudocyst
Causes of splenomegaly with fever
Infection (malaria/IE/EBV/TB/CMV/HIV/hepatitis)
Sarcoid; malignancy
Causes of splenomegaly with lymphadenopathy
Glandular fever
Leukaemias
Lymphoma
Sjögren’s syndrome
Causes of splenomegaly with purpura
Septicaemia Typhus DIC Amyloid Meningococcaemia
Causes of splenomegaly with arthritis
Sjögren's syndrome RA SLE Infection eg Lyme Vasculitis/Behcet's
Causes of splenomegaly with ascites
Carcinoma
Portal hypertension
Causes of splenomegaly with a murmur
IE/SBE
Rheumatic fever
Amyloid
Hypereosinophilia
Causes of splenomegaly with anaemia
Sickle cell
Thalassaemia
Leukaemia
Pernicious anaemia
Causes of splenomegaly with weight loss and CNS signs
Cancer Lymphoma TB Arsenic poisoning Paraproteinanemia
Causes of massive splenomegaly
Malaria
Myelofibrosis
CML
Ddx for smooth hepatomegaly
Hapatitis CCF Sarcoidosis Early alcoholic cirrhosis Tricuspid incompetence (-> pulsatile liver)
Ddx for craggy hepatomegaly
Secondaries or 1o hepatoma
Features of a spleen
Arises in left hypochondrium, below tip of 10th rib
Can’t get above it
Moves downwards and medially on inspiration
May have a palpable notch on supero-medial edge
Dull to percussion
Ddx for unilateral enlarged kidney
Renal cell carcinoma (Wilm’s in children)
Hydronephrosis
Simple cyst
Asymmetrical Polycystic kidney disease
Features of an enlarged kidney
Palpable in lumbar region Descends vertically on inspiration Bimanually palpable (ballotable) Usually resonant to percussion unless very big Can get above it (sometimes!)
Adult Polycystic kidney disease
Autosomal dominant
Usually bilateral
Presents with bleeding, infection, abdominal pain
Hypertension
Chronic renal failure
Subarachnoid haemorrhage (due to poorly controlled HTN)
Often get renal transplant and leave Polycystic kidneys behind
PKD1 gene on chromosome 16 responsible for 85% of cases
