ABDOMINAL LUMP

CASE PRESENTATION OF ABDOMINAL LUMP IN DEPARTMENT OF SURGERY @ NSCBMCH JABALPUR MP INDIA.

1. ABDOMINAL LUMP -Dr. Ayush Khati PG-3 Departement Of Surgery Netaji Subhash Chandra Bose Medical College & Hospital ,Jabalpur Madhya Pradesh

2. HISTORY 01

3. PATIENT DETAILS Name – ABC Age – X years Sex – Male Occupation-Farmer Residence-MP

4. PRESENTING COMPLAINTS Lump in abdomen 7 months Weight loss & d ecrease in appetite 3 months Passing loose stools 2 months Abdominal fullness & distension 2 months

5. • Patient was apparently well 7 months back when he noticed a lump in the central part of abdomen above umbilicus which was initially 4 *4cm in size and its size gradually increased f or the first two months and for the last one month size of lump is same to the current size . 20-25 days later he noticed 4 more lumps in the abdomen located in right hypochondrium region measuring 4*5cm, in right paraumbilical area measuring 4*4cm, in left paraumbilical region measuring 5*4cm and in left hypochondrium measuring 4*4cm.size of these lumps increased for the first two months and for the last one month the size is same to the current size. Lumps were not associated with pain. • Patient gives history of decrease in appetite since 3 months e arlier he used to eat 6 chapatis in a day which has decreased to 2 chapatis per day. • Patient also complains of weight loss since 3 months which was elicited by loosening of clothes. HISTORY OF PRESENTING ILLNESS

6. satiety 2 months • Patient complains of passing loose stools since 2 months once a day not mixed with blood or mucous. Not associated with increase in frequency or tenesmus. • Patient also complains of abdominal fullness & distension since 2 months n ot associated with pain & vomiting. HISTORY OF PRESENTING ILLNESS

7. No history of discharge or bleeding per rectum No h/o pain while defecation No h/o vomiting,fever,chronic cough No h/o yellowish discolouration of sclera or skin No symptoms of intestinal obstruction No h/o hematemesis,melena No h/o haemoptysis ,bony pain NEGATIVE HISTORY

8. No history of Hypertension,Tuberculosis,Bronchial Asthma, D iabetes mellitus,Epilepsy . No history of other chronic medical/surgical illness. PAST HISTORY

9. Patient is married since 23 yrs Belongs to low socioeconomic status Patient is non alcoholic, non smoker, eats mixed diet & has normal sleep pattern. PERSONAL HISTORY

10. No history of similar complains in the family FAMILY HISTORY TREATMENT HISTORY No history of hospital admissions and treatment.

11. GENERAL PHYSICAL EXAMINATION 02

12. Patient was examined in adequate light with implied consent and with proper privacy. He was conscious, cooperative, well oriented to time, place and person. He was having an ectomorphic built. NO SIGNS OF ICTERUS CYANOSIS CLUBBING EDEMA No CERVICAL ,AXILLARY INGUINAL LYMPHADENOPATHY WEIGHT HEIGHT BMI 50KG 147cms 23 PALLOR -PRESENT

13. VITALS Pulse rate - 80 bpm Regular rhythm Blood pressure - 120/70mmhg measured in right brachial artery in supine position Respiratory rate – 24 per minute regular Temperature- afebrile

14. SYSTEMIC EXAMINATION 03

15. PER-ABDOMINAL EXAMINATION INSPECTION Patient was examined in supine position with body exposed from nipple till mid thigh. Abdomen is normal in shape . Two abdominal lumps of size 5*5 cm & 4*4 cm present on epigastrium and right paraumbilical region respectively . Moving with respiration Overlying skin appears normal in colour and non pigmented Umbilicus is in center and transversely stretched. All corresponding quadrants move proportionately with respiration. No scars/ dilated veins/ peristalsis / pulsations seen. The lumps became less appreciable on leg raising . ( Carnett’s Test) Hernial sites and external genitalia are normal.

16. PER-ABDOMINAL EXAMINATION PALPATION Findings of inspection were confirmed. • No rise of temperature, tenderness ,guarding, rigidity Plane is intraabdominal and intraperitone al. • Five lumps were palpated. lump palpable in epigastric region measuring 7*6cm , lump palpable in right hypochondrium region measuring 6*5cm lump palpable in right paraumbilical area measuring 5*4cm lump palpable in left paraumbilical region measuring 6*4cm lump palpable in left hypochondrium measuring 6*4cm • Lumps are non tender, irregular in shape, hard in consistency with distinct margins and irregular surface, with movement during respiration present ,not pulsatile & having l imited mobility in horizontal and vertical planes not fixed anteriorly or posteriorly or to each other.

17. PER-ABDOMINAL EXAMINATION PALPATION • No evidence of hepatospleno megaly • Hernial sites and external genitalia (testis) are normal.

18. PER-ABDOMINAL EXAMINATION PERCUSSION R esonant note all over the abdomen and dull n ote over the lumps. S hifting dullness present

19. PER-ABDOMINAL EXAMINATION AUSCULTATION Normal bowel sounds heard. No bruits/hum heard over the lumps or elsewhere. DIGITAL RECTAL EXAMINATION Normal anal tone present with soft faecal matter. H ard deposits present in rectovesical pouch at 11,12 & 1 o’clock position(Blumer’s Shelf) Rectal mucosa circumferentially smooth No bleeding & discharge.

20. RS Air entry bilaterally equal no added sounds CVS Heart sounds S1 and S2 are heard no murmurs CNS Conscious oriented OTHER SYSTEMS EXAMINATION

21. CASE SUMMARY 04

22. • A 45 yr male with multiple omental deposits which are hard in consistency,irregular in shape associated with weight loss ,decrease in appetite, ascites , blumer’s shelf deposits with no history of tuberculosis,bleeding per rectum,melena and with no organomegaly. CASE SUMMARY

23. CARCINOMA OF UNKNOWN PRIMARY WITH OMENTAL METASTASIS AND ASCITES PROVISIONAL DIAGNOSIS

24. THANKYOU

25. Attachments -FNAC & CECT ABDOMEN a

26. FNAC