Abdominal mass

approach to the abdominal mass

1. Abdominal mass

2. introduction An abdominal mass is any localized enlargement or swelling in the abdomen. Depending on its location, the abdominal mass may be caused by an enlarged  liver (hepatomegaly), enlarged spleen (splenomegaly), protruding kidney, a pancreatic mass, aretroperitoneal mass (a mass in the posterior of the peritoneum), an abdominal aortic aneurysm, or various tumours, such as those caused by abdominal carcinomatosis and  omental metastasis. The treatments depend on the cause, and may range from watchful waiting to radical   surgery .

3. symptoms Many abdominal masses are discovered incidentally during routine  physical examination . An abdominal mass may accompany other symptoms, which will vary depending on the underlying disease. Common symptoms that may occur along with an abdominal mass: 1-Abdominal pain

4. Symptoms cont. 2-Change in appetite 3- frequency, dysuria , polyuria 4-Changes bowel habit 5-Rapid weight loss or weight gain 6- fever,sweating 7-nausea, vomiting 8- fullness 9-hematuria 10-appearance of mass

5. Symptom cont. Serious symptoms that might indicate a life-threatening condition 1-Abdominal mass that is growing rapidly 2-Abdominal mass that is pulsating 3-New abdominal mass accompanied by severe abdominal pain

6. potential complications of an abdominal mass 1-Ascites 2-Gastrointestinal perforation and sepsis 3-Incontinence 4-Infertility due to permanent damage to the reproductive tract 5-Permanent kidney damage 6-Permanent liver damage 7-Permanent pancreas damage 8-Ruptured aortic aneurysm 9-Secondary obstruction of the small and large intestine 10-metastasis in case of CA 11-Spread of infection

7. DDX

8. Medications That May Cause Lymphadenopathy Allopurinol Atenolol Captopril Carbamazepine Cephalosporins Gold Hydralazine  

9. Diagnosis 1-history: Important clues in history include weight loss , diarrhea  , abdominal pain 2-physical examination, the clinician must identify 1-location of the mass. 2-whether it is rigid or mobile . 3-Presence of pulsation or  peristalsis .

10. Diagnosis cont. 4-important sign: 1-tenderness 2-yellowish discoloration of skin& sclera 3-anemia 4-raccon eye 5-oedema 6-lymphadenopathy 7-localized or generalized enlargment of abdomen

11. Diagnosis cont. 8-dullness on percussion 9-ecchymosis 10- elevation of temperature localized(over mass) or generalized 11-redness 12-Scratch marks 13-sign of hormonal disturbance as acne, hirsutism 14- Courvoisier's sign 15-everted umbilicus

12. Diagnosis cont. 3- investigation: A-lab 1- full blood count 2-renal function test 3-liver function test 4-Bone marrow biopsy and/or aspiration 5-GUE 6- other tests: uric acid, and lactate dehydrogenase

13. Diagnosis cont. homovanillic acid , vanillylmandelic & metanephrine Serum B chorionic gonadotropin and alpha-fetoprotein B-radiology 1- Ultrasound: Useful for discerning between solid versus cystic mass

14. Diagnosis cont. 2-Plain abdominal x-ray: Plain abdominal radiograph can be useful for detecting obstruction by looking for the presence of multiple air fluid levels or absence of air in the rectum. also may indicate the presence neuroblastoma , teratomas , Calcification, kidney stones, or,hydronephrosis

15. Diagnosis cont. 3-CT scan: used to obtain more specific anatomical detail especially with massess how are difficult to be visualized by x-ray as metastasis

16. Diagnosis cont. 4-MRI: useful for soft tissue mass 5-angiography: such as a- invasive catheter angiography b-CTA C-MRA 6-PET scan 7-endoscopy, colonoscopy

17. Treatment Depending on the cause of the mass & may range from conservative Rx to radical surgery A-medical: 1-analgesic 2-anti-inflammatory 3-antimicrobial 4- hormonal therapy

18. Treatment B-surgery: 1-aspiration and/or drainage as in case of cystic mass 2-removal of the mass 3-removal of the mass and part of the affected organ 4-removal of the entire organ &may be associated with removal of the draining lymph node as in malignant tumor.

19. Treatment C-chemotherapy &/or radiotherapy which are used either neoadjuvant to shrink the tumor before surgery Or adjuvant when there is risk of recurence or when there is micrometastases

20. Produced by Dr. Haider faroon

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