lump in abdomen (2).pptx

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1. LUMP IN ABDOMEN By : Dr. Atul Khare NSCB,MCH, Jabalpur

2. Patients particulars Name: Sudhiya Choudhary Age/sex:70y/F Occupation: labour Address: Nagod , Satna , MP Religion – Hindu

3. Chief complaints Patient c/o lump in left upper half of abdomen for two months

4. HOPI The patient was apparently alright two months back when she noticed a lump in left upper half of the abdomen which was around 3 finger below left costal margin ,lump was insidious in onset, gradually progressive and enlarges from left hypochondrium toward the umbilicus. Not associated with pain and fever

5. No h/o pain in abdomen No h/o evening rise of temperature, or fever with chills /sweating/ or weight loss. No h/o vomiting and hematemesis No h/o cough with hemoptysis. No h/o yellowish discoloration No h/o alternate bowel habits with passage of black colour stools or per-rectal bleed. No h/o colicky pain in the flanks radiating to inner thigh or passage of stone or blood clots or dark colour urine. No h/o periodic pain or episodes of pain in abdomen radiating to back.

6. Past history No p/h/o PTB/BA/HTN/DM/COPD No p/h/o any chronic medical or surgical illness. No p/h/o any blood transfusion No p/h/o any similar swelling No p/h/o hospitalization within past 10 years No p/h/o trauma

7. Personal history The patient is married and has 3 children The patient attained menopause at 45 yrs of age. Vegetarian by diet Bowel/bladder habits are normal No allergies or any drug addiction. Low socioeconomic status Family history- no h/o similar illness in family

8. Physical examination Patient is cooperative and is conscious, oriented to time ,place and person. The patient is average in built Afebrile Normal facies Pallor – present Icterus, Clubbing ,pedal oedema , cyanosis – absent Supraclavicular or Generalized lymphadenopathy- absent P-80/min taken in right radial artery in supine position, which was regular in rate and rhythm, normo- voluemic and no radio-radial or radio-femoral delay. BP-118/78mmHg taken in right arm supine position

9. Systemic examination CNS-conscious oriented to time place and person CVS - s1s2 + RS – BLAE+ , clear PA – soft, no scar marks , no discolouration, no dilated veins no T/G/R Umbilicus - central in position and inverted.

10. Local Examination Inspection A visible swelling present around 12*10 cm in left hypochondriac region. Oval in shape Extending from below the left costal margin to the umbilicus Smooth surface and well defined margin Skin over swelling- normal, no scar mark, no dilated veins, no pigmentation. All the abdominal quadrants move proportionately with respiration. The swelling doesn’t becomes prominent on Straight leg raising and on head raising. The swelling becomes prominent on knee elbow position No visible peristalsis seen No visible cough impulse seen. External genitalia are normal. Inguinoscrotal region is normal .

11. Palpation On superficial palpation-no local rise of temperature. Abdomen is soft ,no guarding, tenderness or rigidity present. Lump of 15x14cm, oval in shape is present on left hypochondrial region Extending up to the umbilicus Firm in consistency, , smooth surface with well defined margins. Lump moves with respiration. Lump partially moves in all directions. Fingers can not be insinuated below the left costal margins, and getting over the swelling was not possible. Head rising test/Straight leg raising test- swelling was not prominent Knee elbow position- swelling was prominent

12. No hepatomegaly present No cough impulse over the hernial orifices. No supraclavicular/ inguinal lymphadenopathy present. No tenderness present at the renal angles.

13. Percussion On percussion-dull note present over the swelling. tympanic note present over abdomen No shifting dullness /fluid thrill present. Auscultation - no bruit heard over the mass. Per rectal : normal anal tone, no overgrowth with soft fecal matter present. Per vaginal –insignificant

14. SUMMARY A 70y/f presented with a painless lump over left hypochondrium , insidious in onset gradually increasing in size for 2 months and extending toward umbilicus . On inspection left hypochondrial region fullness present . On palpation a well defined painless lump of 15x14 cm is present over left hypochondrial region, extending toward umbilicus, firm in consistency, oval in shape, smooth surface with well defined margins, which moves with respiration and Fingers can not be insinuated below the costal margins, and getting over the swelling was not possible . Lump was not ballotable Percussion- dull note present over lump .

15. MY PROVISIONAL DIAGNOSIS IS 70Y/F WITH SPLENOMEGALY Differential diagnosis= Tropical splenomegaly syndrome HEMATOLOGICAL MALIGNANCIES- CML, HCL,CLL,NHL KALAZAR SPLENIC VEIN THROMBOSIS SPLENIC CYST = hydatid cyst, simple cyst SPLENIC ABSCESS LYMPHOMA SARCOIDOSIS

16. Thank you