Mass in right hypochondrium.pptx

Lecture notes for medical students

1. Tips on using my ppt. You can freely download, edit, modify and put your name etc. Don’t be concerned about number of slides. Half the slides are blanks except for the title. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. At the end rerun the show – show blank> ask questions > show next slide. This will be an ACTIVE LEARNING SESSION x three revisions. Good for self study also. See notes for bibliography.

2. Regions of Abdomen

3. How to Diagnose

4. How to Diagnose History Physical Examination Investigations Laparotomy Histpathology

5. History

6. History Age Sex Pain Vomitings Motions Urination Fever

7. Physical Examination

8. Physical Examination General Systemic Local

9. General Physical Examination

10. General Physical Examination Appearance: emaciated Anemic , jaundiced or Lymph nodes, especially supraclavicular .

11. Per Abdomen

12. Per Abdomen Eyes first and the most Hands next Tongue not at all

13. Per Abdomen Inspection Palpation Percussion Auscultation

14. Inspection

15. Inspection Abdominal distension Visible peristalsis Overlying skin Position, size, shape and surface of the swelling Movement of swelling  on respiration Check sites of hernia Observe scrotum for any fullness

16. Palpation

17. Palpation Whole abdomen soft or rigid Tenderness

18. Palpation of Lump

19. Palpation of Lump local temperature Tenderness Confirming positive findings of inspection Margins Consistency: Soft, firm or hard uniform or variegated Mobility: Level : Is swelling parietal or intra-abdominal?

20. Percussion: Dull or resonant Fluid thrill Auscultation: For rub ( perisplenitis and perihepatitis )

21. Investigations

22. Investigations Laboratory Studies Routine Special Imaging Studies Tissue diagnosis Cytology FNAC Histlogy

23. Diagnostic Studies

24. Diagnostic Studies Imaging Studies X-Ray USG CT ERCP MRI Nuclear scan

25. Other Studies

26. Other Studies Endoscopy Endosonography (EUS)

27. D/D

28. D/D Swellings in the Abdominal Wall Sebaceous Cyst Lipoma Parietal wall abscess

29. D/D Intra-abdominal Swellings Sub- Phrenic Abscess

30. D/D Intra-abdominal Swellings Hepatic Gall Bladder Sub- Phrenic Abscess Stomach and Duodenum Hepatic Flexure of Colon Right Kidney Right Suprarenal Sub- Phrenic Abscess

31. Hepatic

32. Hepatic 1. It moves with respiration but is not mobile sideways 2. The swelling is continuous with the liver dullness without a band of colonic resonance

33. Hepatic swellings Amoebic abscess Pyogenic abscess Riedel’s lobe Hydatid cyst Hepatoma Secondaries Cirrhosis

34. Sub- Phrenic Abscess

35. Sub- Phrenic Abscess 1 Pain in the right hypochondrial region referred to the shoulders 2. Diffuse tender swelling in the right hypochondrial region 3. Signs of septicemia: High fever with rigors, sweating and marked tachycardia 4. Screening: Raised and fixed diaphragm with gas under it 5. Features of the causative condition e.g. perforated peptic ulcer, liver abscess

36. Gall Bladder

37. Gall Bladder 1. Oval smooth swelling, the size of an egg 2. Moves with respiration, Ca Gall bladder Ca. Head of pancreas Mucocele Choledochus cyst

38. Stomach and Duodenum

39. Stomach and Duodenum Ca Stomach Cogenital hypertrophic pyloric stenosis Sub-Acute Perforation of a Peptic Ulcer

40. Stomach and Duodenum Ca Stomach 1. There is irregular firm lump which moves on respiration 2. Patient is usually elderly and has anorexia and weight loss 3. Barium meal would show filling defect 4.Upper GI Endoscopy

41. Stomach and Duodenum Sub-Acute Perforation of a Peptic Ulcer 1. Localized, tender, inflammatory mass may be present with a central abscess 2. History of peptic ulcer 3. Barium meal would reveal the ulcer

42. Hepatic Flexure of Colon

43. Hepatic Flexure of Colon Carcinoma of Colon 1. This commonly occurs in men above the age 40 years 2. Change in bowel habits, melena 3. The lump is irregular, firm and moves poorly on respiration 4. Occult blood may be present in stools 5. Colonoscopy

44. Hepatic Flexure of Colon Intussusception 1. There is sudden intermittent abdominal pain with vomiting. 2.Passage of blood and mucus (red currant jelly) per anum without fecal odour. 3. There may be curved, sausage shaped lump 4. Barium enema would show typical pincer shaped ending of the radio-opaque material.

45. Kidney swelling

46. Kidney swelling Ballotable Slight movement with respiration Renal angle is full Percussion- resonant

47. Kidney swellings Hydronephrosis / Pyonephrosis Carcinoma Nephroblastoma – Wilm’s tumour

48. Suprarenal swelling

49. Suprarenal swelling Like kidney swelling From cortex or medulla

50. From adrenal cortex

51. From adrenal cortex Hyperplasia Benign adenoma Carcinoma

52. From adrenal medula Pheochromocytoma Neuroma Neuroblastoma

53. Get this ppt in mobile Download Microsoft PowerPoint from play store. Open Google assistant Open Google lens. Scan qr code from next slide.

54. Get this ppt in mobile

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