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Abdominal mass

Abdominal mass. Michael S. Hong, MD. University of Florida Oral Exam Review. Abdominal Mass DDx. Narrow your differential Age Gender Location Differential guides your H&P. Pediatric Abdominal Mass. Tumors Wilm Tumor – (~3-4 yo ) renal, flank area

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Abdominal mass

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  1. Abdominal mass Michael S. Hong, MD University of Florida Oral Exam Review

  2. Abdominal Mass DDx • Narrow your differential • Age • Gender • Location • Differential guides your H&P

  3. Pediatric Abdominal Mass • Tumors • Wilm Tumor – (~3-4 yo) renal, flank area • Neuroblastoma – Sympathetic Nervous System, usu. Midline • Beckwith-Wiedemann – enlarged kidneys, liver • Teratoma • Rhabdomyosarcoma • GI • Bowel obstruction • Intussusception • Pyloric stenosis • Organomegaly

  4. Abdominal Mass in Elderly • GI • Sigmoid volvulus, Obstruction, Impacted stool, Colon cancer, gastric cancer, biliary cancer, diverticulitis, portal hypertension • GU • Urinary obstruction/retention • Organomegaly • Spleen, liver, kidney • Vascular • Abdominal aortic aneurysm • Other • Hernias, pancreatic pseudocyst, metastatic disease, sarcomas, neuroendocrine tumors, lymphomas, abscess

  5. Abdominal mass in women • Pregnancy • Endometriosis • Ovarian cyst/tumor • Uterine fibroids

  6. Location of Abdominal Mass • Flank – renal, adrenal • RLQ – appendicitis, Crohn’s, carcinoid • RUQ – biliary CA, liver adenoma, cysts/abscess • Epigastric – gastric CA, pancreatic pseudocyst • LUQ – sigmoid volvulus, splenomegaly • LLQ – diverticulosis/litis, colon CA • Pelvic – GU/GYN

  7. History • OPQRST of Pain • Onset • Provoking/palliative factors • Quality of pain • Region/radiation of pain • Severity • Time • GI: nausea, vomiting, last BM, bloody stools, clay colored stools, floating/foul smelling, caliber • Malignancy: fever, chills, night sweats, weight loss • Bleeding/bruising – spleen and coagulation • Recent travel – infectious

  8. History • Mass • Timeframe, rapidity • Mobile/fixed • Local, diffuse • Tender/non-tender • Prior surgery • Risk factors – smoking, alcohol, family history, cirrhosis

  9. Physical exam • Inspection – location, skin changes, size, surgical scars • Ausculation – bowel sounds, bruits • Percussion - ascites • Palpation – peritonitis, elicit pain, pulsatility, mobility, hardness, lymph nodes, rectal exam

  10. Labs/Studies • CBC, BMP, LFT, amylase, lipase, coags • KUB – free air, air-fluid levels, bowel dilatation • Ultrasound – solid or cystic, location • CT/MRI – enhanced anatomy, inflammation, tumor, obstruction, abscess, volvulus

  11. Example 1 • 91 year old demented man from nursing home • Intermittent abd pain, mass • No BM in last several days • Nausea, vomiting • DDx? • Bowel obstruction, stool impaction, ileus, colon CA, rectal CA • Next? • ROS, rectal exam • Labs: CBC, BMP • NPO, NG tube, replace fluids/electrolytes • KUB, CT scan

  12. Example 1 • Dx: Bowel impaction • Tx: NPO, NGT, replace lytes • Colace, senna • Enemas • Manual disimpaction http://www.urmc.rochester.edu/radiology/education/materials/

  13. Example 2 • 76 year old man, mass in LLQ, gradual growth • Last BM 3 days ago, Nausea, Vomiting • Weight loss • Gradually narrowing caliber stools • DDx & Work up similar

  14. Example 2 • Imaging: air fluid levels (obstruction) • “Apple core” lesion in colon • Dx: colon CA • Tx: NPO, NGT, lytes • Staging/monitoring: • CEA • Chest CT • Colonoscopy • Neoadjuvant therapy, Resection • Diverting ostomy http://allbleedingstops.blogspot.com

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