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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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