Abdominal Masses Differential diagnosis Hayan Bismar, MD,FACS

Abdominal Mass History Physical Examination

Abdominal Mass History Onset Location Associated Symptoms •acute •chronic •progressing Location Associated Symptoms

Abdominal Mass History Onset Location Associated Symptoms •Upper Abdomen Onset •Lower Abdomen Location Associated Symptoms

Abdominal Mass History Onset Location Associated Symptoms • pain • fever • Abdominal Distention • GI symptoms • Urinary Symptoms • OB & Gyne symptoms Onset • Endocrine • Cardiovascular Location • Hematologic Associated Symptoms

Abdominal Mass Physical Examination Inspection •shape of abdomen •scar Auscultation Palpation Percussion •superficial lesions •bulges Other Maneuvers

Abdominal Mass Physical Examination Inspection Auscultation •Bowel sounds •None Auscultation •Hypoactive •Hyperactive Palpation Percussion •bruit Other Maneuvers

Abdominal Mass Physical Examination Inspection Auscultation Palpation •Tenderness •Rigidity •Character of mass Palpation Percussion Other Maneuvers

Abdominal Mass Physical Examination Inspection Auscultation Palpation •Distinguishes causes of distention •Gas •Fluid •Solid Percussion Other Maneuvers

Abdominal Mass Physical Examination Inspection Auscultation Palpation Percussion •Fothergil sign •Psoas sign Other Maneuvers

Abdominal Mass Physical Examination Rectal Examination Pelvic Examination

Abdominal Mass HISTORY AND P.E. Abdominal Wall Intra-abdominal Intraperitoneal Retroperitoneal

Abdominal wall Mass HISTORY AND P.E. INFECTIOUS NON - INFECTIOUS MALIGNANT NON - MALIGNANT

Abdominal wall abscess

• Treatment Option(s) - Medical - Surgical • Antibiotics - bacterial • Incision and drainage • Debridement

Abdominal Mass HISTORY AND P.E. Abdominal Wall Intra-abdominal INFECTIOUS NON - INFECTIOUS MALIGNANT NON - MALIGNANT

Abdominal wall tumors

•Desmoid tumors Sarcoma: Dermatofibrosarcoma • Liposarcoma Malignant abdominal wall tumors •Desmoid tumors Sarcoma: Dermatofibrosarcoma • Liposarcoma

• Epidermal inclusion cysts • Lipoma • Hemangiomas Benign abdominal wall tumors • Epidermal inclusion cysts • Lipoma • Hemangiomas • Vascular Malformations

Intra-abdominal Mass HISTORY AND P.E. INFECTIOUS NON - INFECTIOUS MALIGNANT NON - MALIGNANT

Possible Causes of Abdominal Masses by Regions • Epigastric Area - Gastric Tumors - Hepatomegaly/ Liver tumors - Transverse colon tumors - Abdominal aortic aneurysm - Pancreatic tumors

Gastric cancer

Pancreatic cancer

Pancreatic pseudocyst

Abdominal aortic aneurysm

Possible Causes of Abdominal Masses by Regions • Right Hypochondriac - hepatomegaly / liver tumors - enlarged gallbladder - gastrointestinal malignancy - Colonic tumors - Small Intestinal tumors

Hepatocellular carcinoma HCC

Liver metastasis

Hydatid cyst

Possible Causes of Abdominal Masses by Regions • Left Hypochondriac - Gastric tumors - Splenomegaly - Colonic tumors

Possible Causes of Abdominal Masses by Regions • Umbilical - Small Intestinal tumors - Gastric tumors - Pancreatic tumors - Abdominal aortic aneurysm

Small bowel tumors

Possible Causes of Abdominal Masses by Regions • Right Lateral - Left Lateral - Colonic tumors - renal tumors - adrenal tumors

Renal cell carcinoma

Possible Causes of Abdominal Masses by Regions • Hypogastric/Suprapubic - In a male, causes of a suprapubic mass include: • urinary retention - the distended bladder is felt as a soft mass arising from the pelvis, • rarer causes include colonic carcinoma, huge bladder tumour - In females, causes include: • pregnancy • ovarian / uterine masses • urinary retention rarely

Possible Causes of Abdominal Masses by Regions • Right Iliac - Cecal and ascending colon tumors - Appendix mass - Right ovarian tumors - Chron disease - Psoas abscess

Appendicular mass

Colon cancer

Crohn disease

Possible Causes of Abdominal Masses by Regions • Left Iliac fossa - Colonic tumors -diverticular abscess - Constipation - Left Ovarian tumors

Diverticular abscess

Retroperitoneal tumors Adrenal tumors -retroperitoneal sarcoma

Adrenal carcinoma

Retroperitoneal sarcoma

• Diagnostic tests that may be performed are: - Blood tests such as CBC and Blood Chemistry - Abdominal x-ray - Barium enema - Abdominal Ultrasound - Abdominal CT scan - Angiography - Isotope study - EGD (esophagogastroduodenoscopy) - Colonoscopy - Sigmoidoscopy

Abdominal wall hernias

A hernia is a protrusion of a viscus or part of a viscus through an abnormal opening in the abdominal wall

Inguinal hernia

Indirect Inguinal Hernia Direct Inguinal Hernia Hernia through the internal inguinal ring Direct Inguinal Hernia The sac passes through a weakness or defect of the transversalis fascia in the posterior wall of the inguinal canal

Femoral Hernia Hernia medial to femoral vessels under inguinal ligament

Umbilical Hernia Paraumbilical Hernia Hernia through the umbilical ring Paraumbilical Hernia A protrusion through the linea alba just above or sometimes just below the umbilicus

Epigastric Hernia Protrusion of extraperitoneal fat through the linea alba anywhere between the xiphoid process and the umbilicus

Incisional Hernia Hernia through an incisional site

Lumber Hernia occur through the inferior lumber triangle of Petit(rare)