1. Abdominal Masses
Differential diagnosis
Hayan Bismar, MD,FACS

6. Abdominal Mass
History
Physical Examination

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

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

9. 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

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

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

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

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

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

15. Abdominal Mass Physical Examination
Rectal Examination Pelvic Examination

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

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

18. Abdominal wall abscess

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

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

21. Abdominal wall tumors

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

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

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

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

29. Gastric cancer

30. Pancreatic cancer

31. Pancreatic pseudocyst

32. Abdominal aortic aneurysm

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

34. Hepatocellular carcinoma HCC

35. Liver metastasis

36. Hydatid cyst

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

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

39. Small bowel tumors

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

41. Renal cell carcinoma

42. 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

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

44. Appendicular mass

45. Colon cancer

46. Crohn disease

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

48. Diverticular abscess

49. Retroperitoneal tumors
Adrenal tumors
-retroperitoneal sarcoma

50. Adrenal carcinoma

51. Retroperitoneal sarcoma

52. • 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

53. Abdominal wall hernias

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

55. Inguinal hernia

56. 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

57. Femoral Hernia
Hernia medial to femoral vessels under inguinal ligament

58. 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

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

61. Incisional Hernia
Hernia through an incisional site

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