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 ElderlyGI
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 DDx? Next?
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

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

15. I thank you for your attention and am happy to take questions.