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| Shown below is an algorithm summarizing the diagnosis of <nowiki>abdominal mass</nowiki> according the the [...] guidelines.
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| {{familytree/start |summary=PE diagnosis Algorithm.}}
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| {{familytree | | | | A01 | | | A01=Abdominal mass}}
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| {{familytree | | | | |!| | | | }}
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| {{familytree | | | | B01 | | | B01=History and brief physical exam<br> Past medical history}}
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| {{familytree | | |,|-|^|-|.| | }}
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| {{familytree | | C01 | | C02 | C01=Hemodynamic instability | C02= Stable}}
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| {{familytree | | ! | | | ! | | | }}
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| {{familytree | | | | | | | | | }}
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| {{familytree/start |summary=Abdominal mass causes}}
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| {{familytree | | | | | | | | A01 | | | A01='''Abdominal mass'''<ref name="urlACS/ASE Medical Student Core Curriculum">{{cite web |url=https://www.facs.org/education/program/core-curriculum#:~:text=The%20American%20College%20of%20Surgeons,school%20faculty%2C%20and%20clinical%20faculty. |title=ACS/ASE Medical Student Core Curriculum |format= |work= |accessdate=}}</ref>}}
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| {{familytree | | | | | | | | |!| | | | }}
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| {{familytree | | | | | | |,|-|^|-|.| | | | }}
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| {{familytree | | | | | | |!| | | |!| | | | |}}
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| {{familytree | | | | | | C01 | | C02 | | | |C01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Abdominal wall mass'''<ref name="pmid24378391">{{cite journal |vauthors=Jo VY, Fletcher CD |title=WHO classification of soft tissue tumours: an update based on the 2013 (4th) edition |journal=Pathology |volume=46 |issue=2 |pages=95–104 |date=February 2014 |pmid=24378391 |doi=10.1097/PAT.0000000000000050 |url=}}</ref><ref name="pmid31867236">{{cite journal |vauthors=Li M, Zhang L, Xu XJ, Shi Z, Zhao XM |title=CT and MRI features of tumors and tumor-like lesions in the abdominal wall |journal=Quant Imaging Med Surg |volume=9 |issue=11 |pages=1820–1839 |date=November 2019 |pmid=31867236 |pmc=6902146 |doi=10.21037/qims.2019.09.03 |url=}}</ref><br>
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| ❑Primary tumors ([[WHO]] classification)<br>
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| :❑[[Adipocyte|Adipocytic]] tumors ([[lipoma]], [[liposarcoma]]) <br>
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| :❑Fibroblastic/myofibroblastic tumors ([[Desmoid tumor differential diagnosis|desmoid tumor]])<br>
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| :❑Nerve sheath tumors ([[schwannoma]], [[neurofibroma]])<br>
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| :❑[[Hemangioma]]s <br>
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| :❑Undifferentiated pleomorphic [[sarcoma]]s <br>
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| :❑Smooth muscle tumor ([[leiomyoma]] (not included in WHO classification)<br>
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| ❑[[Metastasis]]<br>
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| ❑Tumor-like mass<br>
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| :❑[[Endometriosis]], [[abscess]], [[hematoma]]<br>
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| :❑[[Hernia]]s ([[epigastric hernia|epigastric]], [[umbilical hernia|umbilical]], [[incisional hernia|incisional]], and [[spigelian hernia|spigelian]])| C02='''Intra-abdominal/<br> [[retroperitoneal]] mass''' }}
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| {{familytree | | | | | | | | | | |!| | |}}
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| {{familytree | | | | | | | | | | |!| |}}
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| {{familytree | | |,|-|-|-|v|-|-|-|+|-|-|-|v|-|-|-|.| }}
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| {{familytree | | |!| | | |!| | | |!| | | |!| | | |!| |}
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| {{familytree | | D01 | | D02| | D03 | | D04 | | D05 |D01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Hepatic mass'''<ref name="pmid20955964">{{cite journal |vauthors=vom Dahl S, Mengel E |title=Lysosomal storage diseases as differential diagnosis of hepatosplenomegaly |journal=Best Pract Res Clin Gastroenterol |volume=24 |issue=5 |pages=619–28 |date=October 2010 |pmid=20955964 |doi=10.1016/j.bpg.2010.09.001 |url=}}</ref><ref name="pmid3003936">{{cite journal |vauthors=Maharaj B, Cooppan RM, Maharaj RJ, Desai DK, Ranchod HA, Siddie-Ganie FM, Goqwana MB, Ganie AS, Gaffar MS, Leary WP |title=Causes of hepatomegaly at King Edward VIII Hospital, Durban. A prospective study of 240 black patients |journal=S. Afr. Med. J. |volume=69 |issue=3 |pages=183–4 |date=February 1986 |pmid=3003936 |doi= |url=}}</ref><br>
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| ❑[[Hepatitis]] (infectious, [[DILI]], [[Alcoholic liver disease|alcoholic]],<br> [[NASH]], [[autoimmune hepatitis|autoimmune]], [[Wilson's disease]]<br>
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| ❑Storage diseases ([[glycogen storage disease]], [[lysosomal storage disease]], [[lipid storage disease]], [[hemochromatosis]])<br>
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| ❑[[Tumors]]<br>
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| :❑Primary Benign:[[Hepatic adenoma|adenoma]], [[Focal nodular hyperplasia|FNH]]<br>
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| :❑Primary malignant:[[Hepatocellular carcinoma|HCC]], [[cholangiocarcinoma]]<br>
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| :❑Metastatic: [[Hemangioma]], [[lymphoma]],<br> [[myeloma]] and solid tumors.<br>
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| ❑[[Cholestasis]] ([[Primary biliary cirrhosis|PBC]], [[Primary sclerosing cholangitis|PSC]]) | D02=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Splenic mass'''<ref name="pmid29135986">{{cite journal |vauthors=Curovic Rotbain E, Lund Hansen D, Schaffalitzky de Muckadell O, Wibrand F, Meldgaard Lund A, Frederiksen H |title=Splenomegaly - Diagnostic validity, work-up, and underlying causes |journal=PLoS ONE |volume=12 |issue=11 |pages=e0186674 |date=2017 |pmid=29135986 |pmc=5685614 |doi=10.1371/journal.pone.0186674 |url=}}</ref><br>❑[[Infections|Infectious]]:[[Infectious Mononucleosis|IM]], [[liver abscess]],<br>[[echinococcosis]]<br>❑[[Myeloproliferative disorders|Myeloproliferative]] ([[lymphoma]]s<br> and [[leukemia]]s)<br>
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| ❑Storage ([[Gaucher’s disease|Gaucher's]], [[Niemann-Pick disease]])<br>❑Infiltrative:[[amyloidosis]], [[sarcoidosis]]<br>
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| ❑Miscellineous ([[Portal hypertension|PH]], [[metastases]] ([[lung cancer]] or [[breast cancer]], [[Felty's syndrome]])| D03=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Pancreatic mass'''<ref name="pmid27065727">{{cite journal |vauthors=Karoumpalis I, Christodoulou DK |title=Cystic lesions of the pancreas |journal=Ann Gastroenterol |volume=29 |issue=2 |pages=155–61 |date=2016 |pmid=27065727 |pmc=4805734 |doi=10.20524/aog.2016.0007 |url=}}</ref><ref name="pmid21620466">{{cite journal |vauthors=Vincent A, Herman J, Schulick R, Hruban RH, Goggins M |title=Pancreatic cancer |journal=Lancet |volume=378 |issue=9791 |pages=607–20 |date=August 2011 |pmid=21620466 |pmc=3062508 |doi=10.1016/S0140-6736(10)62307-0 |url=}}</ref><br>❑[[Pancreatic cyst]]<br>
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| :❑[[Pancreatic cancer differential diagnosis|Neoplastic]] ([[Mucinous cystadenocarcinoma differential diagnosis|mucinous]], [[serous]], [[Intraductal papillary mucinous neoplasm|intraductal papillary]], and solid pseudopapillary)<br>
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| :❑Non-neoplastic (true, [[mucinous]])<br>
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| :❑[[inflammation|Inflammatory]] ([[Pancreatic pseudocyst|pseudocyst]], [[acute]] fluid collection)<br>
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| ❑Solid:<br>
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| :❑[[Adenocarcinoma]]s ([[Pancreatic cancer classification|ductal]], [[bile duct]], [[Pancreatic cancer classification|ampullar]] and [[Small intestine cancer classification|duodenal]])
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| :❑[[Pancreatic neuroendocrine tumor]]s<br>
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| :❑Others ([[lymphoma]] and [[metastasis]])| D04=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''[[Retroperitoneal]] mass'''<ref name="pmid30559557">{{cite journal |vauthors=Mota MMDS, Bezerra ROF, Garcia MRT |title=Practical approach to primary retroperitoneal masses in adults |journal=Radiol Bras |volume=51 |issue=6 |pages=391–400 |date=2018 |pmid=30559557 |pmc=6290739 |doi=10.1590/0100-3984.2017.0179 |url=}}</ref><br>(majority tumors are [[malignant]])<br>
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| ❑[[Liposarcoma]]<br>
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| ❑[[Incidentaloma]]<br>
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| ❑[[Lymphoma]]|D05=[[Abdominal Aortic Aneurysm]](AAA)|}}
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| {{familytree/end}}
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| <span style="font-size:85%"> '''Abbreviations:''' '''ACS:''' Acute coronary syndrome; '''AAA:''' Abdominal aortic aneurysm; '''RUQ:''' Right upper quadrant; '''RLQ:''' Right lower quadrant; '''LUQ:''' Left upper quadrant; '''LLQ:''' Left lower quadrant</span>
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| {{familytree/start |summary=Acute abdominal pain}}
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| {{familytree | | | | | | | | | | | | | | A01 | | | | | | | |A01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Characterize the mass''':<br>
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| :❑Pulsatile mass
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| :❑Constant mass
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| <br>
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| '''Associated [[pain]]:'''<br>
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| :❑ Site (eg, a particular quadrant or diffuse, a change in location may reflect progression of the [[disease]]
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| :❑ Onset (eg, sudden, gradual)
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| :❑ Quality (eg, dull, sharp, colicky, waxing and waning)
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| :❑ Aggravating and relieving factors (e.g, Is the pain related to your meals?)
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| :❑ Intensity (scale of 0-10/ 0-5 with the maximum number; 10/5 being the worst pain of life)
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| :❑ Time course (eg, hours versus weeks, constant or intermittent)
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| :❑ Radiation (eg, to the shoulder, back, flank, groin, or chest)<br>
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| '''Associated [[symptoms]]'''<br>
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| :❑ [[Shortness of breath]]
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| :❑ [[Altered mental status]]
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| :❑ [[Nausea]] & [[vomiting]]
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| :❑ [[Diaphoresis]]
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| :❑ [[Fever]]
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| :❑ [[Hematuria]]
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| :❑ [[Anorexia]]
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| :❑ [[Bloody stool]]
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| :❑ [[Weight loss]]
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| :❑ [[Vaginal discharge]]
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| :❑ [[Penile discharge]]
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| :❑ [[Jaundice]]
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| :❑ [[Mal-digestion]]
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| :❑ [[Flatulence]]
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| :❑ [[Fatigue]]
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| :❑ [[Scrotal pain/swelling]]
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| :❑ Recent trauma
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| :❑ Symptoms suggestive of [[Sepsis history and symptoms|sepsis]]
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| '''Detailed history:'''<br>
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| :❑ Age (Patients above 50 years old are more likely to have severe diseases or cancers, such as ruptured [[abdominal aortic aneurysm]] or [[colon cancer]])
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| :❑ Past medical history (to exclude risk factors for cardiovascular diseases or peripheral vascular disease)
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| :❑ Past surgical history (for previous abdominal surgeries)
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| :❑ Menstrual and contraceptive history (pregnancy should be excluded in all women of childbearing age with abdominal mass)
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| :❑ Social history (alcohol abuse predispose to pancreatitis and hepatitis, smoking also predisposes to different types of cancers, eg. cancer bladder, which may cause abdominal pain)
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| :❑ Occupational history (exposure to chemicals or toxins)
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| :❑ Travel history
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| :❑ Medications (for over the counter drugs as</div>}}
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| {{familytree | | | | | | | | | | | | | | |!| | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | | A02 | | | | | | A02= <div style="float: left; text-align: left; width: 20em; padding:1em;"> '''Examine the patient:''' <br>
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| ❑ Vital signs<br>
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| :❑ [[Temperature]]<br>
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| :❑ [[Heart rate]] ([[tachycardia]]) <br>
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| :❑ [[Blood pressure]] ([[hypotension]])<br>
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| :❑ [[Respiratory rate]] ([[tachypnea]])<br>
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| ❑ Skin <br>
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| :❑ [[Diaphoresis]]
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| :❑ [[Pallor]]
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| :❑ [[Jaundice]]
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| :❑ [[Dehydration]]
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| ❑ Inspection <br>
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| :❑ If the patient is lying still in bed with knees bent, this is suggestive of organ rupture and resulting [[peritonitis]]<br>
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| :❑ Signs of previous surgery<br>
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| :❑ Abdominal pulsations<br>
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| :❑ Signs of systemic disease eg,<br>
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| ::❑ [[Pallor]], suggestive of bleeding<br>
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| ::❑ [[Spider angiomata]], suggestive of [[cirrhosis]]<br>
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| ❑ Auscultation <br>
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| :❑ Abdominal crepitations<br>
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| :❑ Reduced bowel sounds<br>
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| :❑ Increased bowel sounds<br>
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| :❑ Bruit, suggestive of [[abdominal aortic aneurysm]]<br>
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| ❑ Palpation<br>
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| :❑ Rigidity
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| :❑ [[Guarding]]
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| :❑ Abdominal tenderness
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| :❑ [[Distension]]
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| :❑ Detection of masses on palpating the abdomen
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| :❑ [[Carnett's sign]]
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| ❑ [[Psoas sign]] (suggestive of retrocecal appendix)<br>
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| ❑ [[Cullen's sign]]<br>
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| ❑ [[Grey-Turner's sign]]<br>
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| ❑ [[Digital rectal exam]] (tenderness may be present in retrocecal appendicitis)<br>
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| ❑ [[Pelvic exam]] in females<br>
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| ❑ [[Testicular examination]] in males<br>
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| ❑ Cardiovascular system<br>
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| ❑ Respiratory system<br>
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| ❑ Anorectal (bleeding)<br>
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| ❑ [[Signs of sepsis]]: [[tachycardia]], decreased urination, and [[hyperglycemia]], [[confusion]], [[metabolic acidosis]] with compensatory [[respiratory alkalosis]], [[low blood pressure]], decreased [[systemic vascular resistance]], higher [[cardiac output]], and [[coagulation]] dysfunctions<br>
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| </div>}}
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| {{familytree | | | | | | | | | | | | | | |!| | | | | | | }}
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| {{familytree | | | | | | | | | | | | | | C01 | | | | | | | |C01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Consider extraabdominal differential diagnosis:'''<BR> ❑ aaaa</div>}}
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| {{familytree | | | | | | | | | | | | | | |!| | | | | | | }}
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| {{familytree | | | | | | | | | | | | | | E01 | | | | | | | | | |E01=❑ Assess hemodynamic stability }}
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| {{familytree | | | | | | | | | | | | | | |!| | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | | Z02 | | | | | | | | |Z02=<div style="float: left; text-align: left; line-height: 150% ">'''If the patient is unstable,''' <br> '''Stabilize the patient:'''<br> ❑ Establish two large-bore intravenous peripheral lines<br> ❑ [[NPO]] until the patient is stable<br> ❑ Supportive care (fluids and electrolyes as required)<br> ❑ Place nasogastric tube if there is bleeding, obstruction, significant [[nausea]] or [[vomiting]]<br> ❑ Place [[foley catheter]] to monitor volume status<br> ❑ Cardiac monitoring<br> ❑ Supplemental oxygen as needed<br> ❑ Administer early antibiotics if indicated </div>}}
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| {{familytree | | | | | | | | | | | | | | |!| | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | | Z01 | | | | | | | | | | |Z01 =<div style="float: left; text-align: left; line-height: 150% ">'''If the patient is stable,'''<br> '''Order laboratory tests:'''<br> ❑ [[Pregnancy test]] (required in women of child-bearing age) <br>❑ [[CBC]]<br> ❑ [[Hematocrit]]<br> ❑ [[Urinalysis]]<br> ❑ [[Serum electrolytes]]<br>❑ [[ESR]]<br>❑ [[ABG]]<br> ❑ [[D dimer]]<br>❑ [[Serum lactate]]<br> ❑ [[BUN]] <br> ❑ [[Creatinine]] <br> ❑ [[Amylase]] <br> ❑ [[Lipase]] <br> ❑ [[Triglyceride]] <br>❑ Total [[bilirubin]]<br>❑ Direct [[bilirubin]]<br>❑ [[Albumin]]<br>❑ [[AST]]<br>❑ [[ALT]]<br>❑ [[Alkaline phosphatase]]<br>❑ [[GGT]]<br>❑ Stool for ova and parasites<br>❑ C. difficile culture and toxin assay
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| ----
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| '''Order imaging studies:''' <br> ❑ Order urgent trans abdominal [[ultrasound]] (TAUSG)<br> ❑ [[Abdominal CT]]<br> ❑ [[ECG]]<br> ❑ [[MRCP]] <br> ❑ [[Abdominal x-ray]] <br> ❑ [[Angiography]]<br> ❑ Diagnostic [[paracentesis]]<br>
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| ----
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| '''''*Order the tests to rule in a suspected diagnosis<br> or to assess a case of unclear etiology'''''<br> '''''*In case of elderly patients, immunocompromised<br> or those unable to provide a comprehensive<br> history, order broader range of tests''''' </div>}}
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| {{familytree | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | | A01 | | | | | |A01=<div style="float: left; text-align: left; line-height: 150% "> '''Signs of [[peritonitis]] or [[shock]]'''<br> ❑ [[Fever]]<br> ❑ Abdominal tenderness<br> ❑ Abdominal gaurding<br> ❑ Rebound tenderness ([[blumberg sign]])<br> ❑ Diffuse abdominal rigidity<br> ❑ [[Confusion]]<br> ❑ Weakness<br> ❑ Low blood pressure <br> ❑ Decreased urine output<br> ❑ Tachycardia<br> </div>}}
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| {{familytree | | | | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| }}
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| {{familytree | | | | | | | C01 |-|-|-|-|-|.| | | | | | C03 | | | | | | | |C01=No|C02=No|C03=Yes}}
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| {{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }}
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| {{familytree/end}}
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