Sandbox:Javaria: Difference between revisions
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Shown below is an algorithm summarizing the diagnosis of <nowiki>abdominal mass</nowiki> according the the [...] guidelines. | Shown below is an algorithm summarizing the diagnosis of <nowiki>abdominal mass</nowiki> according the the [...] guidelines. | ||
{{familytree/start |summary=PE diagnosis Algorithm.}} | {{familytree/start |summary=PE diagnosis Algorithm.}} | ||
{{familytree | | | | A01 | | | A01=Abdominal mass | {{familytree | | | | A01 | | | A01=Abdominal mass}} | ||
{{familytree | | | | |!| | | | }} | {{familytree | | | | |!| | | | }} | ||
{{familytree | | | | B01 | | | B01=History and brief physical exam}} | {{familytree | | | | B01 | | | B01=History and brief physical exam<br> Past medical history}} | ||
{{familytree | | |,|-|^|-|.| | }} | {{familytree | | |,|-|^|-|.| | }} | ||
{{familytree | | C01 | | C02 | C01=Hemodynamic instability | C02= Stable}} | {{familytree | | C01 | | C02 | C01=Hemodynamic instability | C02= Stable}} | ||
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{{familytree/start |summary=Abdominal mass causes}} | |||
{{familytree | | | | A01 | | | A01=Abdominal mass}} | |||
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{{familytree | | |!| | | |!| | |!| |}} | |||
{{familytree | | C01 | | C02 | | C03 | |C01= '''Groin mass'''<br>[[Inguinal hernia]], [[femoral hernia]],<br> | |||
reactive or malignant [[adenopathy]],<br> iliac or femoral [[aneurysm]] or [[pseudoaneurysm]],<br> | |||
[[Sebaceous cyst]], [[hidradenitis]], [[lipoma]],<br> [[epididymitis]], [[testicular torsion]],<br> [[varicocele]], [[hydrocele]], ectopic | |||
[[testicle]], and [[undescended testicle]]| C02= '''Abdominal wall mass'''<br> | |||
[[epigastric hernia]], | |||
[[umbilical hernia]], [[incisional hernia]],<br> [[diastasis recti]], rectus sheath [[hematoma]],<br> [[spigelian hernia]], | |||
[[desmoid tumor]],<br> and intra-abdominal pathology. | C03=Intra-abdominal/ [[retroperitoneal]] mass }} | |||
{{familytree | | | | | | | | | | |!| | |}} | |||
{{familytree | | | | | | | | | | |!| |}} | |||
{{familytree | | |,|-|-|-|v|-|-|-|+|-|-|-|v|-|-|-|.| }} | |||
{{familytree | | |!| | | |!| | | |!| | | |!| | | |!| |} | |||
{{familytree | | D01 | | D02| | D03 | | D04 | | D05 |D01=Hepatic mass | D02=Splenic mass| D03=Pancreatic mass| D04=[[Retroperitoneal]] mass|D05=Aortic aneurysm|}} | |||
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{{familytree/end}} | {{familytree/end}} | ||
Revision as of 01:38, 14 August 2020
Shown below is an algorithm summarizing the diagnosis of abdominal mass according the the [...] guidelines.
Abdominal mass | |||||||||||||||||||||||
History and brief physical exam Past medical history | |||||||||||||||||||||||
Hemodynamic instability | Stable | ||||||||||||||||||||||
{{{ ! }}} | {{{ ! }}} | ||||||||||||||||||||||
{{familytree | | |!| | | |!| | | |!| | | |!| | | |!| |}
Abdominal mass | |||||||||||||||||||||||||||||||||||||||||
Groin mass Inguinal hernia, femoral hernia, reactive or malignant adenopathy, | Abdominal wall mass epigastric hernia,
umbilical hernia, incisional hernia, and intra-abdominal pathology. | Intra-abdominal/ retroperitoneal mass | |||||||||||||||||||||||||||||||||||||||
Hepatic mass | Splenic mass | Pancreatic mass | Retroperitoneal mass | Aortic aneurysm | |||||||||||||||||||||||||||||||||||||
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
Characterize the mass:
Associated symptoms
Detailed history:
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Examine the patient: ❑ Vital signs
❑ Skin
❑ Inspection
❑ Auscultation
❑ Palpation
❑ Psoas sign (suggestive of retrocecal appendix) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Consider extraabdominal differential diagnosis: ❑ aaaa | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
❑ Assess hemodynamic stability | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
If the patient is unstable, Stabilize the patient: ❑ Establish two large-bore intravenous peripheral lines ❑ NPO until the patient is stable ❑ Supportive care (fluids and electrolyes as required) ❑ Place nasogastric tube if there is bleeding, obstruction, significant nausea or vomiting ❑ Place foley catheter to monitor volume status ❑ Cardiac monitoring ❑ Supplemental oxygen as needed ❑ Administer early antibiotics if indicated | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
If the patient is stable, Order laboratory tests: ❑ Pregnancy test (required in women of child-bearing age) ❑ CBC ❑ Hematocrit ❑ Urinalysis ❑ Serum electrolytes ❑ ESR ❑ ABG ❑ D dimer ❑ Serum lactate ❑ BUN ❑ Creatinine ❑ Amylase ❑ Lipase ❑ Triglyceride ❑ Total bilirubin ❑ Direct bilirubin ❑ Albumin ❑ AST ❑ ALT ❑ Alkaline phosphatase ❑ GGT ❑ Stool for ova and parasites ❑ C. difficile culture and toxin assay Order imaging studies: *Order the tests to rule in a suspected diagnosis or to assess a case of unclear etiology *In case of elderly patients, immunocompromised or those unable to provide a comprehensive history, order broader range of tests | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Signs of peritonitis or shock ❑ Fever ❑ Abdominal tenderness ❑ Abdominal gaurding ❑ Rebound tenderness (blumberg sign) ❑ Diffuse abdominal rigidity ❑ Confusion ❑ Weakness ❑ Low blood pressure ❑ Decreased urine output ❑ Tachycardia | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
No | Yes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||