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{{familytree/start |summary=Abdominal mass causes}} | {{familytree/start |summary=Abdominal mass causes}} | ||
{{familytree | | | | A01 | | | A01=Abdominal mass}} | {{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 | | C01 | | C02 | | | {{familytree | | | | | | C01 | | C02 | | | |C01= '''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. | C02='''Intra-abdominal/<br> [[retroperitoneal]] mass''' }} | |||
[[epigastric hernia]], | |||
[[umbilical hernia]], [[incisional hernia]],<br> [[diastasis recti]], rectus sheath [[hematoma]],<br> [[spigelian hernia]], | |||
[[desmoid tumor]],<br> and intra-abdominal pathology. | | |||
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{{familytree | | D01 | | D02| | D03 | | D04 | | D05 |D01=Hepatic mass | D02=Splenic mass| D03=Pancreatic mass| D04=[[Retroperitoneal]] mass|D05=Aortic aneurysm|}} | {{familytree | | D01 | | D02| | D03 | | D04 | | D05 |D01='''Hepatic mass'''<br>❑[[Hepatitis]] (infectious, [[DILI]], [[Alcoholic liver disease|alcoholic]],<br> [[NASH]], [[autoimmune hepatitis|autoimmune]], [[Wilson's disease]]<br>❑Storage diseases ([[glycogen storage disease]],<br> [[lysosomal storage disease]], [[lipid storage disease]], [[hemochromatosis]]<br>❑[[Tumors]]:❑Primary Benign:[[Hepatic adenoma|adenoma]], [[Focal nodular hyperplasia|FNH]]<br>:❑Primary malignant:[[Hepatocellular carcinoma|HCC]], [[cholangiocarcinoma]]<br>:❑Metastatic: [[Hemangioma]], [[lymphoma]],<br> [[myeloma]] and solid tumors.<br>❑[[Cholestasis]]:[[Primary biliary cirrhosis|PBC]], [[Primary sclerosing cholangitis|PSC]], | D02='''Splenic mass'''<br>❑[[Myeloproliferative disorders]]| D03=Pancreatic mass| D04=[[Retroperitoneal]] mass|D05=Aortic aneurysm|}} | ||
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Revision as of 03:14, 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 | ||||||||||||||||||||||
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Abdominal mass[1] | |||||||||||||||||||||||||||||||||||||||||
Abdominal wall mass epigastric hernia, umbilical hernia, incisional hernia, and intra-abdominal pathology. | Intra-abdominal/ retroperitoneal mass | ||||||||||||||||||||||||||||||||||||||||
Hepatic mass ❑Hepatitis (infectious, DILI, alcoholic, NASH, autoimmune, Wilson's disease ❑Storage diseases (glycogen storage disease, lysosomal storage disease, lipid storage disease, hemochromatosis ❑Tumors:❑Primary Benign:adenoma, FNH :❑Primary malignant:HCC, cholangiocarcinoma :❑Metastatic: Hemangioma, lymphoma, myeloma and solid tumors. ❑Cholestasis:PBC, PSC, | Splenic mass ❑Myeloproliferative disorders | 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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||