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{{familytree/start |summary=Abdominal mass causes}} | {{familytree/start |summary=Abdominal mass causes}} | ||
{{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>}} | {{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 | | | |C01= '''Abdominal wall mass'''<br> | {{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> | ||
[[ | ❑Primary tumors ([[WHO]] classification)<br> | ||
[[ | :❑[[Adipocyte|Adipocytic]] tumors ([[lipoma]], [[liposarcoma]]) <br> | ||
:❑Fibroblastic/myofibroblastic tumors ([[Desmoid tumor differential diagnosis|desmoid tumor]])<br> | |||
:❑Nerve sheath tumors ([[schwannoma]], [[neurofibroma]])<br> | |||
:❑[[Hemangioma]]s <br> | |||
:❑Undifferentiated pleomorphic [[sarcoma]]s <br> | |||
:❑Smooth muscle tumor ([[leiomyoma]] (not included in WHO classification)<br> | |||
❑[[Metastasis]]<br> | |||
❑Tumor-like mass<br> | |||
:❑[[Endometriosis]], [[abscess]], [[hematoma]]<br> | |||
:❑[[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 | | |,|-|-|-|v|-|-|-|+|-|-|-|v|-|-|-|.| }} | {{familytree | | |,|-|-|-|v|-|-|-|+|-|-|-|v|-|-|-|.| }} | ||
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{{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]], | {{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> | ||
❑[[Hepatitis]] (infectious, [[DILI]], [[Alcoholic liver disease|alcoholic]],<br> [[NASH]], [[autoimmune hepatitis|autoimmune]], [[Wilson's disease]]<br> | |||
❑Storage diseases ([[glycogen storage disease]], [[lysosomal storage disease]], [[lipid storage disease]], [[hemochromatosis]])<br> | |||
❑[[Tumors]]<br> | |||
:❑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=<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> | |||
❑Storage ([[Gaucher’s disease|Gaucher's]], [[Niemann-Pick disease]])<br>❑Infiltrative:[[amyloidosis]], [[sarcoidosis]]<br> | |||
❑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> | |||
:❑[[Pancreatic cancer differential diagnosis|Neoplastic]] ([[Mucinous cystadenocarcinoma differential diagnosis|mucinous]], [[serous]], [[Intraductal papillary mucinous neoplasm|intraductal papillary]], and solid pseudopapillary)<br> | |||
:❑Non-neoplastic (true, [[mucinous]])<br> | |||
:❑[[inflammation|Inflammatory]] ([[Pancreatic pseudocyst|pseudocyst]], [[acute]] fluid collection)<br> | |||
❑Solid:<br> | |||
:❑[[Adenocarcinoma]]s ([[Pancreatic cancer classification|ductal]], [[bile duct]], [[Pancreatic cancer classification|ampullar]] and [[Small intestine cancer classification|duodenal]]) | |||
:❑[[Pancreatic neuroendocrine tumor]]s<br> | |||
:❑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> | |||
❑[[Liposarcoma]]<br> | |||
❑[[Incidentaloma]]<br> | |||
❑[[Lymphoma]]|D05=[[Abdominal Aortic Aneurysm]](AAA)|}} | |||
{{familytree | | | | | | | | | }} | {{familytree | | | | | | | | | }} | ||
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Revision as of 08:13, 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 | | |!| | | |!| | | |!| | | |!| | | |!| |}
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:
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
- ↑ "ACS/ASE Medical Student Core Curriculum".
- ↑ Jo VY, Fletcher CD (February 2014). "WHO classification of soft tissue tumours: an update based on the 2013 (4th) edition". Pathology. 46 (2): 95–104. doi:10.1097/PAT.0000000000000050. PMID 24378391.
- ↑ Li M, Zhang L, Xu XJ, Shi Z, Zhao XM (November 2019). "CT and MRI features of tumors and tumor-like lesions in the abdominal wall". Quant Imaging Med Surg. 9 (11): 1820–1839. doi:10.21037/qims.2019.09.03. PMC 6902146 Check
|pmc=
value (help). PMID 31867236. - ↑ vom Dahl S, Mengel E (October 2010). "Lysosomal storage diseases as differential diagnosis of hepatosplenomegaly". Best Pract Res Clin Gastroenterol. 24 (5): 619–28. doi:10.1016/j.bpg.2010.09.001. PMID 20955964.
- ↑ Maharaj B, Cooppan RM, Maharaj RJ, Desai DK, Ranchod HA, Siddie-Ganie FM, Goqwana MB, Ganie AS, Gaffar MS, Leary WP (February 1986). "Causes of hepatomegaly at King Edward VIII Hospital, Durban. A prospective study of 240 black patients". S. Afr. Med. J. 69 (3): 183–4. PMID 3003936.
- ↑ Curovic Rotbain E, Lund Hansen D, Schaffalitzky de Muckadell O, Wibrand F, Meldgaard Lund A, Frederiksen H (2017). "Splenomegaly - Diagnostic validity, work-up, and underlying causes". PLoS ONE. 12 (11): e0186674. doi:10.1371/journal.pone.0186674. PMC 5685614. PMID 29135986.
- ↑ Karoumpalis I, Christodoulou DK (2016). "Cystic lesions of the pancreas". Ann Gastroenterol. 29 (2): 155–61. doi:10.20524/aog.2016.0007. PMC 4805734. PMID 27065727.
- ↑ Vincent A, Herman J, Schulick R, Hruban RH, Goggins M (August 2011). "Pancreatic cancer". Lancet. 378 (9791): 607–20. doi:10.1016/S0140-6736(10)62307-0. PMC 3062508. PMID 21620466.
- ↑ Mota M, Bezerra R, Garcia M (2018). "Practical approach to primary retroperitoneal masses in adults". Radiol Bras. 51 (6): 391–400. doi:10.1590/0100-3984.2017.0179. PMC 6290739. PMID 30559557. Vancouver style error: initials (help)