Sandbox:Javaria: Difference between revisions
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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> | <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> | ||
{{familytree/start |summary=Acute abdominal pain}} | {{familytree/start |summary=Acute abdominal pain}} | ||
{{familytree | | | | | | | | | | | | | | A01 | | | | | | | |A01=<div style="float: left; text-align: left; width: 20em; padding:1em;">''' | {{familytree | | | | | | | | | | | | | | A01 | | | | | | | |A01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Abdominal mass''' | ||
<br> | <br> | ||
'''Associated [[pain]]:'''<br> | '''Associated [[pain]]:'''<br> | ||
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:❑ [[Flatulence]] | :❑ [[Flatulence]] | ||
:❑ [[Fatigue]] | :❑ [[Fatigue]] | ||
:❑ [[ | :❑ Recent [[trauma]] | ||
:❑ Symptoms suggestive of [[Sepsis history and symptoms|sepsis]] | :❑ Symptoms suggestive of [[Sepsis history and symptoms|sepsis]] | ||
'''Detailed history:'''<br> | '''Detailed history:'''<br> | ||
:❑ Age (Patients above 50 years old are more likely to have severe diseases or cancers, such as ruptured [[abdominal aortic aneurysm]] or [[colon cancer]]) | :❑ Age (Patients above 50 years old are more likely to have severe diseases or cancers, such as ruptured [[abdominal aortic aneurysm]] or [[colon cancer]]) | ||
:❑ Past medical history | :❑ Past medical history | ||
:❑ Past surgical history (for previous abdominal surgeries) | :❑ Past surgical history (for previous abdominal surgeries) | ||
:❑ Menstrual and contraceptive history (pregnancy should be excluded in all women of childbearing age with abdominal mass) | :❑ Menstrual and contraceptive history (pregnancy should be excluded in all women of childbearing age with abdominal mass) | ||
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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>}} | {{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>}} | ||
{{familytree | | | | | | | | | | | | | | |!| | | | | | | | | |}} | {{familytree | | | | | | | | | | | | | | |!| | | | | | | | | |}} | ||
{{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]] | {{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]], [[Hematocrit]]<br> ❑ [[Urinalysis]]<br> ❑[[ESR]]<br>❑ [[ABG]]<br> ❑ [[D dimer]]<br>❑ [[Serum lactate]]<br> ❑ [[BMP]] ([[urea]], [[creatinine]], [[serum electrolytes]], [[BSL]]) <br> ❑ [[Amylase]] <br> ❑ [[Lipase]] <br> ❑ [[Triglyceride]] <br>❑[[Liver function tests]] (total [[bilirubin]], direct [[bilirubin]], [[albumin]], [[AST]], [[ALT]], [[Alkaline phosphatase]], [[GGT]]) | ||
---- | ---- | ||
'''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> | '''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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{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }} | {{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }} | ||
{{familytree/end}} | {{familytree/end}} | ||
{| style="border: 2px solid #4479BA; align="left" | |||
! style="width: 100px; background: #4479BA;" | {{fontcolor|#FFF|Cause of abdominal mass}} | |||
! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|CT scan finding}} | |||
! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|Ultrasound finding}} | |||
! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|MRI finding}} | |||
|- | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Hepatic cyst]] | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Reserved for more complicated cases. | |||
For more information [[Hepatic cysts|click here]] | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Most useful initial test. | |||
Assess cyst size, type, location within the liver, type, and anatomic relations with surroundings. | |||
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|- | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Hemangioma]]s | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Asymmetric peripheral enhancement on IV contrast (diagnostic potential) | |||
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| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Hepatic adenoma]]s | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Well-circumscribed hypo-intense lesions. | |||
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| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Hepatocellular carcinoma]] | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Diffuse enhancement with arterial phase contrast, and then washout during delayed venous images. | |||
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| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Focal nodular hyperplasia]] | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Well-circumscribed mass with central stellate scar. With IV contrast hyperintense on | |||
arterial phase and isodense on venous phase. | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | | |||
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| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Cholangiocarcinoma]] | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | he tumor tends to occur in the periphery of the liver | |||
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Revision as of 07:21, 16 August 2020
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
Abdominal 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 ❑ESR ❑ ABG ❑ D dimer ❑ Serum lactate ❑ BMP (urea, creatinine, serum electrolytes, BSL) ❑ Amylase ❑ Lipase ❑ Triglyceride ❑Liver function tests (total bilirubin, direct bilirubin, albumin, AST, ALT, Alkaline phosphatase, GGT) 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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Cause of abdominal mass | CT scan finding | Ultrasound finding | MRI finding |
---|---|---|---|
Hepatic cyst | Reserved for more complicated cases.
For more information click here |
Most useful initial test.
Assess cyst size, type, location within the liver, type, and anatomic relations with surroundings. |
|
Hemangiomas | Asymmetric peripheral enhancement on IV contrast (diagnostic potential) | ||
Hepatic adenomas | Well-circumscribed hypo-intense lesions. | ||
Hepatocellular carcinoma | Diffuse enhancement with arterial phase contrast, and then washout during delayed venous images. | ||
Focal nodular hyperplasia | Well-circumscribed mass with central stellate scar. With IV contrast hyperintense on
arterial phase and isodense on venous phase. |
||
Cholangiocarcinoma | he tumor tends to occur in the periphery of the liver | ||