Sandbox:Javaria: Difference between revisions
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:❑ Signs of previous surgery<br> | :❑ Signs of previous surgery<br> | ||
:❑ Abdominal pulsations<br> | :❑ Abdominal pulsations<br> | ||
:❑ Signs of systemic disease | :❑ Signs of systemic disease e.g.<br> | ||
::❑ [[Pallor]], suggestive of bleeding<br> | ::❑ [[Pallor]], suggestive of bleeding<br> | ||
::❑ [[Spider angiomata]], suggestive of [[cirrhosis]]<br> | ::❑ [[Spider angiomata]], suggestive of [[cirrhosis]]<br> | ||
❑ Auscultation <br> | ❑ [[Auscultation]] <br> | ||
:❑ Abdominal crepitations<br> | :❑ Abdominal crepitations<br> | ||
:❑ Reduced bowel sounds<br> | :❑ Reduced bowel sounds<br> | ||
:❑ Bruit, suggestive of [[abdominal aortic aneurysm]]<br> | :❑ Bruit, suggestive of [[abdominal aortic aneurysm]]<br> | ||
❑ Palpation<br> | ❑ Palpation<br> | ||
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:❑ Detection of masses on palpating the abdomen | :❑ Detection of masses on palpating the abdomen | ||
:❑ [[Carnett's sign]] | :❑ [[Carnett's sign]] | ||
❑ [[Pelvic exam]] in females<br> | ❑ [[Pelvic exam]] in females<br> | ||
❑ [[Testicular examination]] in males<br> | ❑ [[Testicular examination]] in males<br> | ||
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❑ Respiratory system<br> | ❑ Respiratory system<br> | ||
❑ Anorectal (bleeding)<br> | ❑ Anorectal (bleeding)<br> | ||
❑ [[Signs of sepsis]]: [[tachycardia]], decreased urination, and [[hyperglycemia]], [[confusion]], [[metabolic acidosis]] with compensatory [[respiratory alkalosis]], [[ | ❑ [[Signs of sepsis]]: [[tachycardia]], decreased urination, and [[hyperglycemia]], [[confusion]], [[metabolic acidosis]] with compensatory [[respiratory alkalosis]], [[hypotension]], decreased [[systemic vascular resistance]], and [[coagulation]] dysfunctions<br> | ||
</div>}} | </div>}} | ||
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Table illustrates common imaging findings in particular disease.<ref name="pmid10524843">{{cite journal |vauthors=Zhang Y, Uchida M, Abe T, Nishimura H, Hayabuchi N, Nakashima Y |title=Intrahepatic peripheral cholangiocarcinoma: comparison of dynamic CT and dynamic MRI |journal=J Comput Assist Tomogr |volume=23 |issue=5 |pages=670–7 |date=1999 |pmid=10524843 |doi=10.1097/00004728-199909000-00004 |url=}}</ref><ref name="pmid22895392">{{cite journal |vauthors=Khan SA, Davidson BR, Goldin RD, Heaton N, Karani J, Pereira SP, Rosenberg WM, Tait P, Taylor-Robinson SD, Thillainayagam AV, Thomas HC, Wasan H |title=Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update |journal=Gut |volume=61 |issue=12 |pages=1657–69 |date=December 2012 |pmid=22895392 |doi=10.1136/gutjnl-2011-301748 |url=}}</ref><ref name="pmid28229074">{{cite journal |vauthors=Olthof SC, Othman A, Clasen S, Schraml C, Nikolaou K, Bongers M |title=Imaging of Cholangiocarcinoma |journal=Visc Med |volume=32 |issue=6 |pages=402–410 |date=December 2016 |pmid=28229074 |pmc=5290452 |doi=10.1159/000453009 |url=}}</ref> | |||
{| style="border: 2px solid #4479BA; align="left" | {| style="border: 2px solid #4479BA; align="left" | ||
! style="width: 100px; background: #4479BA;" | {{fontcolor|#FFF|Cause of abdominal mass}} | ! style="width: 100px; background: #4479BA;" | {{fontcolor|#FFF|Cause of abdominal mass}} | ||
! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|CT scan | ! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|'''CT scan'''}} | ||
! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|Ultrasound | ! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|'''Ultrasound'''}} | ||
! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|MRI | ! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|'''MRI'''}} | ||
! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|'''PET scan'''}} | |||
|- | |- | ||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Hepatic cyst]] | | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Hepatic cyst]] | ||
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|- | |- | ||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Cholangiocarcinoma]] | | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Cholangiocarcinoma]] | ||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | | | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Lesion occurs in the periphery of [[liver]] | ||
Primary staging: Higher [[sensitivity|Sn]] in detecting extrahepatic invasion and vascular involvement. | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | | | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | | ||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" |Modality of choice for [[diagnosis]] and [[staging]] | |||
Contrast enhancement patterns vary based on tumour size, composition and structure | |||
|- | |- | ||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | | | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | |
Revision as of 07:46, 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
❑ Palpation
❑ Pelvic exam in females | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Table illustrates common imaging findings in particular disease.[1][2][3]
Cause of abdominal mass | CT scan | Ultrasound | MRI | PET scan |
---|---|---|---|---|
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 | Lesion occurs in the periphery of liver
Primary staging: Higher Sn in detecting extrahepatic invasion and vascular involvement. |
Modality of choice for diagnosis and staging
Contrast enhancement patterns vary based on tumour size, composition and structure | ||
- ↑ Zhang Y, Uchida M, Abe T, Nishimura H, Hayabuchi N, Nakashima Y (1999). "Intrahepatic peripheral cholangiocarcinoma: comparison of dynamic CT and dynamic MRI". J Comput Assist Tomogr. 23 (5): 670–7. doi:10.1097/00004728-199909000-00004. PMID 10524843.
- ↑ Khan SA, Davidson BR, Goldin RD, Heaton N, Karani J, Pereira SP, Rosenberg WM, Tait P, Taylor-Robinson SD, Thillainayagam AV, Thomas HC, Wasan H (December 2012). "Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update". Gut. 61 (12): 1657–69. doi:10.1136/gutjnl-2011-301748. PMID 22895392.
- ↑ Olthof SC, Othman A, Clasen S, Schraml C, Nikolaou K, Bongers M (December 2016). "Imaging of Cholangiocarcinoma". Visc Med. 32 (6): 402–410. doi:10.1159/000453009. PMC 5290452. PMID 28229074.