Sandbox:Javaria: Difference between revisions
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*Rule out [[infection]] and [[malignancy]] before diagnosis. | *Rule out [[infection]] and [[malignancy]] before diagnosis. | ||
*[[Fever]] + [[cyst]]= suspect [[pyogenic liver abscess]]/ other infection. | *[[Fever]] + [[cyst]]= suspect [[pyogenic liver abscess]]/ other infection. | ||
*Asymptomatic simple cyst | *Asymptomatic simple cyst: no treatment required. | ||
*Symptomatic cyst | *Symptomatic cyst: [[sclerotherapy]]/ wide unroofing surgery. | ||
*[[Echinococcosis]] | *[[Echinococcosis]]: [[anthelmintic]]s/ and surgery), [[amebic liver abscess]]: [[metronidazole]], [[pyogenic liver abscess]]: [[Pyogenic liver abscess medical therapy|antibiotic]] + percutaneous drainage. | ||
*[[Cystadenoma]] | *[[Cystadenoma]] and cystadenocarcinoma: surgically removed/ lobectomy/partial hepatectomy. | ||
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| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Hemangioma]]s | | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Hemangioma]]s | ||
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| 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;" | | | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | | ||
*Resection (small single lesions, no/limited cirrhosis)/ liver transplant (advanced [[cirrhosis]] but no extrahepatic disease. | *Resection (small single lesions, no/limited cirrhosis)/ liver transplant (advanced [[cirrhosis]]) but no extrahepatic disease. | ||
*If a [[patient]] with [[liver cirrhosis|cirrhosis]] presents with a >1cm liver mass, pursue a definitive diagnosis to rule out HCC. | *If a [[patient]] with [[liver cirrhosis|cirrhosis]] presents with a >1cm liver mass, pursue a definitive diagnosis to rule out HCC. | ||
*Non-surgical transarterial chemoembolization (TACE) and radiofrequency ablation (RFA). | *Non-surgical transarterial chemoembolization (TACE) and radiofrequency ablation (RFA). | ||
*[[Sorafenib]] ( | *[[Sorafenib]] ([[tyrosine kinase inhibitor]]) if patient is not a candidate for resection/ transplant. | ||
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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;" | [[Focal nodular hyperplasia]] | ||
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| 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;" | | | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Reassure and observe (no malignant potential) | ||
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| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Cholangiocarcinoma]] | | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | [[Cholangiocarcinoma]] |
Revision as of 21:40, 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:
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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 (thrombocytopenia, leukopenia, anemia may be associated with splenomegaly) ❑ Urinalysis 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 and management of stabke abdominal masses.[1][2][3]
Cause of abdominal mass | CT scan | Ultrasound | MRI | PET scan | Management |
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Hepatic cyst | Reserved for more complicated cases.
For more information click here |
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Hemangiomas | Asymmetric peripheral enhancement on IV contrast (diagnostic potential) |
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Hepatic adenomas | Well-circumscribed hypo-intense lesions. | ||||
Hepatocellular carcinoma | With IV contrast, diffuse enhancement with arterial phase contrast, and then washout during delayed venous images. |
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Focal nodular hyperplasia | Well-circumscribed mass with central stellate scar. Hyperintense on arterial phase and isodense on venous phase (IV contrast). | Reassure and observe (no malignant potential) | |||
Cholangiocarcinoma | Modality of choice for diagnosis and staging | Surgical resection with negative margin. | |||
Hepatic metastatsis | Hypo-intense on venous phase contrast.Does not reliably detect lesions <1 cm. |
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Splenomegaly |
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Doppler can determine the splenic artery and splenic vein patency. |
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Cystic pancreatic mass |
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Solid pancreatic mass | |||||
Retroperitoneal Sarcoma | Chest, abdomen and pelvis contrast-enhanced CT for diagnosis, staging, and ruling out metastatic disease. | MRI with gadolinium is an alternative in case of contrast allergy, pelvic involvement, and equivocal CT imaging findings. | Not routinely used. |
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AFP level above 500 mg/dL should raise concern for the presence of HCC.
- ↑ 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.