Abdominal mass: Difference between revisions
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Routine [[blood test]]s are usually the next step in diagnosis after a thorough medical history and physical examination. They should include a [[full blood count]], [[blood urea nitrogen]] ([[BUN]]), [[creatinine]], and [[liver function tests]] such as [[Liver function tests#Albumin (Alb)|albumin]], [[international normalized ratio]] ([[INR]]), [[partial thromboplastin time]] ([[PTT]]), [[serum amylase]] and [[Liver function tests#Total bilirubin (TBIL)|total bilirubin]] ([[TBIL]]). If late-stage [[liver disease]] is suspected, then a [[Liver function tests#Serum glucose (BG, Glu)|serum glucose]] may be appropriate. | Routine [[blood test]]s are usually the next step in diagnosis after a thorough medical history and physical examination. They should include a [[full blood count]], [[blood urea nitrogen]] ([[BUN]]), [[creatinine]], and [[liver function tests]] such as [[Liver function tests#Albumin (Alb)|albumin]], [[international normalized ratio]] ([[INR]]), [[partial thromboplastin time]] ([[PTT]]), [[serum amylase]] and [[Liver function tests#Total bilirubin (TBIL)|total bilirubin]] ([[TBIL]]). If late-stage [[liver disease]] is suspected, then a [[Liver function tests#Serum glucose (BG, Glu)|serum glucose]] may be appropriate. | ||
== | ===Causes== | ||
===Causes by Organ System=== | |||
{|style="width:90%; height:100px" border="1" | |||
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular''' | |||
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Abdominal Aortic Aneurysm]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Chemical / poisoning''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Dermatologic''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Drug Side Effect''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Ear Nose Throat''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Endocrine''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Environmental''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Gastroenterologic''' | |||
|bgcolor="Beige"| | |||
[[Acute pancreatitis]], [[Ascites]], [[Autoimmune pancreatitis]], [[Bezoar]], [[Biliary atresia]], [[Blind loop syndrome]], [[Bowel obstruction]], [[Cholangiocarcinoma]], [[Cholecystitis]], [[Choledochal cyst]], [[Cholelithiasis]], [[Cirrhosis]], [[Colonic diverticulitis]], [[Congenital hypertrophic pyloric stenosis]], [[Congenital megacolon]], [[Constipation]], [[Crohn's disease]], [[Distal intestinal obstruction syndrome]], [[Gastroschisis]], [[Hepatomegaly]], [[Hirschsprung's disease]], Liver [[granuloma]], Palpable gallbladder [[Courvoisier's sign]], [[Pancreatic pseudocyst]], [[Pyloric stenosis]], [[Riedel lobe of liver]], [[Splenosis]], [[Toxic megacolon]], | |||
[[Urachal cyst]], [[Vermiform appendix]], [[Volvulus]], [[Wandering spleen]], [[Yersinia enterocolitica]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Genetic''' | |||
|bgcolor="Beige"|[[Acanthocheilonemiasis ]], [[Alpha-L-iduronidase deficiency (Hurler syndrome)]], [[Alpha-L-iduronidase deficiency (Hurler-Scheie syndrome)]], [[Alpha-mannosidase deficiency]], [[Apolipoprotein C-II deficiency]], Beta [[thalassaemia]] (heterozygous), [[Chanarin-Dorfman disease]], [[Chediak-Higashi disease ]], [[Cholesterol ester storage disease ]], [[Common variable hypogammaglobulinaemia]], [[Congenital dyserythropoietic anaemia type 1]], [[Congenital erythropoeitic porphyria]], [[Coproporphyria, hereditary ]], [[Cruveilhier-Baumgarten syndrome]], [[Familial alphalipoprotein deficiency]], [[Familial histiocytic reticulosis]], [[Familial hypertriglyceridaemia]], [[Farber lipogranulomatosis]], [[Fucosidosis ]], [[Fumarase deficiency ]], [[Galactose epimerase deficiency]], [[Galactose-1-phosphate uridyltransferase deficiency]], [[Gangliosidosis GM1 type 1]], [[Gangliosidosis GM1 type 3]], [[Gangliosidosis GM3]], [[Gaucher disease ]], [[Geleophysic dysplasia]], [[Glucose phosphate isomerase deficiency]], [[Glycogenosis type 4]], [[Granulocyte colony stimulating factor]], [[Haemochromatosis ]], [[Haemoglobin C disease]], [[Haemoglobin E disease]], [[Haemoglobin SC disease]], [[Haemolytic disease of the newborn]], [[Hereditary spherocytosis ]], [[Iduronate-2-sulfatase deficiency]], [[Iminodipeptiduria ]][[Kartagener syndrome ]], [[Long chain hydroxyacyl-CoA dehydrogenase deficiency]], [[Macrophage activation syndrome]], [[McLeod phenotype]], [[Mevalonate kinase deficiency]], [[Mucopolysaccharidosis VI ]], [[Neutrophilia, hereditary,]] [[Niemann-Pick disease type B]], [[Niemann-Pick Disease, Type C]], [[ Norrbottnian Gaucher disease]], [[Salla disease ]], [[Sandhoff disease ]], [[Sanfilippo disease]], [[Sarcoidosis ]], [[Sickle cell disease]][[Zimmermann-Laband syndrome]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Hematologic''' | |||
|bgcolor="Beige"|[[Chediak-Higashi disease ]], [[Extramedullary haemopoiesis]], [[Familial histiocytic reticulosis]], [[Fanconi-Bickel syndrome]], [[Haemochromatosis ]], [[Sickle cell crisis ]], [[Haemoglobin C disease]], [[Haemoglobin E disease]], [[Haemoglobin SC disease]], [[Haemolytic disease of the newborn]], [[Hereditary spherocytosis ]], [[Mastocytosis ]], [[Myelofibrosis ]], [[Hereditary neutrophilia]], [[Vitamin B12 deficiency]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Iatrogenic''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Infectious Disease''' | |||
|bgcolor="Beige"| [[Abscess]], [[Actinomyces]], [[Alveolar hydatid disease]], [[Bartonellosis]], [[Brucellosis]], [[Cat scratch fever]], [[Entamoeba histolytica]], [[Gallbladder empyema]], [[kala-azar]], [[Leishmaniasis]], [[Kaposi sarcoma]], [[Liver abscess]], Liver [[granuloma]], [[Lymphogranuloma venereum]], [[Malaria]], [[Mycobacterium tuberculosis]], [[Oesophagostomiasis]], [[Pancreatic abscess]], [[Pelvic inflammatory disease]], [[Psittacosis]], [[Relapsing fever ]], [[Syphilis]], congenital, [[Tertiary syphilis]], [[Toxoplasmosis]], congenital, [[Yersinia enterocolitica]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Musculoskeletal / Ortho''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Neurologic''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Nutritional / Metabolic''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Obstetric/Gynecologic''' | |||
|bgcolor="Beige"| [[Choriocarcinoma]], [[Ectopic pregnancy]], [[Endometriosis]], [[Meigs syndrome]], [[Pelvic inflammatory disease]], [[Pregnancy]], [[Uterine enlargement]], [[Uterine leiomyoma]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Oncologic''' | |||
|bgcolor="Beige"| [[Adrenal tumor]], [[Brenner tumor]], [[Burkitt's lymphoma]], [[Carcinoid tumours]], [[Cholangiocarcinoma]], [[Choriocarcinoma]], [[Chronic myelogenous leukemia]], [[Colorectal cancer]], [[Desmoplastic small round cell tumor]], [[Endodermal sinus tumor]], [[Gallbladder benign tumors]], [[Gallbladder cancer]], [[Gastrointestinal stromal tumor]], [[Germ cell tumor]], [[Hairy cell leukaemia]], [[Hamartoma]], [[Hemangioendothelioma]], [[Hemangiopericytoma]], [[Hepatic adenoma]], [[Hepatoblastoma]], [[Histiocytosis X]], [[Hodgkin's lymphoma]], | |||
[[Kaposi sarcoma]], [[Kidney cancer]], [[Krukenberg tumor]], [[Leiomyoma]], [[Liposarcoma]], [[Metastatic Liver cancer]], [[Primary Liver cancer]], [[Meigs syndrome]], [[Nephroblastoma]], [[Neurilemmoma]], [[Neuroendocrine tumor]], [[Non-Hodgkin lymphoma]], [[Oncocytoma]], [[Ovarian cancer]], [[Pancreatic cancer]], [[Pancreatic islet cell tumors]], [[Phaeochromocytoma]], [[Plexosarcoma]], [[POEMS syndrome]], [[Pseudomyxoma peritonei]], [[Renal cell carcinoma]], [[Renal oncocytoma]], [[Rhabdoid tumor]], [[Sacrococcygeal teratoma]], [[Sickle cell crisis]], [[Sister Mary Joseph nodule]], Small bowel [[lymphoma]], Spleen [[lymphoma]], [[Stomach cancer]], [[Transitional cell carcinoma]], [[Uterine leiomyoma]], [[Wilm's tumor]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Opthalmologic''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Overdose / Toxicity''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Psychiatric''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Pulmonary''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Renal / Electrolyte''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Rheum / Immune / Allergy''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Sexual''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Trauma''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Urologic''' | |||
|bgcolor="Beige"| [[Bladder distention]], [[Cryptorchidism]], [[Hydronephrosis]], [[Kidney cancer]], [[Pelvic kidney]], [[Polycystic kidney disease]], [[Renal cell carcinoma]], [[Renal oncocytoma]], [[Renal transplantation]], [[Transitional cell carcinoma]], [[Urine retention]], [[Varicocele]], [[Wilm's tumor]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Miscellaneous''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|} | |||
===Causes in Alphabetical Order=== | |||
{{MultiCol}} | {{MultiCol}} | ||
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{{EndMultiCol}} | {{EndMultiCol}} | ||
Revision as of 14:31, 13 August 2012
Abdominal mass | |
This infant has massive hepatomegaly due to metastatic neuroblastoma. Intra-abdominal pressure is partially relieved by a silastic pouch. Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: John Fani Srour, M.D.
Overview
An abdominal mass is any localized enlargement or swelling in the human abdomen. Depending on its location, the abdominal mass may be caused by an enlarged liver (hepatomegaly), enlarged spleen (splenomegaly), protruding kidney, a pancreatic mass, a retroperitoneal mass (a mass in the posterior of the peritoneum), an abdominal aortic aneurysm, or various tumours, such as those caused by abdominal carcinomatosis and omental metastasis. The treatments depend on the cause, and may range from watchful waiting to radical surgery.
Features
Many abdominal masses are discovered incidentally during routine physical examination. When they present symptomatically, abdominal masses are most frequently associated with pain or digestive problems. However, depending on the cause, masses may be associated with other signs and symptoms, such as jaundice or bowel obstruction.
Diagnosis
The first steps in diagnosis are a medical history and physical examination. Important clues during history include weight loss, diarrhea and abdominal pain.
During physical examination, the clinician must identify the location of the mass, as well as characterize its location (usually specified in terms of quadrants). The mass should be assessed for whether it is rigid or mobile. It should also be characterized for pulse or peristalsis, as these would help in further identifying the mass.
Routine blood tests are usually the next step in diagnosis after a thorough medical history and physical examination. They should include a full blood count, blood urea nitrogen (BUN), creatinine, and liver function tests such as albumin, international normalized ratio (INR), partial thromboplastin time (PTT), serum amylase and total bilirubin (TBIL). If late-stage liver disease is suspected, then a serum glucose may be appropriate.
=Causes
Causes by Organ System
Causes in Alphabetical Order
Physical Examination
- Associated symptoms:
Abdomen
- Examine abdomen for areas of tenderness
Other
- Examine pelvis for areas of tenderness
Laboratory Findings
- Blood urea nitrogen (BUN)/creatinine
- Complete blood count (CBC)
- LFTs (liver function tests)
- Urinalysis
- Beta-human chorionic gonadotrophin
Electrolyte and Biomarker Studies
- Electrolytes
- Tumor markers (if concern is malignancy)
- Toxicology screen
- Blood culture (if concern is infection)
X Ray
- KUB (kidneys, ureters, bladder) x-rays could possibly reveal free intraperitoneal air, constipation or obstruction.
MRI and CT
- Abdominal CT with oral IV contrast will evaluate for bowel pathology, abscess, and hepatosplenomegaly
Other Diagnostic Studies
- Laparoscopy of the intra-abdominal cavity allows for direct visualization
- Colonoscopy helps in the diagnosis of bowel pathology
- Paracentesis with fluid evaluation.
Treatment
- Immediately treat life-threatening causes (such as abdominal aortic aneurysms).
- Organomegaly typically resolves once the underlying etiology is treated.
Acute Pharmacotherapies
- Ogilvie's syndrome responds to decompression by IV neostigmine or by a rectal tube
- Constipation is usually treated with laxatives, increased dietary fiber and fluids, enemas.
- Manual disimpaction is reserved for fecal impaction.
- Stop use of offending medications.
- Masses caused by infections require antibiotics (and possible surgery)
Surgery and Device Based Therapy
- Several benign and malignant masses require surgical intervention
- Hirschsprung's disease often requires surgery.
References
Additional Resources
- MedlinePlus medical encyclopedia: Abdominal mass - An informative primer on abdominal masses and their common causes.
- First Principles of Gastroenterology: Abdominal Mass - This chapter discusses the basic approach to abdominal masses.