Sandbox:Javaria
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 | ||||||||||||||||||||||
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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:
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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
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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)