Sandbox:Javaria
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 ❑ 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 |
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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. |
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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. |
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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.