ABDOMINAL MASS

فاطمة حسنفاطمة أحمدعلياء عماد

حسينفاطمة

INTRODUCTION The abdominal cavity is the internal compartment

between the chest and pelvis commonly referred to as the belly.

Abdomen surface anatomy The abdomen can be divided into quadrants by a

vertical median plane and a horizontal transumbilical plane, which passes through the umbilicus

the liver and gallbladder are in the right upper quadrant;

the stomach and spleen are in the left upper quadrant;

the cecum and appendix are in the right lower quadrant; and

the end of the descending colon and sigmoid colon are in the left lower quadrant.

DEFINING SURFACE REGIONS TO WHICH PAIN FROM THE GUT IS REFERRED

The abdomen can be divided into nine regions by a midclavicular sagittal plane on each side and by the subcostal and intertubercular planes, which pass through the body transversely ,These planes separate the abdomen into:

three central regions (epigastric, umbilical, pubic); and

three regions on each side (hypochondrium, flank, groin).

WHAT IS AN ABDOMINAL MASS?

An abdominal mass is any localized enlargement or swelling in the abdomen.

Abdominal masses may be large or small, benign or malignant (cancerous), and curable or untreatable. Examples of small benign abdominal masses include hamartomas and cysts, which are solid and fluid-filled collections, respectively, of normal cells. Examples of serious abdominal masses are cancer, abscess, and abdominal aortic aneurysm, which is a life-threatening enlargement of the aorta within the abdomen.

A physician may detect abdominal masses on physical examination. Often, one or more imaging tests, such as an ultrasound or a CAT scan (also known as CT scan or CT), may be required in order to further define the mass. A definitive diagnosis may require a surgical biopsy, in which a piece of the mass is removed for examination under a microscope by a pathologist.

Some abdominal masses, such as simple cysts, require no treatment at all. Others, such as colon cancer, may require extensive treatment with chemotherapy, surgery and radiation. The prognosis of an abdominal mass depends on its diagnosis.

SYMPTOMSMany abdominal masses are

discovered incidentally

during routine physical examination.

An abdominal mass may accompany other symptoms, which will vary depending on the underlying disease.

Common symptoms that may occur along with an abdominal mass:

1-Abdominal pain

2-Change in appetite3-nausea, vomiting 4-Changes bowel habit 5-Rapid weight loss or weight gain6- fever,sweating7-Changes in urination, including too much

urination, too little urination, or pain with urinating

8-hematuria9-Pain when lifting a load10-appearance of mass11-Jaundice (yellowing of the skin and eyes)

Serious symptoms that might indicate a life-threatening condition

1-Abdominal mass that is growing rapidly

2-Abdominal mass that is pulsating

3-New abdominal mass accompanied by severe abdominal pain

WHAT CAUSES AN ABDOMINAL MASS

Abdominal masses can be caused by a wide variety of conditions and diseases. An accumulation of new tissue (a tumor), fluid, a bowel obstruction, bacterial infection, fungal infection, parasitic infection, expansion of an organ, or entrapment of an organ can all cause abdominal masses.Because the causes, treatments, and complications vary so widely, it is very important to have any abdominal mass examined promptly by a physician

EPIGASTRIC MASS causes Gastric outlet obstruction with gastric

dilatation Carcinoma of the stomach or colon Abdominal aortic aneurysm Retroperitoneal swellings – pancreas or lymphoma Small bowel Crohn’s disease Mesenteric cyst

RIGHT ILIAC FOSSA MASS Causes Carcinoma of the caecum Chronic

appendiceal abscess Ileocaecal Crohn’s disease Less common causes

LEFT ILIAC FOSSA MASS

Causes Diverticulitis Carcinoma of the sigmoid

colon Faecal masses in the sigmoid colon Less common causes

ABDOMINAL SWELLINGS ARISING FROM THE PELVIS COMMON CAUSES

Distended bladder The pregnant uterus Uterine fibromyomas Ovarian tumours and cysts, tubo-ovarian masses

An abdominal mass can be a mild condition that is highly treatable or a serious and life-threatening emergency. Because the causes of abdominal mass vary so widely, complications and prognoses also vary widely.

WHAT ARE THE POTENTIAL COMPLICATIONS OF AN ABDOMINAL MASS

Ascites (fluid accumulating within the abdominal cavity)

Gastrointestinal perforation and sepsis Incontinence Infertility due to permanent damage to the

reproductive tract Permanent kidney damage Permanent liver damage

DIAGNOSIS An abdominal mass may be discovered on routine

physical examination or during assessment of a patient for deterioration in general health. These forms of presentation are surprisingly common and many common diseases can present in this way. For example, patients with mucocele of the gall bladder, pseudocyst of the pancreas, carcinoma of the colon and carcinoma of the stomach often seek medical help because of vague deterioration in general health. A mass is then found on examination, without a proffered history of abdominal pain or of altered bowel habit, which might indicate the cause of the abdominal swelling. A careful further history and systems review will, however, often reveal subtle symptoms. These, together with a precise delineation of the mass, usually suggest the clinical diagnosis

DIAGNOSIS1-history: Important clues in history include weight loss ,diarrhea  ,abdominal

painQuestions for diagnosing the cause of an abdominal massTo diagnose condition,So ask several questions related to abdominal mass including:Where is the mass located?When did you notice the mass?Does it come and go?Has the mass changed in size or position? Has it become more or less painful?What other symptoms do you haveHow long have the mass?Is the mass painful or tender?taking any medications?Has anyone in family ever had an abdominal mass such as this?Have abdominal surgery before?Have any other symptoms along with the abdominal mass?Have recently lifted heavy objects?

2-physical examination, the clinician must identify

1-location of the mass.

2-whether it is rigid or mobile.

3-Presence of pulsation or peristalsis.

4-important sign:1-tenderness2-yellowish discoloration of skin& sclera3-anemia4-oedema5-lymphadenopathy 6-localized or generalized enlargment of

abdomen

8-dullness on percussion9-ecchymosis10- elevation of temperature localized(over

mass) or generalized11-redness12-Scratch marks13-sign of hormonal disturbance as acne,

hirsutism14- Courvoisier's sign (or law) describes enlarged

palpable gallbladder in patients with obstructive jaundice  caused by tumors of biliary tree or  pancreatic head tumors

15-everted umbilicus

3- investigation: A-lab 1- full blood count

2-renal function test 3-liver function testGamma GT level may be raised early in alcoholic

liver disease. Significant elevation of serum alkaline phosphatase suggests infiltrative conditions such as secondary carcinoma or primary biliary cirrhosis

4-Bone marrow biopsy and/or aspiration 5-GUE 6- other tests: uric acid, and lactate

dehydrogenase

Serum B chorionic gonadotropin and alpha-fetoprotein

B-radiology 1- Ultrasound:

Useful for discerning between solid versus cystic mass

2-Plain abdominal x-ray: Plain abdominalradiograph can be useful for detecting

obstruction by looking for the presence of

multiple air fluid levels or absence of air in the rectum. also may indicate the presence neuroblastoma, teratomas, Calcification, kidney stones, or,hydronephrosis

3-CT scan: used to obtain more specific anatomical detail especially with massess how are difficult to be visualized by x-ray as metastasis

4-MRI: useful for soft tissue mass5-angiography: such as

a- invasive catheter angiography

b-CTA C-MRA6-PET scan7-endoscopy, colonoscopy

TREATMENT The most common treatment options to

eliminate abdominal masses include:

medications to correct hormones surgical removal of the mass methods to shrink the mass chemotherapy radiation therapy

Depending on the cause of the mass & may range from conservative Rx to radical surgery

A-medical: 1-analgesic 2-anti-inflammatory 3-antimicrobial 4- hormonal therapy

B-surgery: 1-aspiration and/or drainage as in case

of cystic mass 2-removal of the mass 3-removal of the mass and part of the

affected organ 4-removal of the entire organ &may be

associated with removal of the draining lymph node as in malignant tumor.

C-chemotherapy &/or radiotherapy which are used either neoadjuvant to shrink the tumor before

surgery Or adjuvant when there is risk of

recurence or when there is micrometastases

If cysts in the abdomen that are large and/or causing considerable pain, opt to remove them through surgery. Surgical removal is also used to remove tumors. However, if removal is dangerous, may suggest methods to shrink the mass instead.

Chemotherapy or radiation treatment may also be suggested to shrink the mass. Once the mass reaches a smaller size, may opt to end the chemotherapy and remove the mass through surgery. This option is often used for people who have cancerous abdominal masses.

Masses that are caused by changes in the hormones, such as uterine fibroids or ovarian cysts, may be treated through hormone replacement medication or low-dose hormone birth control pills.