[08.13] CMD - Abdominal Masses V2.3.pdf

Abdominal mass

What term refers to any abnormal swelling or enlargement arising from the abdominal wall or within the abdominal cavity?

Abdominal wall, intra-abdominal, and retroperitoneal

What are the three anatomical planes of origin for an abdominal mass?

Organ, blood vessel, lymphatic structure, or mesentery

From what anatomical structures within the abdomen can a mass arise?

Determining whether the mass is intra-abdominal or part of the abdominal wall

What is the first fundamental question to answer when evaluating an abdominal mass?

4-quadrant system and 9-region system

What are the two anatomical division systems used to localize abdominal masses?

Lipoma, desmoid tumor, hematoma, hernia sac, and abscess

What are five common examples of superficial tumors or masses of the abdominal wall?

Fothergill's sign

Which physical examination sign is positive when an abdominal mass remains palpable while the rectus abdominis muscle is tensed?

Abdominal wall origin

What anatomical origin is indicated by a positive Fothergill's sign?

Intra-abdominal origin

If a palpable mass becomes non-palpable when the patient tenses their rectus abdominis muscle, what is its likely anatomical origin?

Carnett's sign

Which physical examination sign evaluates whether abdominal pain remains the same, worsens, or decreases when the rectus muscle is tensed?

Abdominal wall origin

What anatomical origin of pain is indicated when Carnett's sign is positive (pain remains unchanged or worsens during rectus muscle tension)?

Intra-abdominal origin

What anatomical origin of pain is indicated when tensing the rectus muscle reduces or relieves the pain?

Solid viscera and hollow viscera

From which two main categories of internal organs do intra-abdominal masses arise?

Liver, spleen, and kidney

What are three examples of solid viscera that can form intra-abdominal masses?

Stomach, small intestine, and large intestine

What are three examples of hollow viscera that can form intra-abdominal masses?

Movement with respiration

What specific physical exam observation during inspiration and expiration serves as a key clue that a mass is intra-abdominal and attached to upper organs?

Diaphragm

Attachment of an upper abdominal organ mass to which muscle causes it to move during respiration?

Kidneys, body and tail of pancreas, aorta, adrenal glands, and lymph nodes

What anatomical structures are located in the retroperitoneum and can give rise to retroperitoneal masses?

Fixed, deep-seated, and non-moving with respiration

What are the physical examination characteristics of retroperitoneal masses regarding depth, mobility, and respiratory motion?

Appendiceal abscess, diverticular abscess, and ileocecal tuberculosis

What are three examples of inflammatory or infectious abdominal masses?

Hydronephrosis

What is a very common intra-abdominal mass of congenital or developmental origin arising from the renal system?

Enteric duplication cyst

What is an example of a congenital developmental GI tract cyst that presents as an abdominal mass?

Pancreatic pseudocyst

Which fluid-filled cystic mass develops when injured pancreatic ducts leak juice following pancreatitis or trauma, prompting the body to form a fibrous seal around it?

Ovarian cyst

Which fluid-filled mass forms in the ovary during the follicular phase when a follicle fills with fluid after egg release?

Abdominal Aortic Aneurysm (AAA)

What is a classic vascular etiology of an epigastric abdominal mass characterized by arterial dilation?

Splenic vein thrombosis

What vascular condition can lead to localized venous dilation and enlargement in the left upper quadrant?

Infiltration, congestion, or storage

What three underlying pathophysiological mechanisms cause organomegaly?

Hepatomegaly, splenomegaly, and polycystic kidneys

What are three clinical examples of organomegaly presenting as abdominal masses?

Abdominal pain or fullness

What are the most common chief complaints presented by a patient with an abdominal mass?

Ruptured Abdominal Aortic Aneurysm (AAA)

What sudden-onset, life-threatening vascular emergency presenting with abdominal pain carries a mortality rate as high as 90%?

Malignancy or abscess

Rapid enlargement of an abdominal mass suggests which two main pathological conditions?

Neoplastic / Cancerous condition

What underlying disease process is strongly suggested by a mass associated with persistent, unremitting abdominal pain that grows larger over time?

Obstructive process or hyperperistalsis in the bowel

What mechanism causes colonic or intestinal abdominal pain to present as colicky?

Infection or inflammation of an organ

What does localized tenderness over an abdominal mass signify?

Anorexia, nausea, vomiting, constipation, diarrhea, bloody stool, melena, and hematochezia

What associated gastrointestinal symptoms should be asked about during history-taking for an abdominal mass?

Unexplained weight loss

Which systemic symptom is very common in cancer patients presenting with an abdominal mass?

Inflammation or lymphoma

Fever and night sweats accompanying an abdominal mass suggest which two general categories of disease?

Hepatobiliary pathology

Jaundice accompanying a upper abdominal mass points directly to pathology in which organ system?

Cancer recurrence

Why is past medical history of malignancy crucial when evaluating a new abdominal mass?

Intestinal obstruction secondary to adhesions

A history of prior abdominal surgery places a patient at lifelong risk for what acute abdominal complication?

Asbestos and pesticides

Exposure to which environmental or occupational chemicals should be explored when taking history for an abdominal mass?

Cachexia, jaundice, and lymphadenopathy

What three general physical inspection signs of systemic disease should be noted in a patient with an abdominal mass?

Distention, masses, surgical scars, and visible pulsations

What four specific findings should be evaluated on inspection of the abdominal wall?

Abdominal Aortic Aneurysm (AAA)

A vascular bruit heard on auscultation over the epigastrium suggests what condition?

Renal artery stenosis

A vascular bruit heard on auscultation over the renal arteries suggests what condition?

Early intestinal obstruction

Hyperactive or increased bowel sounds on auscultation indicate what gastrointestinal state?

Ischemic bowel obstruction

Decreased or absent bowel sounds in a patient presenting with mechanical intestinal obstruction signify what severe complication?

Ileus

Hypoactive or decreased bowel sounds present from the initial onset of abdominal distention suggest what condition?

3 bowel sounds per minute

What bowel sound frequency threshold can indicate an ileus?

Tympany

What hollow, high-resonant, drum-like percussion note is normally heard over the stomach and intestines and becomes widespread in bowel obstruction?

Dullness

What muffled, thud-like percussion note is normally heard over solid organs like the liver and is elicited over organomegaly, solid masses, ascites, or stool-filled intestines?

Hard consistency

What physical palpation consistency of an abdominal mass strongly points toward malignancy?

Rough and irregular

What size and shape characteristics on palpation suggest a mass is cancerous rather than benign?

Smooth contour and mobility

What two physical palpation features favor a benign etiology over a malignant mass?

Fixed mass

Is a fixed mass on palpation more likely benign or malignant?

Ballottement

Which bimanual physical examination test uses one hand on the flank and the other over the costovertebral angle to feel a floating renal mass?

Murphy's sign

Which special test elicits inspiratory arrest when the examiner palpates the right upper quadrant over the gallbladder as the patient inspires?

Acute cholecystitis

Inspiratory arrest during a positive Murphy's sign indicates what diagnosis?

Castell's sign

Which physical examination test assesses for splenomegaly by percussing the anterior axillary line at the 8th intercostal space during full inspiration?

Dullness on percussion during inspiration

What percussion result at Castell's point indicates a positive Castell's sign for splenomegaly?

12 cm

What is the normal upper limit for liver size, beyond which hepatomegaly is diagnosed?

Hepatic congestion secondary to right-sided heart failure

What circulatory mechanism causes hepatomegaly when blood backs up from the IVC into the liver?

Hepatitis B and Hepatitis C

Which two common viral infections cause liver swelling and infectious hepatomegaly?

Acetaldehyde

Which toxic reactive oxygen species metabolite produced during alcohol metabolism induces severe hepatic inflammation and alcoholic fatty liver disease?

Congestion, infection, non-alcoholic fatty liver disease, alcoholic fatty liver disease, and cancer

What are the five primary causes of hepatomegaly?

Ultrasound

What is the preferred first-line imaging modality for evaluating the hepatobiliary tree and liver masses?

CT scan and MRI

Which advanced imaging modalities are required for detailed anatomical mapping and surgical planning of liver masses?

Liver biopsy

What diagnostic procedure provides histological confirmation when the underlying cause of a liver mass remains uncertain?

Gallstone obstructing the cystic duct

What is the most common etiology of a gallbladder mass leading to bile accumulation and organ distention?

Sudden severe RUQ pain radiating to the back or right shoulder, nausea, vomiting, and post-fatty meal pain

What are the classic symptoms of a symptomatic gallbladder mass secondary to cholecystitis?

Ultrasound

What is the first-line imaging modality of choice for diagnosing gallbladder masses and gallstones due to its high sensitivity and specificity?

Alkaline phosphatase (ALP), GGT, direct bilirubin, and indirect bilirubin

Which liver function tests are specifically elevated when a gallbladder mass causes biliary obstruction and jaundice?

Asymptomatic gallstones

Which category of gallstones does not require immediate surgical intervention or treatment, as most remain symptom-free for life?

Laparoscopic cholecystectomy

What is the standard of care surgical procedure for symptomatic gallstone disease?

Renal Cell Carcinoma (RCC)

What is the most common cause of a renal mass in adults, typically presenting between ages 55 and 74?

Wilms tumor

What is the most common renal mass in pediatric patients?

Flank pain, palpable mass, and hematuria

What is the classic clinical diagnostic triad for a renal mass?

BUN and Creatinine

Which laboratory tests evaluate baseline renal function when a renal mass is identified?

CT scan

What is the imaging modality of choice for diagnosing, evaluating, and staging a renal mass?

Chest imaging (X-ray or CT)

Which extra-abdominal imaging test is essential for complete staging of a malignant renal mass?

Renal biopsy

What diagnostic procedure is performed for tissue confirmation of a renal mass?

Surgical resection

What treatment serves as the gold standard for cure in stage 1, 2, or 3 renal cell carcinoma?

Chemotherapy, immunotherapy, and radiotherapy

What systemic treatment modalities are indicated for stage 4 metastatic renal cell carcinoma?

Pancreatic adenocarcinoma

What is the most common malignant cell type of pancreatic mass?

Pancreatic cysts

Which pancreatic lesions are common incidental findings in 10-20% of adults aged 60 and above, mostly benign but carrying potential for malignant transformation?

Pancreatic pseudocysts

Which pancreatic fluid collections account for 70-80% of pancreatic cystic lesions and arise secondary to pancreatitis or trauma?

Jaundice

What early clinical sign occurs when a pancreatic mass develops specifically in the head of the pancreas, compressing the biliary tree?

Pain, jaundice, unexplained weight loss, and new-onset or worsening diabetes

What are four major clinical manifestations of pancreatic adenocarcinoma?

Elevated direct bilirubin, ALP, and GGT

Which blood chemistry markers indicate biliary obstruction from a pancreatic head mass?

CA 19-9

Which tumor marker is characteristically elevated and used to monitor pancreatic adenocarcinoma?

CT scan

What is the preferred initial imaging modality for diagnosing and staging solid pancreatic masses?

Whipple's procedure (Pancreaticoduodenectomy)

What complex surgical operation involving resection of part of the duodenum, pancreas, gallbladder, and cystic duct with anastomosis is performed for localized pancreatic head cancer?

Abdominal Aortic Aneurysm (AAA)

What condition is defined as an abnormal swelling or bulge in the abdominal aorta?

Deep constant abdominal or back pain and a throbbing feeling near the navel

What symptoms develop when an abdominal aortic aneurysm expands or becomes large?

Ultrasound

What is the preferred screening modality for detecting an abdominal aortic aneurysm?

CT scan or CT Angiography (CTA)

Which imaging modalities provide anatomical assessment and surgical planning for abdominal aortic aneurysms?

Diameter 5.5 cm or greater, rapid expansion (>0.5 cm in 6 months), or presence of symptoms

What three criteria indicate the need for elective surgical repair of an abdominal aortic aneurysm?

Portal hypertension secondary to liver disease

What pathophysiological state causes backflow of blood through the splenic vein to produce congestive splenomegaly?

Superior Mesenteric Vein (SMV)

Which vessel joins the splenic vein to form the portal vein?

Portal vein thrombosis, splenic vein thrombosis, and congestive heart failure

Besides liver disease, what three vascular/cardiac conditions cause congestive splenomegaly?