Medical symptom checker - Mass in the abdomen - General overview.
Medical symptom checker - mass in the abdomen - General overview
Mass in the abdomen (abdominal mass) is routinely detected on physical examination. It presents with localized swelling in one of the abdominal quadrants (right upper quadrant, left upper quadrant, right lower quadrant or left lower quadrant). It is insidiously developed and may be related to localized abscess, neoplasm, organ enlargement, vascular defect or fetal masses.
It is difficult to distinguish between a normal structure or an abdominal mass. Proper examination technique (palpation) is required in this case. Palpation of the abdominal mass should be performed by two clinicians or while the patient in two different positions. Abdominal mass which is palpable is a sign of severe and life threatening condition.
The differential diagnosis of abdominal mass may include splenomegaly, ovarian cyst, uterine enlargement (fibroids), hernia, hydronephrosis, colon cancer, Crohn disease, abdominal aortic aneurysm and cholecystitis as well as hepatomegaly.
Splenomegaly is most commonly associated with hemolytic anemia, leukemia and lymphoma. Patient with splenomegaly is presented with various signs and symptoms which are influenced by the causative disorders. Patient typically complains of abdominal fullness, pain and tenderness on the lower part of the upper quadrant. The patient also may suffer from low grade fever. On auscultation the patient may present with splenic bruits and splenic friction rubs. While palpating the abdomen the spleen is felt as a large mass with smooth edges.
Ovarian cyst is characterized by large, round, smooth and flactuant cyst (fluid filled cyst).It is mostly present as swelling in the suprapubic region which is similar to distention of the bladder. Symptoms and signs such as menstrual irregularities, lower back pain, hirsutism and mild discomfort of the pelvis are associated with the presence of large multiple cysts. Abdominal distention, rigidity and tenderness are associated with twisted, ruptured and bleeding cysts
Uterine enlargement (fibroid)
Uterine enlargement (fibroid) is a benign tumors of the uterine. It is mostly present in the suprapubic region. It is characterized by large round multi nodular masses. Typically the patient may present with menorrhagia. Other signs may include the feeling of heaviness in the abdomen and constipation as well as back pain as a result from the pressure of the fibroids onto the surrounding structures. The patient may also present with urgency and urinary frequency. Late signs may include varicosities of lower extremities and edema. Further evaluation is required for peri menopausal and post menopausal patient who develop fibroid.
The hernia is caused by a prolonged increase of intra abdominal pressure on the weak abdominal wall. It may present as a soft tender bulge that will appear while coughing which is the signs of strangulation of the hernia.
Hydronephrosis is an enlargement of one or both of the kidneys. It is characterized by smooth boggy mass in the flank region. The patient may complain of dullness or colicky abdominal pain in the renal or flank regions that will radiate later to the testes, vaginal and vulva. Patient may also suffer from alternating polyuria and oliguria, nocturia, hematuria, pyuria and dysuria as well as nausea, vomiting and accelerated hypertension.
Colon cancer may present as a mass on the right upper quadrant or left upper quadrant. Right upper quadrant is associated with cancer of the right colon and the presenting symptoms are anemia, occult bleeding, dull abdominal cramping, abdominal pain /aching or pressure on the abdomen. Other signs may include vertigo, fatigue, weakness, exertional dyspnea and signs of intestinal obstruction such as constipation, abdominal distention, obstipation and vomiting. Cancer of the left colon typically presents as an occasional palpable mass on the left sides. It is typically present with the feeling of rectal pressure, rectal bleeding, intermittent abdominal fullness/ cramping. The patient may also complain of pelvic discomfort, fremitus and later mucous, bloody, pencil shaped streaks stools as well as diarrhea and obstipation. The pain in the abdomen is relieved by defecating.
Crohn disease may present with sausage shaped mass on the right lower quadrant. The sausage shaped mass appears to be palpable and tender. The patient may present with fever, nausea, vomiting, anorexia, hyperactive bowel sounds and abdominal guarding and tenderness. The patient may also suffer from diarrhea and colicky right lower quadrant abdominal pain.
Abdominal aortic aneurysm
Abdominal aortic aneurysm is presented as a pulsating mass in the peri umbilical region. It is noticeable when the patient is in the supine position and presented with systolic bruit over the aorta. It is a life threatening condition especially when the walls of the blood vessel/ aorta are weakening and the aneurysm is expanding. In this scenario, the patient commonly complains of constant upper abdominal pain and occasionally dull lower back pain. Rupture of the abdominal aortic aneurysm will cause the patient to complain of severe back and abdominal pain. Besides that, no pulsation is detected in the region when the aneurysm ruptured. Other signs and symptoms may include signs of shock such as pale, cool, clammy, tachycardia and hypotension as well as guarding, abdominal rigidity, absent of pedal and femoral pulses; blood pressure is lowered in the legs than in the arms and mottled skin below waist.
Cholecystitis is also known as inflammation of the gallbladder. It presents with abdominal pain (right upper quadrant) that will radiate later to the chest, right shoulder and back. The patient may later present with abdominal tenderness, rigidity, fever, pallor, anorexia, nausea and vomiting and diaphoresis Recurrent attack of abdominal pain usually occurs 1- 6 hours after meals. Cholecystitis is presented as smooth, firm, sausage shaped mass that is felt on deep palpation below the liver. In case of acute inflammation, it will be tender to palpate the gallbladder . Murphy’s sign is important to confirm the presence of cholecystitis . (The clinician will palpate the right upper quadrant while asking the patient to take a deep breath and hold the breath. Cholecystitis is confirmed when the patient complains of pain / tenderness on the right upper quadrant.)
Hepatomegaly is also present as a blunt, firm, irregular mass. The mass is present in the epigastric area or below the right costal margin. The signs and symptoms may include, jaundice, nausea, vomiting, ascites, anorexia, right upper quadrant pain and tenderness, leg edema, spider angioma, gynecomastia, testicular atrophy and Palmar erytherma.
In elderly patients with mid epigastric mass, it is advisable to use ultrasound scan. Neonates may present with mass in the abdomen as a result of congenital hydronephrosis or polycystic kidney disease. Enlarge organs such as liver and spleen ( hepato splenomegaly ) may present in children and older infants. Other common causes of abdominal mass in children may include abdominal abscess, pyloric stenosis, Wilm’s tumor, intussusception , neuroblastoma, volvulus and Hirchsprung’ s disease. (Congenital mega colon).
Mass on the right upper quadrant includes - hepatomegaly , pancreatic abscess, hydronephrosis, pseudocysts, gallbladder carcinoma, hepatic carcinoma, gastric carcinoma, abdominal aortic aneurysm, cholecystitis, cholelithiasis and renal carcinoma.
Mass on the left upper quadrant may includes - renal cell carcinoma, abdominal aortic aneurysm, splenomegaly, pancreatic pseudocysts, pancreatic abscess, hydronephrosis and gastric carcinoma.
Mass on the right lower quadrant may include- Crohn’ disease, colon cancer, uterine leiomyomas, ovarian cysts, inguinal hernia and bladder carcinoma/ distention.
Mass on the left lower quadrant may includes- volvulus, diverticulitis, ovarian cyst, uterine leiomyomas, colon cancer and bladder distention or bladder carcinoma.
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