Makindo Medical Notes

Abdominal masses are a significant clinical finding that may arise from various underlying conditions. Identifying and managing an abdominal mass requires a systematic approach, incorporating a detailed patient history, thorough physical examination, and appropriate diagnostic investigations.

Following steps: Patient History

• Obtaining a detailed history is crucial in guiding the diagnostic process. Key points to explore include:
• Onset and duration: Whether the mass appeared suddenly or gradually.
• Associated symptoms: Pain, changes in bowel habits, nausea, vomiting, weight loss, or fatigue.
• Relevant medical history: History of malignancies, surgeries, infections, or trauma.
• Family history: Genetic predispositions to certain conditions, such as polycystic kidney disease or cancers.

Physical Examination

• Location: Upper or lower abdomen, central or lateral mass.
• Size and shape: Measure the dimensions of the mass if palpable.
• Consistency: Determine if the mass is hard, soft, fluid-filled, or nodular.
• Mobility: Assess if the mass moves with respiration (e.g., liver or spleen), or is fixed.
• Pulsatility: Check for a pulsatile mass, which could indicate an abdominal aortic aneurysm.
• Signs of tenderness or guarding: Suggestive of inflammation or infection.

Causes

Investigations

• Blood tests: Complete blood count, liver and renal function tests, and tumour markers.
• Imaging: Ultrasound, CT scan, or MRI can help visualize the mass and determine its characteristics.
• Biopsy: In cases where malignancy is suspected, a biopsy can provide a definitive diagnosis.
• Endoscopy: For gastrointestinal masses, upper or lower endoscopy may be necessary.

Common Causes of Abdominal Masses

• Liver: Hepatomegaly due to cirrhosis, tumours, or infections.
• Spleen: Splenomegaly from infections, hematological disorders, or malignancies.
• Kidneys: Renal cysts, tumours, or hydronephrosis.
• Aorta: Aortic aneurysm or vascular malformations.
• Gastrointestinal tract: Intestinal obstruction, tumours, or hernias.
• Reproductive organs: Ovarian cysts, fibroids, or pregnancy-related masses.
• Bladder: Bladder distension from urinary retention or tumours.

Management

Treatment depends on the underlying cause of the mass:

• Infections: Antibiotics or antivirals.
• Tumours: Surgery, chemotherapy, or radiotherapy may be required based on the type of tumour.
• Cysts: Simple cysts may not require treatment, while larger cysts may need drainage or surgical removal.
• Vascular conditions: Aortic aneurysms may require surgical repair depending on their size and risk of rupture.

In summary, identifying an abdominal mass requires a careful, methodical approach. Accurate diagnosis, coupled with appropriate treatment, ensures the best possible outcome for the patient.