Abdominal lump

Dr DEEPAK GEN SURGEON drdeepkims@yahoo.co.in

GPE

EXAMINATION INSPECTION

 CONDITION OF THE SKIN OVER THE SWELLING

TENSE , RED, SHINING PIGMENTED

POSITION, SIZE AND SHAPE

 MOVEMENT WITH RESPIRATION

IF ARISING FROM
LIVER GB ( MOVES WELL) STOMACH SPLEEN KIDNEY ( LITTLE MOVEMENT) SUPRARENAL STRUCTURES

 VISIBLE PERISTALISIS
CA PYLORUS OF STOMACH ( LEFT TO RIGHT) CA TRANSVERSE COLON ( RIGHT TO LEFT ) SMALL INTESTINAL MALIGNANCY ( STEP LADDER PATTERN)

HERNIAL SITES THE SCROTUM LEFT SUPRACLAVICULAR LN ( SHOWS INOPERABILITY OF THE TUMOUR ) - TROSIER S SIGN

 PALPATION
POSITION ; LIES FLAT ON BACK WITH ONE PILLOW BELOW HIS HEAD WITH FLEXION OF HIPS AND KNEES FLAT OF HAND IS USED WITH FOREARM IN HORIZANTAL PLANE SUPERFIAL PALPATION ( START FROM FARTHEST FRO M THE SITE OF THE DISEASE) DEEP PALPATION( WHOLE OF VOLAR SURFACE OF HAND)

LOCAL TEMPERATURE TENDERNESS POSITION SIZE

 SHAPE SURFACE MARGIN

NEOPLASM ;WELL DEFINED AND DISTINCT MARGIN INFLAMATORY/ TRAUMATIC ; ILLDEFINED MARGIN

CONSISTENCY
SOFT CYSTIC ; FLUCTUATION FLUID THRILL ABSENT IF TENSE CYSTIC FIRM HARD IS IT SAME IN ALL AREAS PITTING ON PRESSURE ;PARITAL ABSCESS , COLON LOADED WITH FAECES

 MOVEMENT
WITH RESPIRATION;UP AND DOWN MOVEMENT ( NOT AP MOVEMENT OF ABDOMINAL WALL
PUT THE HAND OVER THE LOWER BORDER OF THE SWELLING

 IN ALL DIRECTIONS ; VERTICAL AND THEN HORIZONTAL

MESENTRIC CYST ;MOVES RT ANGLE TO LINE OF ATTACHMENT TO MESENTRY ( OBLIQUE LINE 1 INCH LEFT OF MIDLINE AND 1 INCH BEOLW THE TP LINE AND EXTENDING DOWNWARDS AND TO RT FOR ABOUT 6 INCHES OVARIAN CYST/ LUMP IF SMALL MOVES FREELY IN LOWER ABDOMEN AND MAY CROSS MIDLINE . IS SWELLING BALLOTABLE
ONE HAND BELOW THE LOINAND OTHER IN FRONT OF ABDOMEN ; AP MOVEMENT IS ASCESSED ( KIDNEY SWELLING)

BIMANNUALLY PALPABILITY

 PARIETAL OR INTRAABDOMINAL
Leg lifting /carnetts test
Parietal ; becomes prominent ex hematoma of rectus,recurrent fibroid of paget. Intra abdominal ;disappears or becomes smaller, moves vert ically with respiration

 IS SWELLING PULSATILE OR NOT

Transmitted ; swelling infront of aorta Expansile; aneurysm- fingers will divert Knee- elbow position swelling infront of aorta gets separated and becomes non pulsatile

HERNIAL SITE PALPATE LIVER ,SPLEEN AND KIDNEY RECTAL EXAMINATION VAGINAL EXAMINATION

 PERCUSSION
SOLID ; DULL( IF SUPERFICIAL) EX LIVER ,SPLEEN ; RESONANT (IF BOWEL OVERLIES ) EX KIDNEY ( RENAL FOSSA WILL BE DULL ) SHIFTING DULLNESS
PT IN SUPINE POSITON START FROM XIPHISTERNU M TO UMBILICAL REGION THEN MOVE TOWARD S FLANK IDENTIFY POINT OF DULLNESS THEN CHANGE THE POSITION OF THE PT TO RT /LT LATERAL POSTION THEN PERCUSSE FROM THE FLANK NOTE CHANGE IN THE PERCUSSION FROM DULL TO RESONANT IN THE PREVIOUS IDENTIFIED POINT OF DULLNESS

 SHIFTING DULLNESS +VE IN ASCITES OF 500ML TO 1000 ML (OVARIAN CYST DULLNESS DOES NOT SHIFTS) HYDATID THRILL ; PLACE 3 FINGERS OVER THE SWELLLING AND PERCUSS OVER THE MIDDLE ONE THRILL WILL BE FELT BY OTHER 2 FINGERS LIVER DULLNESS ; UPPER LIMIT RAISED IN
SUBPHRENIC ABSCESS LIVER ABSCESS HYDATID CYST IN SUP ASPECT

SPLEENIC DULLNESS

DD
RT HYPOCHONDRIUM SWELLING PARIETAL :
SKIN AND SC
SEBACEOUS CYST LIPOMA FIBROMA NEUROFIBROMA ANGIOMA COLD ABSCESS : SOFT CYSTIC AND FLUCTUATING PARIETAL ABSCESS

RT HYPOCHONDRIUM SWELLING
INTRA ABDOMINAL
LIVER ENLARGEMENT
CONG RIEDAL LOBE TONGUE SHAPED ,MORE FLATER THAN GB AMOEBIC ABSCESS RT SHOULDER PAIN WITH FEVER,INTERCOASTAL TENDERNESS SUPPARATIVE PYLEPHLEBITIS;SUSPECT IF A CASE ACUTE APPPENDICTISOR INFECTED PILES SHOW RIGORS SUPPARATIVE CHOLANGITIS HYDATID CYST CA LIVER: SECONDARY-UMBILICATED NODULES :DUE TO CENTRAL NECROSIS

 GB ;OVAL SMOOTH ,TENSE CYSTIC

 SUBPHRENIC SPACE
ABSCESS; DUE TO PER PEPTIC ULCER,TRAUMA,BILLIARY LEAK ETC

PYLOROUS OF STOMACH AND DUODENUM

CARCINOMA SUBACUTE PERFORATION OF PEPTIC ULCER

HEPATIC FLEXURE OF COLON

INTUSSCEPTION HYPERTROPHIC TUBERCULOSIS CARCINOMA