ABDOMINAL MASS Michael S. Hong, MD University of Florida Oral Exam Review

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  • ABDOMINAL MASS Michael S. Hong, MD University of Florida Oral Exam Review
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  • Abdominal Mass DDx Narrow your differential Age Gender Location Differential guides your H&P
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  • Pediatric Abdominal Mass Tumors Wilm Tumor (~3-4 yo) renal, flank area Neuroblastoma Sympathetic Nervous System, usu. Midline Beckwith-Wiedemann enlarged kidneys, liver Teratoma Rhabdomyosarcoma GI Bowel obstruction Intussusception Pyloric stenosis Organomegaly
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  • Abdominal Mass in Elderly GI Sigmoid volvulus, Obstruction, Impacted stool, Colon cancer, gastric cancer, biliary cancer, diverticulitis, portal hypertension GU Urinary obstruction/retention Organomegaly Spleen, liver, kidney Vascular Abdominal aortic aneurysm Other Hernias, pancreatic pseudocyst, metastatic disease, sarcomas, neuroendocrine tumors, lymphomas, abscess
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  • Abdominal mass in women Pregnancy Endometriosis Ovarian cyst/tumor Uterine fibroids
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  • Location of Abdominal Mass Flank renal, adrenal RLQ appendicitis, Crohns, carcinoid RUQ biliary CA, liver adenoma, cysts/abscess Epigastric gastric CA, pancreatic pseudocyst LUQ sigmoid volvulus, splenomegaly LLQ diverticulosis/litis, colon CA Pelvic GU/GYN
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  • History OPQRST of Pain Onset Provoking/palliative factors Quality of pain Region/radiation of pain Severity Time GI: nausea, vomiting, last BM, bloody stools, clay colored stools, floating/foul smelling, caliber Malignancy: fever, chills, night sweats, weight loss Bleeding/bruising spleen and coagulation Recent travel infectious
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  • History Mass Timeframe, rapidity Mobile/fixed Local, diffuse Tender/non-tender Prior surgery Risk factors smoking, alcohol, family history, cirrhosis
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  • Physical exam Inspection location, skin changes, size, surgical scars Ausculation bowel sounds, bruits Percussion - ascites Palpation peritonitis, elicit pain, pulsatility, mobility, hardness, lymph nodes, rectal exam
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  • Labs/Studies CBC, BMP, LFT, amylase, lipase, coags KUB free air, air-fluid levels, bowel dilatation Ultrasound solid or cystic, location CT/MRI enhanced anatomy, inflammation, tumor, obstruction, abscess, volvulus
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  • Example 1 91 year old demented man from nursing home Intermittent abd pain, mass No BM in last several days Nausea, vomiting DDx? Bowel obstruction, stool impaction, ileus, colon CA, rectal CA Next? ROS, rectal exam Labs: CBC, BMP NPO, NG tube, replace fluids/electrolytes KUB, CT scan
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  • Example 1 Dx: Bowel impaction Tx: NPO, NGT, replace lytes Colace, senna Enemas Manual disimpaction http://www.urmc.rochester.edu/radiology/education/materials/
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  • Example 2 76 year old man, mass in LLQ, gradual growth Last BM 3 days ago, Nausea, Vomiting Weight loss Gradually narrowing caliber stools DDx & Work up similar
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  • Example 2 Imaging: air fluid levels (obstruction) Apple core lesion in colon Dx: colon CA Tx: NPO, NGT, lytes Staging/monitoring: CEA Chest CT Colonoscopy Neoadjuvant therapy, Resection Diverting ostomy http://allbleedingstops.blogspot.com
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