abdominal mass
Introduction
Abdominal mass introduction Abdominal mass refers to abnormal mass that can be touched during abdominal examination. Common causes include swelling of organs, swelling of hollow organs, tissue hyperplasia, inflammatory adhesions and benign and malignant tumors. basic knowledge The proportion of the disease: the incidence rate is about 0.001% -0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: abdominal pain
Cause
Abdominal mass cause
(1) Causes of the disease
1. Upper right abdomen mass
(1) Liver enlargement: such as hepatitis, liver abscess, liver tumor, liver cyst and so on.
(2) gallbladder enlargement: such as acute cholecystitis, gallbladder hydrocephalus, gallbladder hemorrhage, cholestatic cystic cyst, congenital choledochal cyst, primary gallbladder cancer, gallbladder torsion and so on.
(3) Hepatic curvature of colon cancer.
2. Middle and upper abdominal masses
(1) stomach mass: such as ulcer disease, gastric cancer and other benign and malignant tumors in the stomach, gastric mucosal prolapse, stomach stone disease and so on.
(2) pancreatic masses: such as acute pancreatitis, pancreatic cysts, pancreatic cystic adenoma, pancreatic cancer, etc.
(3) The left hepatic lobe is swollen.
(4) Mesenteric and omental masses: such as mesenteric lymph node tuberculosis, mesenteric cysts and the like.
(5) Small intestine tumors: such as small intestine malignant lymphoma, small intestine cancer, and other rare small intestine tumors.
(6) Abdominal aortic aneurysm.
3. Left upper abdominal mass
Common reasons are:
(1) Spleen enlargement: cirrhosis of the liver, spleen and spleen.
(2) Pancreatic tumors and pancreatic cysts.
(3) spleen curvature colon cancer.
4. Left and right lumbar masses
(1) Lump caused by kidney disease: such as renal ptosis and kidney, congenital renal cyst, hydronephrosis, renal empyema, hoof-shaped kidney, renal hydatid cyst, kidney tumor and so on.
(2) pheochromocytoma and other tumors of the adrenal gland.
(3) Primary retroperitoneal tumor.
5. Right lower abdomen mass
(1) appendic disease: such as abscess around the appendix, appendix carcinoid, appendix mucus cyst.
(2) ileocecal mass: more common in ileocecal tuberculosis, Crohn's disease, cecal cancer, ectopic amebic granuloma, ileocecal actinomycosis.
(3) Large omentum twist.
(4) Right ovarian tumor.
6. Middle and lower abdominal masses can be seen in bladder tumors, bladder diverticulum, and uterine tumors.
7. The left lower abdominal mass can be seen in ulcerative colitis, rectum, sigmoid colon cancer, rectum, sigmoid schistosomiasis granuloma, left ovarian cyst and so on.
8. Common causes of extensive and non-localized masses are tuberculous peritonitis, abdominal paragonimiasis, abdominal hydatid cysts, peritoneal metastases, intussusception, aphid intestinal obstruction, and intestinal torsion.
(two) pathogenesis
Although the cause of abdominal mass is numerous, its pathogenesis is not the following.
1. Organs swollen abdominal organs, often due to inflammation or organ tumor tissue hyperplasia caused by organ enlargement, circulatory disorders, such as chronic congestive heart failure or constrictive pericarditis, the liver can be swollen due to congestion The kidney may be blocked due to ureteral obstruction, stenosis or compression, causing hydronephrosis to enlarge the kidney. Portal hypertension caused by various causes may cause spleen enlargement due to obstruction of splenic vein blood flow, and may also be due to organ torsion. Or ectopic formation.
2. Cavity organ expansion cavity organ can often cause obstruction due to inflammation, tumor or organ torsion, after the obstruction, the accumulation of gas in the cavity causes the organ to expand, such as pyloric obstruction can be seen in the upper abdomen Swelling of the stomach, intestinal obstruction can be seen in the upper part of the obstruction of the intestine, lower urinary tract obstruction causes bladder expansion caused by bladder accumulation, biliary obstruction of bile excretion causes gallbladder enlargement.
3. Inflammation of the abdominal cavity When inflammation occurs in the abdominal organs or tissues, if an abscess is formed, inflammatory masses may occur, such as liver abscess, peri-renal abscess, abscess around the appendix, inflammation of the abdominal cavity may cause organs and organs, and tissue They stick together to form a mass, the most common being tuberculous peritonitis.
4. The benign and malignant tumors of the abdominal cavity of the abdominal cavity, due to the abnormal proliferation of the tissue often form a mass in the site, such as gastric cancer, pancreatic cancer often sees a mass in the upper abdomen, the tumor compresses adjacent organs, such as the pancreas The cancer compresses the common bile duct to cause gallbladder enlargement. The benign mass of the abdominal cavity is more common in cysts, which may be congenital or secondary to inflammation. Generally, the growth rate is slow, but the volume can be large.
Prevention
Abdominal mass prevention
prevention
1. Early diagnosis and early treatment.
2. Change bad habits and cultivate a healthy lifestyle.
Complication
Abdominal mass complications Complications, abdominal pain
Depending on the source, nature, location, or different organs of the mass, different complications may occur.
1, inflammatory mass: can lead to sepsis, abscess and other complications.
2, tumor mass: distant metastasis, cachexia, anemia and other complications.
3, cystic mass: sometimes cysts can be bleeding, malignant transformation, secondary infection, obstruction and other complications.
4, obstructive mass: complicated by complications such as jaundice, hepatomegaly, water and electrolyte disorders.
Symptom
Abdominal mass symptoms Common symptoms Peritonitis Abdominal "gas-like" mass Liver enlargement Upper abdominal cystic mass Right upper abdominal pain Yellow sputum Abdominal pain Intussusception Abdominal mass Surrounding appendix Abscess
Abdominal masses mainly rely on palpation examination. If the mass is found, the location, size, shape, quality, presence or absence of tenderness and mobility of the mass should be noted to identify the source and nature of the mass.
1. The location of the abdominal mass determines the location of the mass to understand the source of the mass. The mass of a certain part is derived from the organ of the site. For example, the mass in the right upper abdomen is mostly from the liver, gallbladder or hepatic collateral colon, with pedicle Or mesentery, the position of the omentum is variable, the larger part of the intestinal tube distribution area, if accompanied by obstruction, the mass may be the mass of the intestine tube, if not accompanied by obstruction, mostly from the mesentery, large net Membrane or retroperitoneal organs, multiple and scattered in common mesenteric lymph node tuberculosis, peritoneal tuberculosis or abdominal metastatic cancer.
2. The size of the mass touches a small mass around the umbilicus. It may be a swollen mesenteric lymph node. A huge mass usually occurs in the liver, spleen, pancreas, kidney, ovary and uterus. It is more common in cysts. The block size varies indefinitely and can even disappear, possibly caused by an inflated bowel.
3. The shape of the mass is a smooth surface with a mass of cysts, irregular cysts, irregular shape, uneven surface, hard and mostly malignant tumors, inflammatory masses or tuberculosis masses, cord-like or tubular masses, short time If the internal shape is variable, it may be a mites or intussusception. The right upper abdomen touches the oval mass. The smooth may be the gallbladder or the kidney. The swollen spleen can touch the spleen.
4. The hardness and texture of the mass are more common in tumors, inflammatory or tuberculous masses, such as gastric cancer, liver cancer and tuberculous peritonitis. If the mass is cystic, the mass is soft and more common in cysts.
5. Painful inflammatory mass has obvious tenderness, such as the mass in the right lower abdomen, tenderness is obvious, mostly abscess around the appendix, the liver may have obvious tenderness may be liver abscess.
6. Mobility If the mass moves up and down with the breath, it may be the liver, spleen, kidney, stomach or the mass of these organs. The mass of the gallbladder and the transverse colon can also move up and down with the breath, if the mass can be pushed by hand. It may come from the stomach, intestines or mesentery. It has a wide range of movements, large distance tumors, mostly pedicled masses, spleen and kidneys, and all the peritoneal tumors and local inflammatory masses generally do not move.
Examine
Abdominal mass examination
Laboratory examination is of great significance for the diagnosis of abdominal mass. If the mass is obviously tender, white blood cells are elevated, the mass is mostly inflammatory mass, huge spleen, accompanied by significant increase of white blood cells up to tens of thousands to hundreds of thousands, and there are naive cells, suggesting For chronic myeloid leukemia, the bone marrow image can be diagnosed clearly, the upper abdominal mass, if the occult blood test continues to be positive, the tumor may be gastric cancer, liver enlargement, often accompanied by abnormal liver function, liver with alpha-fetoprotein increased, suggesting For primary liver cancer, if accompanied by ascites, routine examination of ascites can identify ascites as exudate or leakage, liver with leakage of ascites, may be liver cirrhosis caused by cirrhosis or circulatory disorders, can be classified according to white blood cells of ascites Identification of purulent infection or tuberculosis infection, blood ascites more suggestive of malignant tumors, if cancer cells are found in ascites, indicating that the cancer has metastasized, the tumor is puncture to extract living tissue, histological examination, often can confirm the mass nature.
In order to understand the exact location of the abdominal mass and the nature of the organ and the mass, it is necessary to select appropriate equipment for examination, in order to provide a reliable basis for the surgical treatment plan. Commonly used examination methods are X-ray, B-mode ultrasound. CT, magnetic resonance, endoscopy, etc.
The tumor of the digestive tract is feasible for barium meal examination, B-mode ultrasound, CT, and magnetic resonance are suitable for the examination of substantial organs to understand the space-occupying lesions in the organs. It is also an important means for diagnosing bladder and uterine masses. The best way to check the mass of the intestine is to use a gastroscope and a colonoscopy. The abdominal cavity can be examined by laparoscopy. When performing endoscopy, the living tissue should be taken for histological examination to determine the nature of the mass. The choice of inspection methods should be economical and accurate, and repeated inspections should be avoided.
Diagnosis
Diagnosis of abdominal mass
Diagnostic criteria
1. A detailed understanding of the history of the diagnosis of abdominal disease is of great significance, the growth rate of the mass, accompanied by symptoms can provide some clues to the diagnosis, gastric cancer in the history of the history of a lack of appetite, anemia, weight loss, gallbladder enlargement, with Progressive jaundice without abdominal pain often suggests pancreatic head cancer, gallbladder enlargement, intermittent jaundice with paroxysmal right upper abdominal pain and fever are more common in cholelithiasis, liver enlargement, such as chronic heart failure in the history may be hepatic congestion Inflammatory masses often have fever and a history of pain in the corresponding parts. The history is long, the growth rate of the mass is slow, and no other symptoms are present. It is often a benign mass.
2. Clinical manifestations.
3. Laboratory and other auxiliary inspections.
Differential diagnosis
Because abdominal masses can be found in a variety of diseases, the following are only common for multiple diseases.
1. Gastric cancer is more common in middle-aged male patients. The clinical manifestations are weight loss, upper abdominal pain and discomfort, upper gastrointestinal bleeding, etc. When abdominal masses appear, the multiple lesions are late, and the mass is mostly located in the upper abdomen or above the umbilicus. Hard, irregular surface, unclear border, late pyloric obstruction, can be diagnosed by X-ray barium or gastroscopy and biopsy.
2. Patients with intestinal obstruction and intestinal obstruction have a history of abdominal surgery, injury or inflammatory disease, manifested as abdominal pain, vomiting, abdominal distension, cessation of exhaust and defecation, etc., due to intestinal tube swelling and abdominal mass, may have fixed tenderness or peritoneal irritation, In the case of mechanical intestinal obstruction, reverse peristaltic waves can be seen. Auscultation can be heard of gas over water or metal sound. X-ray standing abdominal fluoroscopy or plain film can see most liquid level or flatulence.
3. Pancreatic cancer The abdominal mass caused by pancreatic cancer is often deep and fixed, the texture is hard, the edge is unclear, the head cancer of the pancreas is located in the right middle upper abdomen, and the tail cancer of the pancreas is located in the left upper abdomen. The main clinical symptoms are upper abdominal pain. A small number of patients have severe abdominal pain. Pain is often related to body position. When the body is tilted forward, the pain is relieved. In the supine position, the pain is aggravated. In addition, there are symptoms such as nausea, vomiting, and bloating. Obstructive jaundice often occurs in cancer of the head of the pancreas. Astragalus membranaceus is progressively deepened, and it can enlarge the enlarged gallbladder without tenderness. B-ultrasound can be seen to enlarge the cancer site and expand the pancreatic duct. X-ray gas angiography can be seen in duodenal enlargement; serum carcinoembryonic antigen, The saccharide antigens CA19-9, CA50, etc. are positive; ERCP, CT, radionuclide scanning and endoscopic ultrasonography, as well as fine needle aspiration cytology can provide a basis for diagnosis.
4. Pancreatic pseudocysts are often secondary to pancreatitis or pancreatic trauma. Abdominal masses are mostly located in the middle and upper abdomen. They vary in size and are round or elliptical. The surface is smooth. If the pseudocyst is compressed in the lower part of the common bile duct, it may appear. Continuous or slow-enhanced jaundice; B-ultrasound, CT and other examinations can be found in the cystic mass of the pancreas.
5. Acute cholecystitis acute cholecystitis, due to gallbladder mucosa congestion and edema, vasodilation, increased exudation can cause gallbladder empyema, so the gallbladder is swollen, swollen gallbladder is generally oval, smooth surface, can be with the breath Activity, if the internal pressure of the gallbladder continues to rise, it can cause tissue necrosis, perforation of the wall of the capsule, and localization of the surrounding adhesions will form an abscess around the gallbladder. At this time, the gallbladder appears as a large inflammatory mass with unclear edges and obvious Tenderness and abdominal muscle tension, jaundice and systemic symptoms, according to medical history, physical signs, B-ultrasound, CT and other examinations can often be clearly diagnosed.
6. Intestinal tuberculosis is more common in young adults, often secondary to extraintestinal tuberculosis (lung, ovary, fallopian tube or peritoneal tuberculosis, etc.), proliferative intestinal tuberculosis can form an inflammatory mass in the ileocecal area, the position is relatively fixed, the texture is medium and hard, Mild tenderness, clinical manifestations of abdominal pain, alternating diarrhea and constipation, fever, night sweats, etc. X-ray examination found sensation in the ileocecal area, sputum filling defect or stenosis, colonoscopy can detect ulcerative lesions, such as histology When the carnivorous granuloma is found, it can be diagnosed.
7. Crohn's disease (Crohn's disease) is more common in young adults, with chronic recurrent right lower quadrant pain, diarrhea, fever and other symptoms, due to intestinal adhesions, mesenteric lymphadenopathy, internal hemorrhoids or abscess formation, so often in the lower right abdomen And the mass of the mass, the edge of the mass is unclear, the texture is medium, and there is tenderness. In addition, the patient is often accompanied by extra-intestinal manifestations such as arthritis. X-ray signs can be seen in the segmental ileal mucosal folds disappearing, showing a line-like sign; colonoscopy can be seen In the case of a groove-like or fissure-like longitudinal ulcer lesion, the mucosa between the lesions is normal or a paving stone-like change is observed, and a histological examination can establish a diagnosis if non-caseal granuloma is found.
8. Amoeba or schistosomiasis granulomatous amoeba or schistosomiasis granuloma can form abdominal inflammatory mass, mass can occur in the ileum, colon, rectum, etc., patients often have a history of pathogen infection, pus and blood Common, common stools or hatching tests can find related pathogens, colonoscopy can confirm the diagnosis.
9. Colon cancer Colon cancer occurs in male patients with middle-aged or older, manifested as bloody stools, abdominal pain, diarrhea and other symptoms. Colon cancer segments can appear in the corresponding parts of the mass, the block is irregular in outline, hard texture, size Inconsistent, the performance is nodular, generally can be promoted; when the mass is found, it is suggested that the cancer has developed to the middle and late stage, and the fecal occult blood test can be continuously positive. The diagnosis mainly depends on X-ray barium enema or colonoscopy. Endoscopic biopsy can be confirmed.
10. Polycystic kidney polycystic kidney is generally congenital, often bilateral, multiple cysts grow into masses, the surface is mostly nodular, hard texture, can compress normal kidney tissue and produce low back pain, hematuria, urinary system Symptoms such as infection, B-ultrasound, pyelography, CT, MRI and other tests can be confirmed.
11. Mesenteric lymph node tuberculosis is more common in young and middle-aged, can be expressed as a mass of mesenteric mass, lesions involving multiple lymph nodes, large mass, irregular shape, hard texture, small activity, often accompanied by chronic abdominal pain, weight loss, low fever , fatigue, anemia and other symptoms, B-ultrasound, CT, lymphangiography and other examinations can help diagnose.
12. Appendices with acute suppurative appendicitis after perforation of the appendix abscess can form an acute inflammatory mass near the Mai's point in the right lower abdomen. The boundary of the mass is often unclear, with local tenderness and abdominal muscle tension, high fever, total white blood cell count and neutrophils. Increase, if the appendix abscess is not completely absorbed, the mass can be left in the right lower abdomen, the boundary is unclear, according to the history of appendicitis, signs combined with B-ultrasound can make a diagnosis.
13. Ovarian cysts Ovarian cysts are more common in young and middle-aged women. The initial cysts are small and mostly asymptomatic. It is only found in gynecological examinations. Large cysts can be seen in the middle and lower abdomen. They are round or oval and have a large degree of activity. There is a sac sexy, huge ovarian cyst can occupy the entire abdomen, physical examination can be found on both sides of the abdomen percussion as drum sound, the center is voiced, and it is not difficult to distinguish from ascites, gynecological examination or B-ultrasound can be seen that the cyst can be separated from the uterus, and accessories The relationship is clear so that a correct diagnosis can be made, and sometimes a large ovarian cyst needs to be diagnosed at the time of surgery.
