abdominal mass
Introduction
Introduction Abdominal mass refers to an abnormal mass that can be accessed during abdominal examination. Common causes include swelling of organs, swelling of hollow organs, tissue hyperplasia, inflammatory adhesions, and benign and malignant tumors. A detailed understanding of medical history is important for the diagnosis of abdominal diseases. The growth rate of the tumor, accompanied by symptoms, can provide some clues to the diagnosis. Abdominal masses can be found in a variety of diseases, so they should be identified with common multiple diseases. Abdominal masses mainly rely on palpation examination. If palpation is found, attention should be paid to the location, size, shape, quality, presence or absence of tenderness and mobility of the mass.
Cause
Cause
Etiology classification
First, the upper right abdomen mass
(1) Liver enlargement: such as hepatitis, liver swelling, liver tumor, liver cyst and so on.
(B) 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) Colon cancer of the liver.
Second, the upper abdomen mass
(A) stomach mass: such as ulcer disease, gastric cancer and other benign and malignant tumors in the stomach, gastric new membrane prolapse, stomach stone disease.
(B) pancreatic masses: such as acute pancreatitis, pancreatic cysts, cystic adenoma of the pancreas. Pancreatic cancer, etc.
(3) The left side of the liver is swollen.
(D) mesenteric and omental mass: such as mesenteric lymph node tuberculosis, mesenteric cysts and so on.
(5) Small intestine tumors: such as small intestine malignant lymphoma, small intestine cancer, and other rare small intestine tumors.
(6) Abdominal aortic aneurysm.
Third, the upper left abdomen mass
Common reasons are:
(1) Spleen enlargement: cirrhosis, spleen, and deck cards.
(B) pancreatic tumors and pancreatic cysts.
(3) Colon cancer of the spleen.
Fourth, left and right lumbar masses
(1) Lumps caused by kidney diseases: such as renal ptosis and migratory kidney, congenital renal cyst, hydronephrosis, renal empyema, hoof-shaped kidney, renal hydatid cyst, kidney tumor, etc.
(B) pheochromocytoma and other tumors of the adrenal gland.
(3) Primary retroperitoneal tumors.
Fifth, right lower abdomen mass
(A) appendic disease: such as abscess around the appendix, appendix carcinoid, appendix fluid cyst and so on.
(2) Tumors of the National Blind: more common in 400 tuberculosis, Crohn's disease, cecal cancer, amoebic granuloma in the ileocecal area, and actinomycosis in the ileocecal area.
(three) large omentum torsion
(four) right ovarian tumor
Six, middle and lower abdominal masses
Can be seen in the bladder off the tumor, the brave room, the uterus tumor.
Seven, left lower abdomen mass
Can be seen in ulcerative colitis, rectum, sigmoid colon cancer, rectal, sigmoid schistosomiasis granuloma, left ovarian cyst and so on.
Eight, extensive and non-positioning lumps
Common causes are tuberculous peritonitis, abdominal paragonimiasis, abdominal hydatid cysts, peritoneal metastases, intussusception, intestinal obstruction, and intestinal torsion.
Examine
an examination
Related inspection
Abdominal shape palpation organ palpation fiber colonoscopy fecal color endoscopic ultrasonography
Film degree exam
1, commonly used examination methods are X-ray, angiography, ultrasound, CT, nuclear magnetic resonance, endoscopy and so on.
2, the tumor of the digestive tract is feasible for barium meal examination.
3, B-mode ultrasound, CT, nuclear magnetic resonance is suitable for the examination of substantial organs, in order to understand the space-occupying lesions in organs, is also an important means to diagnose bladder and uterine masses.
4, the best way to check the gastrointestinal mass is to use a gastroscope and colonoscopy.
5, abdominal cavity mass can be used for laparoscopy. Biopsy should be performed for histological examination during endoscopy to determine the nature of the mass.
Diagnosis
Differential diagnosis
Disease identification
1. Gastric cancer: more common in male patients with middle-aged or older, the clinical manifestations are weight loss, upper abdominal pain, discomfort, upper gastrointestinal bleeding, etc. When there is an abdominal mass, the multiple lesions are late, and the mass is mostly located in the upper abdomen or above the umbilicus. The texture is hard, the surface is irregular, the boundary is unclear, and the pyloric obstruction can be complicated in the late stage. Diagnosis can be made by X-ray barium meal or gastroscopy in parallel with biopsy.
2. Intestinal obstruction: patients with 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, 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 pancreatic head cancer is located in the right middle upper abdomen, and the pancreatic body cancer 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 the head cancer of the pancreas, and the jaundice is progressively deepened, and the enlarged gallbladder can be seen without tenderness. B-ultrasound examination showed an enlarged cancer site and dilated pancreatic duct. X-ray gas sputum double angiography showed duodenal curvature. Serum carcinoembryonic antigen, carbohydrate antigen CA19-9, CA50, etc. were positive. ERCP, CT, radionuclide scanning and endoscopic ultrasonography, as well as fine needle aspiration cytology can provide a basis for diagnosis. Pancreatic pseudocysts are often secondary to pancreatitis or pancreatic trauma. Abdominal masses are mostly located in the middle and upper abdomen, varying in size, round or oval, with a smooth surface. If the pseudocyst is compressed in the lower part of the common bile duct, there may be jaundice that continues or slowly deepens. B-ultra, CT and other examinations can be found in the cystic mass of the pancreas.
4. Acute cholecystitis: In acute cholecystitis, gallbladder mucosa congestion, edema, vasodilation, increased exudation can cause gallbladder empyema, so the gallbladder is enlarged. The swollen gallbladder is generally elliptical with a smooth surface that can move up and down with the breath. 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. Abdominal muscle tension, jaundice and systemic symptoms, according to medical history, physical signs, B-ultrasound, CT and other examinations often abdominal mass can be clearly diagnosed.
5. Intestinal tuberculosis: 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 hard, light tenderness, clinical manifestations of abdominal pain, alternating diarrhea and constipation, fever, night sweats, etc. X-ray examination found that the ileocecal area is irritating Laryngeal filling defects or stenosis, colonoscopy can detect ulcerative lesions. If a carnivorous granuloma is found by histological examination, it can be diagnosed.
6. Crohn's disease (Crohn's disease): more common in young and strong, with chronic recurrent right lower quadrant pain, diarrhea, fever and other symptoms. Due to intestinal adhesions, mesenteric lymphadenopathy, internal hemorrhoids or abscess formation, it is often in the lower right abdomen and mass, the edge of the mass is unclear, the texture is medium, and there is tenderness. In addition, patients are often accompanied by extraintestinal manifestations such as arthritis. X-ray signs showed that the segmental ileal mucosal folds disappeared, showing a line-like sign; cystic or fissure-like longitudinal ulcer lesions were seen by colonoscopy, and the mucosa was normal or the paving stone-like changes were observed between the lesions. Histological examination can establish a diagnosis if non-caseal granuloma is found.
