lower abdominal mass
Introduction
Introduction The lower abdomen mass refers to a mass in the lower abdomen. The touch has a hard feeling. It may be benign or malignant. It is mostly a symptom of gynecological diseases or intestinal and peritoneal diseases with gastrointestinal symptoms and signs. Late anemia, weight loss Or intestinal obstruction.
Cause
Cause
The following diseases can go to the lower abdomen mass:
1, pregnancy uterus:
Women of childbearing age, with a history of menopause, and a solid mass in the lower abdomen, should first be considered as a pregnant uterus. However, this case is older, has an intrauterine device, and has no history of menopause. The history of lower abdominal mass is longer, and the mass is hard and irregular. It is definitely not a pregnant uterus.
2, uterus menstrual blood retention: due to abnormal uterus or vaginal development, as well as due to trauma or inflammation, resulting in vaginal or cervical atresia, is blocked by menstrual blood flow, causing the uterus to enlarge, touching the mass in the lower abdomen. The patient has lower abdominal pain or periodic lower abdominal pain, which is often caused by a history of puberty or trauma and vaginitis. The characteristics of this case are not consistent with the retention of uterine menstrual blood, except for.
3, adenomyosis:
The uterus is evenly enlarged, the quality is hard, the growth is slow, the menstruation can be normal, but there is obvious dysmenorrhea, and it gradually increases its characteristics. This case can be excluded.
4, uterine malignant tumors:
The lower abdomen mass is increased rapidly, accompanied by irregular vaginal bleeding, or low back pain and lumbosacral pain. The patient is older and has poorer overall symptoms. This case can be excluded.
5, ovarian fibroma:
It is a more common benign ovarian tumor, which occurs mostly in middle-aged women. It is mostly unilateral, medium-sized, smooth or nodular, and has good mobility. Sometimes accompanied by ascites or pleural effusion, called Meigs syndrome. Gynecological examination can touch the normal size of the uterus, the mass is biased to one side, and the activity is very good. This case can be excluded.
6, ovarian malignant tumors: In addition to ovarian fibroids, most ovarian solid tumors are malignant, such as granulosa cell tumor, anaplastic cell tumor, immature teratoma, etc., can touch the mass in the lower abdomen. However, this case may be excluded according to its unique clinical manifestations and gynaecological examinations and corresponding auxiliary examinations.
7, intestinal malignant tumors:
The lower abdomen mass is located on one side or in the middle abdomen, often accompanied by gastrointestinal symptoms and signs. Anemia, weight loss or intestinal obstruction occurs in the late stage. This case can be excluded.
8, retroperitoneal tumor:
Located in the rectum and posterior vaginal, fixed in the posterior abdominal wall, no activity. Most of the patients were sarcoma, venous pyelography, and ureteral displacement. This case can be excluded.
9, uterine fibroids:
A: Myometrial fibroids, accounting for 60% -70%, more frequent menstruation. B: Subserosal fibroids, accounting for 20%, generally no change in menstruation. C: submucosal fibroids, accounting for 10% to 15%, persistent or irregular vaginal bleeding. The largest possible case of this case is subserosal uterine fibroids.
Examine
an examination
Related inspection
Abdominal MRI examination of abdominal shape palpation
Color ultrasound examination, in order to exclude urinary frequency symptoms caused by urinary tract infections, there are many methods for classification of abdominal masses in urine routine examination. According to the nature of masses, they can be roughly divided into six types:
1. Physiological "tumor": Not a real disease, but sometimes mistaken for a pathological mass. In addition to the uterus, bladder, and feces, the muscles of the developed rectus abdominis, the thinner's spine or humerus and the spontaneous intestinal tract may be misdiagnosed as pathological. Even the abdominal aorta, which is soft or weak in the abdominal wall, is mistaken for a "pulsating mass."
2. Obstructive mass: Obstructive mass in the gastrointestinal tract can cause abdominal pain, bloating, vomiting or constipation without venting; obstruction of the biliary tract causes painless jaundice, generally no fever; obstruction of the urinary tract often causes the waist Pain. Strictly speaking, congestive splenomegaly and stagnation hepatomegaly are also obstructive masses.
3. Inflammatory mass: more often associated with fever, local pain, elevated white blood cell count and other signs of inflammation. Such as inflammation around the appendix, mesenteric lymph node tuberculosis, peri-renal abscess.
4. Cystic mass: mostly round or oval, with a smooth surface and a sense of undulation. Common congenital polycystic liver, polycystic kidney, urachal cyst; retention of pancreatic cyst, hydronephrosis; neoplastic ovarian cyst; inflammatory gallbladder effusion, hydrosalpinx, entrapped effusion Parasitic hydatid cysts, etc.
5. Tumorous mass: mostly a substantial mass. Malignant tumors are the majority, characterized by rapid development, accompanied by anemia, weight loss and cachexia in the late stage; benign tumors have a long history, large tumors, smooth, and a certain degree of activity.
6. Traumatic masses: such as rupture of the spleen in the left upper abdomen, pseudo-pancreatic cysts in the upper abdomen, retroperitoneal hematoma in the lower abdomen or pelvis. See abdominal trauma.
Diagnosis
Differential diagnosis
Left lower abdomen mass:
1, the left ovarian tumor: tumor development is slow, early often asymptomatic, often found by chance during the gynecological examination. As the tumor grows, there will be a feeling of bloating. The patient can touch the tumor from the abdomen. If the tumor grows up and fills the pelvic cavity, it can produce symptoms of compression, such as frequent urination and constipation. Abdominal examinations can reach a clearly contoured mass. During the gynecological examination, cystic or solid masses are touched on one side or both sides of the uterus. The surface is smooth and movable, and is not connected to the uterus.
2, rectosigmoid colon cancer: rectal cancer is more common in the clinic but the abdomen is not easy to reach the mass. Sigmoid colon cancer infiltrates into adjacent tissues, and can reach a hard, nodular, non-moving mass in the left lower abdomen. Often accompanied by diarrhea and blood in the stool. Diagnosis requires X-ray barium enema and colonoscopy. Colonoscopy biopsy should be differentiated from rectal, sigmoid schistosomiasis granulomatosis and sigmoid lateral granulomatosis.
3, ulcerative colitis: common symptoms of ulcerative colitis is abdominal pain and diarrhea, mostly mucus and blood will be accompanied by urgency and heavy. Some patients may touch the shape of the sausage in the lower left abdomen, usually a contracted or thickened colon. Mainly rely on X-ray barium enema and colonoscopy for diagnosis.
Right lower abdomen mass:
1. Tuberculosis in the Department of Reproductive: Proliferative intestinal tuberculosis often forms a mass in the back to the 100th or ascending colon. Most of the patients are young adults, more women than men, and the course of disease is slow. Common symptoms include abdominal distension, abdominal pain, diarrhea or diarrhea and constipation. There may be symptoms such as low fever and night sweats. The right lower quadrant can reach the mass of the mass and the surface is not smooth.
2. Abscess around the appendix: It is the main complication of acute appendicitis. Acute appendicitis can not be treated in time. The appendix has been wrapped by the omentum and intestine before perforation. After perforation, suppurative infection is limited to the appendix around the appendix. .
3. Cecal cancer: The right lower abdominal mass is the most common sign of cecal cancer with the following clinical features: 1 the onset age is over 50 years old; 2 disease is bilateral. The surface of the mass is not smooth or nodular, and may be accompanied by varying degrees of lower abdominal pain and bloating uterine bleeding, menstrual disorders, ascites and other symptoms.
4. Crohn's disease (Cohn's disease): also known as localized enteritis, segmental enteritis, granulomatous enterocolitis. This disease and ulcerative colitis are collectively referred to as inflammatory bowel disease. The main clinical features are abdominal pain, diarrhea, abdominal tube thin tube formation and intestinal obstruction. Can be associated with fever, nutritional disorders, etc. The age of onset is mostly 15-40 years old, more men than women.
