Palpable tender mass in left lower abdomen
Introduction
Introduction The painful mass in the left lower abdomen can be seen in ulcerative colitis, rectum, and sigmoid cancer. Rectal, sigmoid schistosomiasis granuloma, left oocysts and so on.
Cause
Cause
First, the organ is swollen: the abdominal organs are often caused by inflammation or organ tumor tissue hyperplasia. In circulatory disorders such as chronic congestive heart failure or constrictive pericarditis, the liver can be swollen by congestion. The kidney may be swollen due to clogging, stenosis or compression of the ureter, causing the kidney to enlarge. Portal hypertension caused by various causes causes the blood flow of the splenic vein to be blocked and cause splenomegaly. It can also be formed due to torsion or ectopicity of the organ.
Second, the hollow organ expansion: cavity organs can often cause obstruction due to inflammation, tumor or organ torsion. After obstruction, the accumulation of gas in the cavity causes the organ to expand. If the pyloric obstruction can be seen in the upper abdomen, the swelling of the stomach can be seen. Intestinal obstruction can be seen in the upper part of the obstruction. Lower urinary tract obstruction causes the bladder to swell to the bladder. Biliary obstruction of bile excretion causes gallbladder enlargement.
Third, the inflammation of the abdominal cavity: when inflammation occurs in the abdominal organs or tissues, if an abscess is formed, an inflammatory mass may appear. Such as liver abscess, abscess around the kidney, abscess around the appendix. Inflammation of the abdominal cavity can cause organs and organs. The tissues adhere to each other to form a mass. The most common is tuberculous peritonitis.
Fourth, abdominal mass: benign and malignant tumors of the abdominal organs, due to abnormal growth of the tissue often formed in the site of the mass, such as gastric cancer, pancreatic cancer often seen in the upper abdomen. The tumor compresses adjacent organs, such as pancreatic cancer, which compresses the common bile duct and causes gallbladder enlargement. Benign masses in the abdominal cavity are more common in cysts. May be congenital or secondary to inflammation. Generally, the growth rate is slow, but the volume can be large.
Examine
an examination
Related inspection
Abdominal plain film abdomen shape palpation abdominal mass
(A) ulcerative colitis: common symptoms of ulcerative colitis are abdominal pain, diarrhea, mostly sputum and blood will be accompanied by urgency and weight. 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.
(B) rectal, sigmoid colon cancer: rectal cancer is more common in the clinic, but the abdomen is not easy to touch the mass. Sigmoid colon cancer infiltrates into adjacent tissues, and can reach a hard, non-nodular mass in the left lower abdomen. Often accompanied by diarrhea, blood in the stool. Diagnosis requires X-ray barium enema and colonoscopy. Colonoscopy biopsy. It should be differentiated from rectal, sigmoid schistosomiasis granulomatosis and sigmoid lateral granulomatosis.
(3) Ovarian tumors on the left side.
Diagnosis
Differential diagnosis
Differential diagnosis of tenderness mass in the left lower abdomen:
First, the abdominal wall mass: When the tumor is found in the abdomen, it should first be determined whether it is an abdominal wall mass or an abdominal mass. Abdominal wall masses such as lipoma, subcutaneous fat nodules, abdominal wall abscess, umbilical cysts, etc., are superficial and can move with the abdominal wall. When the patient sits or tightens the abdominal muscles, the mass is more prominent, and the mass of the abdominal muscles relaxes. That is not obvious. When the patient is examined in the supine position, the lumps are still clearly visible as abdomen wall mass. If the intra-abdominal mass is often inaccessible.
Second, the upper right abdomen mass: (1) liver enlargement;
(two) gallbladder enlargement:
1. About 1/3 of patients with acute cholecystitis can reach the enlarged gallbladder. The diagnosis of this disease is not difficult. Patients often have fever, chills, nausea J vomiting, abdominal distension and severe pain in the right upper quadrant. Abdominal pain is severely intermittent and can be radiated to the right shoulder. In the right upper abdomen, there may be tenderness and muscle tension plus positive. Some patients have jaundice. A diagnosis can be made based on the above symptoms and signs.
2. Gallstone water is caused by a chronic chemical inflammation. Due to obstruction of the cystic duct, bile is retained in the gallbladder, and the bile pigment is absorbed and causes chemical stimulation to cause chronic inflammation.
Abdominal examination can reach the enlarged gallbladder, with mild tenderness or no tenderness, and clinical diagnosis is difficult. B-mode ultrasound and CT examination can assist in diagnosis, and the diagnosis of this disease depends on surgical exploration.
3, cholestatic gallbladder enlargement due to extrahepatic biliary obstruction caused by cholestatic gallbladder enlargement, can be seen in ampullary cancer and pancreatic cancer. Often the typical clinical manifestations of obstructive jaundice, such as skin sclera yellow staining, skin itching, clay-like stools, direct bilirubin increased, B-mode ultrasound, CT examination can provide a diagnosis. If the X-ray barium meal of the pancreatic head cancer is seen, the ten M refers to the enlargement of the intestinal ring.
4, congenital choledochal cyst This disease is also known as cystic dilatation of the common bile duct, pancreaticobiliary duct abnormal syndrome, mostly congenital malformations, is a rare disease. Most of the patients are female adolescents and children. If a fixed cystic mass that does not follow the respiratory movement is found in the right upper abdomen. Clinically, there is dull or no pain in the right upper quadrant, intermittent fever and jaundice. X-ray examination has a greater significance for the diagnosis of this disease. X-ray abdominal plain film can be seen in the right upper quadrant. Barium meal angiography showed that the stomach was displaced to the left front, the duodenum was displaced to the left front and lower, the duodenal ring was enlarged, and the colonic hepatic artery was shifted downward. More gallbladder angiography is not developed. Endoscopic retrograde cholangiopancreatography is of great value in the diagnosis of this disease. B-mode ultrasound and CT examination can show that the tumor is cystic, clearly indicating the location and size of the tumor, and can generally be diagnosed. Some patients need to be diagnosed at the time of surgical exploration.
5, gallbladder cancer gallbladder cancer, mostly young and middle-aged women over 50 years old. Clinically, there may be upper right abdominal pain and jaundice. Progressive loss of appetite and weight loss.
More complicated by gallstone disease. Often covered by cholelithiasis symptoms. Ultrasound, CT, MRI, and selective celiac angiography can be used to diagnose the diagnosis. Sometimes diagnosed must be surgically explored.
6, the incidence of gallbladder torsion is sharp, and suddenly the upper right abdomen persistent severe cramps. Swelling to the right side and radiation to the back. In a short time, the swollen gallbladder can be touched in the right upper abdomen, the surface is smooth, the tenderness is obvious, and the right upper abdominal muscle is tense. The swollen gallbladder can move with the breath. Cong has no history of cholelithiasis, no fever at the onset of the disease, and low white blood cells are clinically associated with acute cholecystitis and cholelithiasis. Emergency surgery is often required to confirm the diagnosis.
(three) liver cancer
This disease often has discomfort or pain in the right upper abdomen, may have bloody stools and incomplete intestinal obstruction, and sometimes can touch the strip in the right upper abdomen, the texture is hard. Barium enema and colonoscopy help to determine the diagnosis.
Third, the upper middle and upper abdominal mass: middle and upper abdominal mass is common in stomach diseases, pancreatic masses. Left hepatic lobe enlargement, mesenteric mass, small intestine mass, etc.
(1) A lump in the stomach:
1. Ulcer disease Generally, a simple gastroduodenal ulcer does not have an upper abdominal mass. Common in ulcer disease with chronic penetrating ulcers or pyloric obstruction. A typical history of ulcer disease, such as chronic onset, periodic onset, rhythm of pain, and pantothenic heartburn, can occur before these complications occur. The rhythm of pain after the occurrence of chronic penetrating ulcers disappears, and the pain radiates to the back. Conventional treatment is not effective. Often due to adhesion to the surrounding tissue in the upper abdomen to form a mass. The boundary of the mass is unclear and there is tenderness. X-ray barium meal angiography and gastroscopy can help diagnose. Some patients have to be surgically explored. When ulcer disease complicated with pyloric obstruction, a tender mass can be reached in the middle and upper abdomen. Patients often have refractory nausea and vomiting, and vomit contains food. The stomach and stomach reverse peristaltic waves can be seen in the upper abdomen, and there is a sound of water in the stomach. It is generally not difficult to diagnose according to clinical manifestations.
2, gastric cancer patients with gastric cancer in the upper abdomen is already in the advanced stage. There is often a progressive loss of appetite in the clinic. Loss or anemia, the occult blood test continued to be positive. The upper abdominal mass is unclear, irregular, hard, and tender. It can be moved. Sometimes the enlarged lymph nodes are touched in the upper clavicle. X-ray barium meal angiography and gastroscopy can confirm the diagnosis.
3, gastric mucosal prolapse can sometimes touch the flexible mass in the pyloric area. The following conditions should be considered clinically to take into account the possibility of gastric prolapse.
1 irregular upper abdominal pain, the right side of the face is aggravated;
2 unexplained upper gastrointestinal bleeding;
3 pyloric obstruction occurred without a history of ulcer disease. The diagnosis depends on X-ray barium meal. The typical image is in the form of an umbrella and the pyloric tube is widened. Under the gastroscope, the gastric film can be seen entering the duodenum or exiting from the duodenum. The tympanic membrane that is withdrawn from the duodenum often has congestion or edema or bleeding.
4, other tumors of the stomach, gastric sarcoma, gastric leiomyosarcoma is a stomach Hodgkin's disease, are rare. X-ray barium meal imaging is also difficult for differential diagnosis. Often in the operation of the frozen slice dialect confirmed.
5, stomach stone disease is common with stomach persimmon, stomach hair stone. Persimmon stone is more common in men, hair stone is more common in women, history of eating persimmon, lean meat, hair history. Upper abdominal fullness, pain, nausea. Vomiting and so on. The upper abdomen can touch a mass that can move. X-ray examination revealed a visible shadow or a gastroscopy to find a stone to confirm the diagnosis.
(B) the mass of the pancreas: the mass of the pancreas is found in the inflammation of the pancreas, cysts and pancreatic tumors.
1, pancreatitis: a small number of patients with acute pancreatitis, sometimes in the left upper abdomen or umbilicus can touch the edge of the unclear, obvious tenderness of the mass. The mass may be caused by enlarged pancreatic and localized peritonitis. Caused by a pancreatic abscess or cyst. Generally have a history of acute pancreatitis. Such as fever, severe upper abdominal pain, nausea, vomiting and other symptoms. There may be tenderness and rebound tenderness in the upper abdomen. Elevated blood and urine amylase contribute to diagnosis.
2, pancreatic cysts: pancreatic cysts can be divided into true cysts and pseudocysts. True cysts are rare in clinical practice. Most of them are small in size and located in the retroperitoneum. Generally, there is no special clinical manifestation. Pseudocysts are more common in clinical practice, and about 75% of patients are secondary to acute or chronic pancreatitis. 20% occurred after trauma. The rest is due to other reasons. The possibility of pancreatic pseudocyst should be considered in the following clinical situations:
1 After acute pancreatitis or pancreatic trauma, a cystic mass appears in the upper abdomen and gradually increases;
2 accompanied by upper abdominal pain or discomfort, postprandial bloating, nausea, vomiting, loss of appetite and other symptoms of dyspepsia. Or have blood sugar and urine sugar increased;
3X line barium meal angiography showed that the stomach, duodenum or transverse colon showed compression, and the cyst located in the head of the pancreas could enlarge the duodenal ring. The abdominal plain film is sometimes seen to have calcification in the wall of the capsule. Intravenous pyelography can show a downward shift of the left kidney and an elevation of the left lateral septum;
4B type ultrasound into T, Wb examination found that there are cystic masses in the abdominal cavity, such as cysts other than other organs @ liver cysts, polycystic kidney disease, mesenteric cysts, ovarian cysts, etc. can make a diagnosis. If there is an increase in blood and urine amylase, it supports diagnosis.
3, pancreatic cancer, patients over the age of 40, clinically intractable upper abdominal distension, upper abdominal pain, adjacent to progressive weight loss or steatorrhea, should pay attention to the possibility of pancreatic cancer. Because the anatomical position of the pancreas itself is deep, and the pancreas is closely related to liver and gallbladder, many of the symptoms of hepatobiliary and pancreatic diseases are similar, and the differential diagnosis is complicated. Therefore, early diagnosis of pancreatic cancer is very difficult. If the upper abdominal mass is suspected of pancreatic cancer, the following tests can be done to help diagnose. X-ray inspection:
1 sputum angiography, there may be widening of the eleven finger loop, the duodenal descending pancreatic side showed "reverse 3 sign", the stomach and duodenum transverse part was pushed to the front, the transverse colon shifted downward; 2 Selective angiography, the inside of the pancreas or adjacent blood vessels are covered by the tumor and the development is poor, the blood vessels are displaced, and the pressure is pressed. Poor development of blood vessels in cancer. Endoscopic retrograde cholangiopancreatography (ERCP) ER-CP can show pancreatic duct stenosis, distortion or obstruction. Duodenal microscopy: The condition of the ampulla can be observed under direct vision, and there is no tumor. Collect pancreatic juice for cytology. B-mode ultrasound, CT, MRI examination: can show the location, size, nature of the space-occupying lesions in the pancreas, changes in the shape of the pancreas, and the presence or absence of dilatation of the common bile duct and pancreatic duct, which is an important means for the diagnosis of pancreatic masses.
Biopsy of pancreatic puncture: percutaneous pancreatic puncture or pancreatic puncture through the gastroscope to absorb the living tissue for pathological examination, has a diagnostic significance. For those who are very difficult to diagnose, they can be opened for exploration.
(c) Liver left to the mass
Left hepatic lobe mass can be seen in left lobe liver cancer, amoebic liver abscess, and hepatic cyst. ~ B-mode ultrasound, cT or MRI can make a diagnosis.
(4) Mesenteric and omental masses
1, mesenteric lymph node tuberculosis: often part of peritoneal tuberculosis, more common in children and adolescents, swollen mesenteric lymph nodes adhere to each other into a larger four, uneven edges, deeper, medium hardness. Acute phase may be accompanied by severe abdominal pain and fever in the umbilical cord. Calcification can be seen in the chronic phase X-ray plain film. Clinically, it is possible to exclude tumors from feasible diagnostic treatment for tuberculosis. The curative effect is not good, it is advisable to do a surgical exploration to confirm the diagnosis.
2, mesenteric cyst and omental cyst: more common in women, the surface of the tumor is smooth, sac sexy, a certain mobility. No tenderness. Barium meal angiography and urography can exclude intestinal and renal lesions, as well as intestinal tube compression. B-mode ultrasound, CT or MRI can often suggest cystic masses, but the exact source of the tumor must be surgically diagnosed.
(5) Tumors in the small intestine: Small intestine tumors are rarer than tumors in other parts of the intestine. 2/3 is a malignant tumor, and malignant tumors have the most sarcoma. Small bowel cancer is rare. Patients with one or more of the following conditions should consider the possibility of small bowel malignancies:
1 Short-term weight loss, lack of running, often abdominal pain or tar-like stools without reason;
2 chronic diarrhea, fever with acute or chronic intestinal obstruction;
3 abdominal masses;
4X angiography or endoscopy can exclude gastric and colonic lesions. If the clinical signs are suspicious, the occult blood is positive, and a small bowel system examination should be performed to assist in the diagnosis.
(6) Abdominal aortic aneurysm: The mass is mostly located in the upper abdomen, with an expansive pulsation, does not move with the breath, and has tenderness. A thin patient can experience tremors and can hear a drum-like noise. There is often a history of arteriosclerosis, syphilis and trauma, caused by syphilis, syphilis seropositive. The X-ray film can be immersed in the vertebral body, but the intervertebral disc is normal. Doppler ultrasound, CT, ECT, MRI and other examinations can provide a diagnosis.
Fourth, the upper left abdomen mass
(a) splenomegaly
(2) Traveling the spleen: When the spleen leaves its anatomical position and is released to other parts, it is called swimming spleen or swimming spleen. The cause of spleen migration is splenomegaly and relaxation of the spleen and ligament. Can be induced by abdominal wall relaxation or abdominal trauma. Occurs in middle-aged women, especially those who have multiple maternal or visceral ptosis. The walking card generally does not produce clinical symptoms. If you compress or pull nearby organs, you can develop symptoms. If the stomach is pulled, it can return to abdominal pain, nausea, vomiting, belching and other symptoms. If you walk to the I pelvic pressure, you may have difficulty urinating. If you press the rectum, you may have symptoms such as urgency and urgency. The main diagnostic basis is:
1 The abdominal cavity touches the surface with a smooth and elastic mass, the tumor has a notch, can move, no tenderness;
2 The spleen area of the spleen disappeared;
There is no spleen in the 3B type spleen area, and the sound and shadow similar to the spleen in other parts can be diagnosed. X-ray pneumoperitoneography can also prompt diagnosis. (C) pancreatic tumors and pancreatic cysts refer to this section "pancreatic cysts" and "pancreatic cancer."
(4) Colon cancer of the spleen: The colon cancer sometimes can be infiltrated by the cancer tissue and infiltrated into the surrounding area. The mass can be touched in the left upper abdomen. The mass is hard, not smooth, and can be active. Often accompanied by intestinal obstruction with constipation, blood in the stool and so on. Barium enema and colonoscopy can confirm the diagnosis.
Five, left and right waist and abdomen mass
(1) Kidney drooping and walking kidney
Normal human kidneys are generally inaccessible in the abdominal cavity, and can be touched when there is a kidney sag or a kidney. Kidney ptosis and kidneys occur in elongated women between the ages of 20 and 40. More common on the right side, but also on both sides. Clinically many asymptomatic, if symptoms, usually symptoms of backache, back pain, hematuria. A patient with a thin body can reach the lower part of the kidney, which is round and blunt, solid and elastic, and has a smooth surface. When the patient is touched, the patient has nausea or discomfort. Kidney shift can be divided into three levels: level 1, can only touch the lower part of the kidney or half of the kidney; level 2, can touch the entire kidney; level 3: the kidney can travel across the spine line to the opposite side Abdominal cavity. Congenital renal ectopic is more fixed and cannot be pushed back into the kidney socket. B-mode ultrasound and intravenous pyelography are helpful in the diagnosis of renal ptosis and migratory kidney.
(B) huge hydronephrosis: generally with the content of more than 1000ml of hydronephrosis is called giant hydronephrosis. Common causes are congenital renal pelvis, ureteral junction stenosis or stone. The main symptoms are abdominal pain. Low back pain, hematuria, etc. A cystic mass can be reached in the waist and abdomen. The main diagnostic basis is:
1 cystic mass gradually enlarged on one side of the waist and abdomen, the mass is smooth, no tenderness;
2 After a large amount of urination, the mass can be quickly reduced, and the mass can be increased when the urine volume is reduced;
3 The mass extends outward to the outer edge of the spinous muscle, which has a sense of fluctuation;
4 There was no obvious abnormality in urine examination;
5B type ultrasound and CT examination generally provide diagnosis;
3 Intravenous pyelography was not developed on the affected side, and the healthy side was normal. Retrograde ureteral angiography showed that the ureter was displaced to the contralateral side and the upper end of the ureter was obstructed.
1 Renal angiography by lumbar puncture is the most reliable diagnosis, which can clarify the cause and location of hydronephrosis. Provide a basis for the development of surgical treatment programs. Giant hydronephrosis must be differentiated from ovarian cysts, mesenteric cysts, pancreatic cysts, renal cysts, polycystic kidney and adrenal cysts.
(C) renal pelvis empyema: caused by hydronephrosis secondary to purulent bacterial infection. Patients may have aversion to cold or chills, high fever, tenderness in the kidney area, and snoring pain. Leukocytosis in the blood, neutrophil nucleus left shift. It can drain pyuria or bacteriuria. E. coli is often grown in urine culture.
(D) congenital polysacral kidney: congenital polycystic kidney disease has infant type and adult type. Infant type is a serious condition and is more than two years old.
The adult type is mild, and the onset is slow, and it usually occurs after adulthood. Mostly bilateral, one side is more obvious. If it is a single side, it is more common on the left side. Polycystic kidneys can be large, 5-6 times normal kidney, and the shape is approximately spherical. Early patients may be asymptomatic or have only low back pain or waist discomfort. As the cysts increase, the back pain gradually increases, from one side of the paroxysmal pain to persistent bilateral pain. In the medium term, symptoms such as headache, vomiting, hematuria, proteinuria, tubular urine, and high blood pressure may occur. Uremia can occur in the advanced stage. The main diagnosis basis:
1 The double kidney area touches the nodular spherical mass, the texture is tough, and there is no obvious fluctuation;
2 unilateral renal enlargement with renal dysfunction;
3 renal mass with hematuria or hypertension;
4B ultrasound, CT and pyelography are of great value in the diagnosis of this disease. The disease must be differentiated from simple renal cysts and renal hydatid cysts. Renal cysts generally have no renal impairment. Kidney hydatid cysts, often accompanied by echinococcosis in other organs, increased eosinophils in the blood. The echinocoage antigen was positive in the intradermal test and the indirect hemagglutination test was positive.
(5) Kidney tumors: Benign tumors of the kidney are rare. Common malignant tumors are: kidney cancer. Kidney cancer is the most common kidney tumor, accounting for about 75% of kidney tumors. It is more common in men and occurs in 4O-60 years old. between. Renal sputum cancer, more common in men, hematuria is its main symptom. Renal embryonal tumor is one of the common malignant tumors in infants and young children. Renal sarcoma, which is rare in clinical practice and grows rapidly, can form a huge mass in a short period of time.
Malignant tumors of the kidney are mostly located at the waist or can be pushed back to the waist, which is kidney-shaped and can move with the breath. Diagnosis relies on bladder dissection and pyelography. The wrist scan showed that the ureteral spurting of the affected side showed renal pelvis cancer, and the pyelography showed filling defects and deformation of the renal pelvis and renal pelvis. B-mode ultrasound, CT, MRI) examinations are also helpful for diagnosis.
(6) Primary retroperitoneal tumors: Primary retroperitoneal tumors occur in the retroperitoneal space. Tumors can be derived from adipose tissue, connective tissue, fascia, muscle, blood vessels, nerves, and lymphoid tissues. Tumors are benign or malignant, with multiple males.
The patient is often asymptomatic at an early stage until symptoms develop when the tumor grows to a considerable extent. Generally, the malignant tumor is poor in general condition, the tumor grows fast, and the tumor is irregular and hard. Benign tumors are in good general condition, tumors grow slowly, and the surface is smooth or cystic. Common clinical symptoms are bloating and abdominal pain. When swollen to a certain extent, adjacent organs and organs are stressed and corresponding symptoms may appear. diagnosis method:
1 Gastrointestinal barium meal, barium enema can be found in gastrointestinal compression;
2 pyelography can exclude kidney disease;
3 retroperitoneal angiography is of great value in the diagnosis of retroperitoneal tumors;
Type 4B ultrasound, CT, and MRI are also helpful for diagnosis.
Sixth, right lower abdomen mass: the right lower abdomen mass is usually an inflammatory mass, tuberculosis and tumor in the ileocecal area, and women's attachment masses.
(A) abscess around the appendix: is the main complication of acute appendicitis. Perforation can occur in the treatment of acute appendicitis. The appendix has been covered by the omentum and intestine before perforation. After perforation, the suppurative infection is confined to the appendix around the appendix. diagnosis:
1 typical medical history, such as right lower quadrant pain, aversion to cold or chills, fever, increased white blood cells, etc.; 2 lumps appear 2-3 days after the disease, irregular rounded edges, obvious tenderness, local muscle tension;
3 rectal examination can touch the wall of the abscess. Generally, no special examination is needed to confirm the diagnosis.
(2) Tuberculosis of the Ministry of Rehabilitation
Proliferative intestinal tuberculosis often forms a mass in the back 100 or ascending colon. Most of the patients are young adults, more women than men, and the course of disease is slow. Common symptoms include bloating, abdominal pain, diarrhea, or alternating diarrhea and constipation. There may be symptoms such as low fever and night sweats. The right lower abdomen can reach the mass, the texture is medium hardness and the surface is not smooth. Continued development may lead to incomplete intestinal obstruction. The main diagnosis basis:
1 Clinically, there is a history of tuberculosis, alternating right lower abdominal pain, diarrhea or diarrhea and constipation, or unexplained intestinal obstruction;
2 butterfly meal or sputum enema ileocecal area has filling defect image;
3 colonoscopy can be confirmed by pathological biopsy;
4 people with diagnosing difficulties can give experimental treatment to anti-tuberculosis drugs.
(3) Crohn's Crohn's disease is also known as localized enteritis, segmental enteritis, and granulomatous enterocolitis. This disease and ulcerative colitis are collectively referred to as inflammatory bowel disease. The main clinical features are abdominal pain, diarrhea, abdominal mass, thin tube formation and intestinal obstruction. May be accompanied by fever, nutritional disorders and other performance. The age of onset is mostly 15-40 years old, more men than women. Diagnosis of this disease: Young and middle-aged patients have the above-mentioned clinical features; X-ray angiography or colonoscopy found that the lesions are mainly at the end of the ileum and adjacent right colon or segmental changes, should consider this disease. Histological examination revealed non-case-like granulomatous tissue, which can rule out other related diseases and can make a diagnosis of the disease. According to the clinical pathology concept proposed by the World Health Organization, the diagnostic criteria established by Japan in 1976 are:
1 discontinuous or regional lesions;
2 lesions of the tympanic membrane are paving stones or longitudinal ulcers;
3 full-thickness inflammatory lesions; accompanied by a mass or stenosis;
4 nodular non-case granuloma;
5 cracks or thin tubes;
3 anal lesions, refractory ulcers, atypical anal or anal fissure. Those with 1, 2, or 3 above are suspected, plus one of 4, 5, or 5 can be diagnosed. There are two, 1, 2, and 3, plus 4 can also be diagnosed. The disease must be differentiated from ulcerative colitis, intestinal tuberculosis, and right colon cancer. (4) Cecal cancer: The right lower quadrant is the most common sign of cecal cancer. Has 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 associated with varying degrees of lower abdominal pain and bloating, uterine bleeding, menstrual disorders, ascites and other symptoms. The distinguishing points of benign and malignant ovarian tumors are:
1 The course of benign tumor is long, the mass of the lower abdomen is gradually enlarged, the course of malignant tumor is short, and the mass of the tumor grows rapidly;
2 benign tumors are generally asymptomatic in the early stage; the symptoms of compression appear in the early stage of malignant tumors, and they are progressive;
3 benign tumor masses are mostly cystic, smooth surface, and mobile. The malignant tumor mass is mostly substantial, the surface is uneven or nodular, the mass is fixed, and generally there is no mobility;
4 benign tumors, multi-shoal water, systemic condition; malignant tumors have more bloody ascites, tumor cells can be found in ascites.
Seven, lower abdomen mass:
(1) Bladder tumor: This disease is a common disease in urology and is the most common tumor in genitourinary tumors. Bladder tumors are more common in men, and the ratio of men to women is 3-4:1. The age of good hair is 50 to 70 years old. The main clinical manifestation is hematuria, followed by frequent urination, dysuria and nocturia. Tumors located in the neck or pedicle of the bladder can cause dysuria or urine retention. Sometimes a mass can be reached on the pubic bone. Diagnosis: The diagnosis of bladder tumors mainly relies on the examination of the bladder. B Super T check also helps a lot of diagnosis. Urine cytology also plays an important role. Abdominal angiography can assist in diagnosis. Other methods include flow cytometry, examination of marker chromosomes, and specific red blood cell sequestration assays.
(2) Uterine tumors:
1, uterine fibroids uterine fibroids is a common benign tumor of the female reproductive system, the age of good hair is 30-50 years old. Larger tumors often form a mass in the lower abdomen, which may have compression symptoms, such as a feeling of sinking in the pelvic cavity. Frequent urination or urine retention, constipation, lower extremity edema, etc. Often accompanied by menstrual disorders, dysmenorrhea, increased vaginal discharge and other symptoms. The mass has a solid feel, a tough texture, a smooth surface, and can move forward and backward and left and right, but cannot move up and down. It is not difficult to make a diagnosis based on age, infertility history, symptoms, signs and gynecological examinations. Large cystic uterine fibroids must be differentiated from ovarian cysts. B-ultrasound and CT examination are helpful for diagnosis.
2, uterine sarcoma uterine sarcoma is less common. More common in women over the age of 40. As usual, after the menopause, the uterus rapidly increases, accompanied by a large number of irregular vaginal bleeding, lower abdominal pain, such as sarcoma ulceration, there is a odorous liquid from the vagina. The diagnosis of uterine sarcoma mainly relies on scraping tumor tissue from the uterine cavity, or performing biopsy after surgical resection.
3, endometrial cancer endometrial cancer occurs in women aged 50-60 years. There is often functional uterine bleeding before onset. When infiltrated into adjacent tissues, irregular, hard, nodular masses can sometimes be reached deep in the upper part of the pubic bone. B-ultrasound and CT examination can assist in diagnosis. The most reliable diagnosis method is pathological biopsy of intrauterine scraping.
Eight, extensive and non-positioning abdominal mass:
(1) Tuberculous peritonitis: cheese-type and adhesion-type tuberculous peritonitis can often reach the size of the abdomen, the boundary is not clear, there is a tender mass. Patients often have fever, night sweats, and occasionally intestinal obstruction. This disease often has extra-abdominal tuberculosis lesions, and the anti-tuberculosis treatment effect is good. Sometimes it is difficult to identify with ventral lymphoma in the abdominal cavity, and it is necessary to perform a surgical diagnosis to confirm the diagnosis.
(two) metastatic carcinoma of the peritoneum
Abdominal wall metastasis is often derived from digestive system malignancies such as stomach, liver, pancreas, colon, and rectum, and ovarian cancer. In the abdomen, lumps of varying sizes, irregular shapes, and hard textures can be accessed. There is a large amount of ascites, which affects palpation, and palpation is more clear after draining ascites. The main point of diagnosis is to find the original cancer and find cancer cells in the ascites.
1, ulcerative colitis: ulceral colitis common symptoms are abdominal pain, diarrhea, mostly sputum sputum blood with urgency and weight. 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.
2, rectal, sigmoid colon cancer: rectal cancer is more common in the clinic, but the abdomen is not easy to touch the mass. Sigmoid colon cancer infiltrates into adjacent tissues, and can reach a hard, non-nodular mass in the left lower abdomen. Often accompanied by diarrhea, blood in the stool. Diagnosis requires X-ray barium enema and colonoscopy. Colonoscopy biopsy. It should be differentiated from rectal, sigmoid schistosomiasis granulomatosis and sigmoid lateral granulomatosis.
3. Ovarian tumor on the left side.
