Abdominal mass

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Abdominal mass
This infant has massive hepatomegaly due to metastatic neuroblastoma. Intra-abdominal pressure is partially relieved by a silastic pouch.
Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: John Fani Srour, M.D. Please Join in Editing This Page and Apply to be an Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.

Overview

An abdominal mass is any localized enlargement or swelling in the human abdomen. Depending on its location, the abdominal mass may be caused by an enlarged liver (hepatomegaly), enlarged spleen (splenomegaly), protruding kidney, a pancreatic mass, a retroperitoneal mass (a mass in the posterior of the peritoneum), an abdominal aortic aneurysm, or various tumours, such as those caused by abdominal carcinomatosis and omental metastasis. The treatments depend on the cause, and may range from watchful waiting to radical surgery.

Features

Many abdominal masses are discovered incidentally during routine physical examination. When they present symptomatically, abdominal masses are most frequently associated with pain or digestive problems. However, depending on the cause, masses may be associated with other signs and symptoms, such as jaundice or bowel obstruction.

Diagnosis

The first steps in diagnosis are a medical history and physical examination. Important clues during history include weight loss, diarrhea and abdominal pain.

During physical examination, the clinician must identify the location of the mass, as well as characterize its location (usually specified in terms of quadrants). The mass should be assessed for whether it is rigid or mobile. It should also be characterized for pulse or peristalsis, as these would help in further identifying the mass.

Routine blood tests are usually the next step in diagnosis after a thorough medical history and physical examination. They should include a full blood count, blood urea nitrogen (BUN), creatinine, and liver function tests such as albumin, international normalized ratio (INR), partial thromboplastin time (PTT), serum amylase and total bilirubin (TBIL). If late-stage liver disease is suspected, then a serum glucose may be appropriate.

Complete Differential Diagnosis of Causes of Abdominal Mass

In alphabetical order. [1] [2]

Complete Differential Diagnosis of Causes of Abdominal Mass (by organ system)

Cardiovascular *Abdominal Aortic Aneurysm
Chemical / poisoning No underlying causes
Dermatologic No underlying causes
Drug Side Effect No underlying causes
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic

Acute pancreatitis, Ascites, Autoimmune pancreatitis, Bezoar, Biliary atresia, Blind loop syndrome, Bowel obstruction, Cholangiocarcinoma, Cholecystitis, Choledochal cyst, Cholelithiasis, Cirrhosis, Colonic diverticulitis, Congenital hypertrophic pyloric stenosis, Congenital megacolon, Constipation, Crohn's disease, Distal intestinal obstruction syndrome, Gastroschisis, Hepatomegaly, Hirschsprung's disease, Liver granuloma, Palpable gallbladder (Courvoisier's sign, Pancreatic pseudocyst, Pyloric stenosis, Riedel lobe of liver, Splenosis, Toxic megacolon, Urachal cyst, Vermiform appendix, Volvulus, Wandering spleen, Yersinia enterocolitica

Genetic Acanthocheilonemiasis , Alpha-L-iduronidase deficiency (Hurler syndrome), Alpha-L-iduronidase deficiency (Hurler-Scheie syndrome), Alpha-mannosidase deficiency, Apolipoprotein C-II deficiency, Beta thalassaemia (heterozygous), Chanarin-Dorfman disease, Chediak-Higashi disease , Cholesterol ester storage disease , Common variable hypogammaglobulinaemia, Congenital dyserythropoietic anaemia type 1, Congenital erythropoeitic porphyria, Coproporphyria, hereditary , Cruveilhier-Baumgarten syndrome, Familial alphalipoprotein deficiency, Familial histiocytic reticulosis, Familial hypertriglyceridaemia, Farber lipogranulomatosis, Fucosidosis , Fumarase deficiency , Galactose epimerase deficiency,

[[Galactose-1-phosphate uridyltransferase deficiency ], Gangliosidosis GM1 type 1 Gangliosidosis GM1 type 3, Gangliosidosis GM3, Gaucher disease , Geleophysic dysplasia, Glucose phosphate isomerase deficiency, Glycogenosis type 4 Granulocyte colony stimulating factor, Haemochromatosis , Haemoglobin C disease Haemoglobin E disease, Haemoglobin SC disease, Haemolytic disease of the newborn Hereditary spherocytosis , Iduronate-2-sulfatase deficiency, Iminodipeptiduria Kartagener syndrome , Long chain hydroxyacyl-CoA dehydrogenase deficiency Macrophage activation syndrome, McLeod phenotype, Mevalonate kinase deficiency Mucopolysaccharidosis VI , Neutrophilia, hereditary, Niemann-Pick disease type B Niemann-Pick Disease, Type C' Norrbottnian Gaucher disease, Salla disease Sandhoff disease , Sanfilippo disease, Sarcoidosis , Sickle cell disease Zimmermann-Laband syndrome

Hematologic Chediak-Higashi disease , Extramedullary haemopoiesis, Familial histiocytic reticulosis, Fanconi-Bickel syndrome, Haemochromatosis , Sickle cell crisis , Haemoglobin C disease, Haemoglobin E disease, Haemoglobin SC disease, Haemolytic disease of the newborn, Hereditary spherocytosis , Mastocytosis , Myelofibrosis , Hereditary neutrophilia, Vitamin B12 deficiency
Iatrogenic No underlying causes
Infectious Disease Abscess, Actinomyces, Alveolar hydatid disease, Bartonellosis, Brucellosis, Cat scratch fever, Entamoeba histolytica, Gallbladder empyema, kala-azar, Leishmaniasis, Kaposi sarcoma, Liver abscess, Liver granuloma, Lymphogranuloma venereum, Malaria, Mycobacterium tuberculosis, Oesophagostomiasis, Pancreatic abscess, Pelvic inflammatory disease, Psittacosis, Relapsing fever , Syphilis, congenital, Tertiary syphilis, Toxoplasmosis, congenital, Yersinia enterocolitica
Musculoskeletal / Ortho No underlying causes
Neurologic No underlying causes
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic Choriocarcinoma, Ectopic pregnancy, Endometriosis, Meigs syndrome, Pelvic inflammatory disease, Pregnancy, Uterine enlargement, Uterine leiomyoma
Oncologic Adrenal tumor, Brenner tumor, Burkitt's lymphoma, Carcinoid tumours, Cholangiocarcinoma, Choriocarcinoma, Chronic myelogenous leukemia, Colorectal cancer, Desmoplastic small round cell tumor, Endodermal sinus tumor, Gallbladder benign tumors, Gallbladder cancer, Gastrointestinal stromal tumor, Germ cell tumor, Hairy cell leukaemia, Hamartoma, Hemangioendothelioma, Hemangiopericytoma, Hepatic adenoma, Hepatoblastoma, Histiocytosis X, Hodgkin's lymphoma,

Kaposi sarcoma, Kidney cancer, Krukenberg tumor, Leiomyoma, Liposarcoma, Metastatic Liver cancer, Primary Liver cancer, Meigs syndrome, Nephroblastoma, Neurilemmoma, Neuroendocrine tumor, Non-Hodgkin lymphoma, Oncocytoma, Ovarian cancer, Pancreatic cancer, Pancreatic islet cell tumors, Phaeochromocytoma, Plexosarcoma, POEMS syndrome, Pseudomyxoma peritonei, Renal cell carcinoma, Renal oncocytoma, Rhabdoid tumor, Sacrococcygeal teratoma, Sickle cell crisis, Sister Mary Joseph nodule, Small bowel lymphoma, Spleen lymphoma, Stomach cancer, Transitional cell carcinoma, Uterine leiomyoma, Wilm's tumor

Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic Bladder distention, Cryptorchidism, Hydronephrosis, Kidney cancer, Pelvic kidney, Polycystic kidney disease, Renal cell carcinoma, Renal oncocytoma, Renal transplantation, Transitional cell carcinoma, Urine retention, Varicocele, Wilm's tumor
Miscellaneous No underlying causes


Physical Examination

Abdomen

Other

Laboratory Findings

Electrolyte and Biomarker Studies

X Ray

MRI and CT

Other Diagnostic Studies



Treatment

  • Immediately treat life-threatening causes (such as abdominal aortic aneurysms).
  • Organomegaly typically resolves once the underlying etiology is treated.

Acute Pharmacotherapies

  • Ogilvie's syndrome responds to decompression by IV neostigmine or by a rectal tube
  • Constipation is usually treated with laxatives, increased dietary fiber and fluids, enemas.
    • Manual disimpaction is reserved for fecal impaction.
    • Stop use of offending medications.
  • Masses caused by infections require antibiotics (and possible surgery)

Surgery and Device Based Therapy

  • Several benign and malignant masses require surgical intervention
  • Hirschsprung's disease often requires surgery.

References

  1. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

Additional Resources

Acknowledgements

The content on this page was first contributed by Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3]

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