Intra-abdominal masses

43 Pages·2007·1.39 MB·English

by  Nihat Yavuz

ABDOMINAL MASS
Prof. Dr. Turgut IPEK
A Palpable abdominal mass must be
presumed to be due to serious abdominal
disease unless the doctor is certain that the
mass is a normal abdominal viscus.
PALPABLE ABDOMINAL MASS
Normal
In abdominal wall
At umbilicus
Intra-abdominal
Normal
Bladder
Right (left) kidney
Aorta
Intestine with gas and liquid
Faeces
Pregnant uterus
Neonatal liver
Normal abdominal masses
The normal bladder becomes palpable in
everyone if it is sufficiently distended by
retained urine. The lower pole of the right
kidney is sometimes, of the left kidney rarely,
palpable. In a thin person with left kidney rarely,
palpable. In a thin person with ill-developed
musculature, the abdominal aorta is palpable in
the epigastrium.
Status of the liver
Every abdominal surgeon knows from the
experience of laparotomy that, in the patient
lying supine, the liver projects well below the
costal margin in the vast majority of patients, so
that this projection in itself is unlikely to be the
cause of the palpability of the normal liver.
Site
Most palpable abdominal swellings can be
classified according to their site into one of
the following categories:
hernial orifices including the umbilicus, right
upper quadrant, left upper quadrant, mid-line
epigastric, right lower puadrant, left lower
quadrant and suprapubic.
Abdominal wall or intra-abdominal?
When the patient contracts his abdominal
muscles, an intra-abdominal swelling becomes
less prominent or disappears while a mass in
the abdominal wall becomes firmer and more
obvious.
Movement with respiratory excursions
The part of the organ connecting the mass with
the under-surface of the diaphragm must be
rigid enough to transmit the thrust, and that the
mass will move with ventilation if it is in indirect
contact with the diaphragm via another
interposed organ which is rigid enough to
transmit the thrust.