STUDY - Technical - New Dacian's Medicine
Abdominal
MASS (Classical / Allopathic Medicine)
Commonly detected
on routine physical assessment, an abdominal mass is a
localized swelling in an abdominal quadrant. This sign
typically develops insidiously and may represent an enlarged
organ, neoplasm, abscess, vascular defect, or fecal mass.
Distinguishing an
abdominal mass from a normal structure requires skillful
palpation. At times, palpation must be repeated with the
patient in a different position or performed by a second
examiner to verify initial findings. A palpable abdominal mass
is an important clinical sign and usually represents a serious
and, perhaps, life-threatening disorder.
ALERT:
If the patient presents with symptoms that suggest an abdominal aortic aneurysm, such as a pulsating midabdominal mass and severe abdominal or back pain:
- quickly take his vital signs
- withhold food and fluids in case of emergent surgery
- obtain routine preoperative tests
- prepare the patient for angiography, if appropriate
- be alert for signs of shock, such as tachycardia, hypotension, and cool, clammy skin, which may indicate significant blood loss.
If the patient's abdominal mass doesn't suggest an aortic aneurysm, perform a focused assessment.
If the patient presents with symptoms that suggest an abdominal aortic aneurysm, such as a pulsating midabdominal mass and severe abdominal or back pain:
- quickly take his vital signs
- withhold food and fluids in case of emergent surgery
- obtain routine preoperative tests
- prepare the patient for angiography, if appropriate
- be alert for signs of shock, such as tachycardia, hypotension, and cool, clammy skin, which may indicate significant blood loss.
If the patient's abdominal mass doesn't suggest an aortic aneurysm, perform a focused assessment.
HISTORY:
Ask the patient if the mass is painful. If so, ask if the pain is constant or if it occurs only on palpation. Is the pain localized or generalized? Determine if the patient was already aware of the mass. If he was, find out if he noticed any change in its size or location.
Review the patient's medical history, noting especially GI disorders.
Ask the patient about GI signs and symptoms, such as constipation, diarrhea, rectal bleeding, abnormally colored stools, and vomiting. Has the patient noticed a change in his appetite?
If the patient is female, ask whether her menstrual cycles are regular. Also, ask her when the first day of her last menses was.
Ask the patient if the mass is painful. If so, ask if the pain is constant or if it occurs only on palpation. Is the pain localized or generalized? Determine if the patient was already aware of the mass. If he was, find out if he noticed any change in its size or location.
Review the patient's medical history, noting especially GI disorders.
Ask the patient about GI signs and symptoms, such as constipation, diarrhea, rectal bleeding, abnormally colored stools, and vomiting. Has the patient noticed a change in his appetite?
If the patient is female, ask whether her menstrual cycles are regular. Also, ask her when the first day of her last menses was.
PHYSICAL
ASSESSMENT:
Auscultate for bowel sounds, bruits, and friction rubs in each quadrant.
Lightly palpate the abdomen, assessing painful or suspicious areas last; then perform deep palpation. Be sure to note the patient's position when you locate the mass.
Determine the shape, contour, and consistency of the mass.
Percuss the mass. A dull sound indicates a fluid-filled mass; a tympanic sound, an air-filled mass.
Determine if the mass moves when you palpate it or if it moves in response to respiration.
Auscultate for bowel sounds, bruits, and friction rubs in each quadrant.
Lightly palpate the abdomen, assessing painful or suspicious areas last; then perform deep palpation. Be sure to note the patient's position when you locate the mass.
Determine the shape, contour, and consistency of the mass.
Percuss the mass. A dull sound indicates a fluid-filled mass; a tympanic sound, an air-filled mass.
Determine if the mass moves when you palpate it or if it moves in response to respiration.
SPECIAL
CONSIDERATIONS:
If an abdominal mass causes bowel obstruction, watch for symptoms of peritonitis, such as abdominal pain and rebound tenderness, and for signs of shock, such as tachycardia and hypotension.
If an abdominal mass causes bowel obstruction, watch for symptoms of peritonitis, such as abdominal pain and rebound tenderness, and for signs of shock, such as tachycardia and hypotension.
PEDIATRIC
POINTERS:
In older infants and children, enlarged organs, such as the liver and spleen, usually cause abdominal masses. Other common causes include Wilms’ tumor, neuroblastoma, intussusception, volvulus, Hirschsprung's disease, pyloric stenosis, and abdominal abscess.
In older infants and children, enlarged organs, such as the liver and spleen, usually cause abdominal masses. Other common causes include Wilms’ tumor, neuroblastoma, intussusception, volvulus, Hirschsprung's disease, pyloric stenosis, and abdominal abscess.
AGING ISSUES:
Ultrasonography should be used to evaluate a prominent mid-epigastric mass in thin, elderly patients.
Ultrasonography should be used to evaluate a prominent mid-epigastric mass in thin, elderly patients.
PATIENT
COUNSELING:
Instruct the patient on what to expect from diagnostic testing, which may include blood and urine studies, abdominal X-rays, barium enema, computed tomography scan, and gastroscopy or sigmoidoscopy. A pelvic or rectal examination is usually indicated.
Instruct the patient on what to expect from diagnostic testing, which may include blood and urine studies, abdominal X-rays, barium enema, computed tomography scan, and gastroscopy or sigmoidoscopy. A pelvic or rectal examination is usually indicated.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)