Abdominal mass

Medicine > Gastrointestinal

Differential Diagnosis Schema 🧠

Gastrointestinal Causes

Colorectal carcinoma: May present with a mass in the lower abdomen, often associated with altered bowel habits, rectal bleeding, and weight loss.
Intestinal obstruction: Typically presents with diffuse abdominal distension, vomiting, and colicky pain. A palpable mass may suggest a specific cause like intussusception or volvulus.
Diverticular disease: Can present with a mass due to inflammation or abscess formation, often accompanied by left lower quadrant pain and fever.

Hepatobiliary Causes

Hepatocellular carcinoma: Presents as a hard, irregular mass in the right upper quadrant, often in patients with a history of chronic liver disease or cirrhosis.
Liver metastases: Can present as a palpable liver mass, often with weight loss and symptoms of the primary malignancy.
Cholecystitis: An inflamed gallbladder can present as a right upper quadrant mass, typically with associated pain, fever, and positive Murphy’s sign.

Renal Causes

Renal cell carcinoma: Often presents as a mass in the flank, possibly associated with haematuria, weight loss, and flank pain.
Polycystic kidney disease: Typically presents with bilateral flank masses, hypertension, and renal impairment.
Hydronephrosis: May present with a palpable kidney due to urinary tract obstruction, often associated with flank pain and urinary symptoms.

Gynecological Causes

Ovarian cyst: Typically presents as a lower abdominal or pelvic mass, often with bloating or pelvic discomfort.
Uterine fibroids: Present as a firm, irregular mass in the pelvis, associated with heavy menstrual bleeding and pelvic pain.
Ovarian cancer: May present as a solid, irregular mass, often with nonspecific symptoms like bloating, early satiety, and weight loss.

Key Points in History 🥼

Symptom Onset and Duration

Sudden onset: Suggests conditions such as volvulus, intussusception, or acute cholecystitis.
Chronic onset: More consistent with malignancies, chronic liver disease, or polycystic kidney disease.

Associated Symptoms

Pain: Characteristics and location can suggest specific causes. Colicky pain may suggest renal or intestinal causes; dull, constant pain may suggest malignancy.
Weight loss: Significant weight loss is highly suggestive of malignancy.
Fever: May indicate infection or inflammation, such as cholecystitis or diverticulitis.
Bowel habit changes: Could suggest gastrointestinal malignancies, obstruction, or diverticular disease.

Background

Past Medical History: Previous cancers, chronic liver disease, or known polycystic kidney disease may inform the differential.
Drug History: Certain medications (e.g., immunosuppressants) can predispose to malignancy or infection.
Family History: Hereditary conditions like polycystic kidney disease or familial cancers are important.
Social History: Alcohol use can predispose to liver disease, and sexual history may be relevant in gynaecological causes.

Possible Investigations 🌡️

Laboratory Tests

Full blood count: May show anaemia in malignancy or infection.
Liver function tests: Abnormal results may suggest hepatobiliary causes.
Tumour markers: E.g., CA 125 for ovarian cancer, AFP for hepatocellular carcinoma.

Imaging

Ultrasound: First-line for many abdominal masses, particularly in liver, renal, and gynaecological conditions.
CT scan: Provides detailed cross-sectional imaging, useful for characterising masses and assessing spread.
MRI: May be used for further characterisation, particularly in liver or gynaecological masses.

Histology and Biopsy

Fine needle aspiration: Often used for thyroid, breast, or lymph node masses.
Core biopsy: Provides more tissue than FNA, useful in diagnosing malignancies.
Endoscopic biopsy: May be performed during procedures like colonoscopy or endoscopy for gastrointestinal masses.

No comments yet 😉

Leave a Reply Cancel reply

You must be logged in to post a comment.

Don't take our word for it

"The stations you provide are strikingly similar to those I came across during my medical school finals (some even verbatim!), and I have tried many other exam platforms. I'm truly grateful for your priceless support throughout my final couple of years at medical school!"

Raza Q 🇬🇧

"It has absolutely everything for medical school, so many histories with detailed differential diagnoses, how to approach emergencies, commonly prescribed drugs..every kind go examination you’ll ever need in osces"

John R 🇬🇧

"Thank you SO MUCH for the amazing educational resource. I’ve tried lots of platforms and books with mock OSCE stations and yours is by far and away the best I’ve tried"

Ed M 🇳🇿

"Get this right away. So helpful for OSCEs but also general clinical learning and understanding. Wish I had brought it sooner"

Emma W 🇬🇧

"Without a doubt, your platform outshines all other OSCE resources currently available. In all honesty, I can confidently attribute my success in securing a distinction in my finals to OSCEstop."

Harish K 🇬🇧

"OSCEstop distinguishes itself from many other platform banks by offering a wealth of questions that mimic the demanding and complex aspects of our finals. This platform played a crucial role in ensuring I was ready for the level of difficulty that awaited me in my final exams."

Natasha W 🇳🇿

😃 More:

📖 Learning notes: 247

🏥 Stations available: 207

🧠 Qbank questions: 2255