Abdominal swellings (localized): lower abdominal
Abdominal swellings (localized): lower abdominal
KEY POINTS
Retroperitoneal mass: no movement with respiration, difficult to delineate, resonant to percussion.
Bowel masses: often mobile, may be well defined.
Pelvic mass: difficult to get below', bimanually palpable on PR/PV
examination.
Sigmoid colon
Diverticular mass: tender, ill defined, rubbery hard, non-mobile.
Paracolic abscess: acutely tender, ill defined, ?fluctuant, systemic
upset.
Carcinoma: hard, craggy, non-tender unless perforated, immobile,
associated with altered bowel habit/obstructive symptoms.
Faeces: firm, indentable/malleable', mobile with colon.
Normal: only in a thin person, non-tender, chord like.
Caecum/ascending colon
Appendix mass/abscess: acutely tender, ill defined, fluctuant,
systemic upset.
Carcinoma: hard, craggy, non-tender unless perforated, immobile,
associated with anaemia/weight loss and anergia.
Terminal ileum
Crohn's mass: tender, ill defined, rubbery hard, non-mobile.
Tuberculous mass: mildly tender, ill defined, firm, associated with cutaneous sinuses, systemic TB.
Ovary/fallopian tube
Cyst: may be massive, usually mobile, ?bimanually palpable on PV examination.
Neoplasm.
Ectopic pregnancy: very tender, associated with PV bleeding/ intra-abdominal bleeding and collapse.
Salpingo-oophoritis: very tender, bimanually palpable, associated with PV discharge.
Bladder
Generally: midline swelling, extends up towards umbilicus, dull to percussion, non-mobile, cannot get below' it.
Retention of urine: stony dull to percussion, associated with desire to pass urine, disappears on voiding/catheterization.
Transitional cell carcinoma: hard, irregular, fixed, may be associated with dysuria, haematuria and desire to pass urine on examination.
Uterus
Pregnancy: smooth, regular, fetal heart sounds heard/ movements!
Fibromyoma: usually smooth, may be pedunculated and mobile, non-tender, associated menorrhagia.
Uterine carcinoma: firm uterus, may be tender, irregular only if tumour is extrauterine, associated PV bloody discharge.
Rectum
Carcinoma: firm, irregular, non-tender, relatively immobile, associated alteration in bowel habit/PR bleeding.
Urachus (rare)
Cyst: small swelling in midline, ?associated umbilical discharge.
Other
Pelvic kidney: smooth, regular, non-tender, non-mobile.
KEY INVESTIGATIONS
FBC: anaemiabtumours.
WCC: lymphomas, Crohn's disease, appendicitis/diverticulitis.
LFTs: liver lesions.
Ultrasound: ovarian lesions, appendix/diverticular mass or abscess, Crohn's mass, pelvic kidney, ovarian lesions, pregnancy, uterine lesions, bladder tumours.
CT scan: retroperitoneal/mesenteric cysts, omental deposits, appendix/diverticular mass or abscess, Crohn's mass. Allows guided drainage of abscesses and biopsy of some tumours.
Colonoscopy: colonic tumours, diverticular disease.
Small bowel enema: small intestinal tumours, ileal Crohn's disease.
Barium enema: diverticular disease, colonic tumours.
MSU: infected urinary retention.
-HCG: pregnancy.
Source: Surgery At a Glance
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