Download - Teaching Plan 4
![Page 1: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/1.jpg)
![Page 2: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/2.jpg)
![Page 3: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/3.jpg)
What’s the problems of these What’s the problems of these patients??patients??
![Page 4: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/4.jpg)
Abdominal massesAbdominal masses
![Page 5: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/5.jpg)
overviewoverview
• Not easy to be detected by patient Not easy to be detected by patient himselfhimself
• Usually detected by routine physical Usually detected by routine physical examinationexamination
• Most of them develop slowlyMost of them develop slowly
• crypticcryptic
![Page 6: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/6.jpg)
overviewoverview
Abdominalmass
abscess
Problem with a blood vessel
Enlarged Organ
(spleen,kidney,
liver etc.)
tumorAccumulation
of feces
![Page 7: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/7.jpg)
Symptoms and signsSymptoms and signs
![Page 8: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/8.jpg)
SymptomsSymptoms
![Page 9: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/9.jpg)
Abdominal aortic aneurysmAbdominal aortic aneurysm
• Pulsating mass around navelPulsating mass around navel
![Page 10: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/10.jpg)
aneurysmaneurysm
![Page 11: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/11.jpg)
postoperationpostoperation
![Page 12: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/12.jpg)
Bladder distentionBladder distention
• Firm mass in the Firm mass in the center of lower center of lower abdomen above abdomen above pelvic bonespelvic bones
• Some can extend Some can extend as far up as navelas far up as navel
![Page 13: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/13.jpg)
![Page 14: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/14.jpg)
cholecystitischolecystitis
• Tender mass felt below the liver in RUQTender mass felt below the liver in RUQ
![Page 15: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/15.jpg)
![Page 16: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/16.jpg)
COLON CANCERCOLON CANCER
• Mass anywhere in abdomenMass anywhere in abdomen
![Page 17: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/17.jpg)
Crohn’s disease or bowel obstrucCrohn’s disease or bowel obstructiontion• Multiple tender, sausage-shaped massesMultiple tender, sausage-shaped masses
![Page 18: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/18.jpg)
diverticulitisdiverticulitis
• Mass located Mass located in LLQin LLQ
![Page 19: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/19.jpg)
Gallbladder tumorGallbladder tumor
• Moderately tender, irregularly Moderately tender, irregularly shaped mass in RUQshaped mass in RUQ
![Page 20: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/20.jpg)
hydronephrosishydronephrosis
• Smooth , Smooth , spongy-feeling spongy-feeling mass mass
• In one or both In one or both sides or toward sides or toward the backthe back
![Page 21: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/21.jpg)
Kidney cancerKidney cancer
• Sometimes a mass in abdomenSometimes a mass in abdomen
![Page 22: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/22.jpg)
Liver cancerLiver cancer
• A firm, lumpy mass in RUQA firm, lumpy mass in RUQ
![Page 23: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/23.jpg)
![Page 24: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/24.jpg)
Liver enlargement (hepatomegalLiver enlargement (hepatomegaly)y)• Firm, irregular mass below right rib cage Firm, irregular mass below right rib cage
(right costal margin)(right costal margin)• Or on the left side in stomach area (epigOr on the left side in stomach area (epig
astric)astric)
![Page 25: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/25.jpg)
![Page 26: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/26.jpg)
neuroblastomaneuroblastoma
• Malignant tumorMalignant tumor• In lower abdomenIn lower abdomen• Occurs in children and in fantsOccurs in children and in fants
![Page 27: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/27.jpg)
Ovarian cystOvarian cyst
• Smooth, rounded, rubbery mass Smooth, rounded, rubbery mass above pelvis in lower abdomen above pelvis in lower abdomen
![Page 28: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/28.jpg)
![Page 29: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/29.jpg)
Pancreatic abscessPancreatic abscess
• Mass in epigastric area of upper abdomeMass in epigastric area of upper abdomenn
![Page 30: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/30.jpg)
Pancreatic pseudocystPancreatic pseudocyst
• Lumpy mass in epigastric area of upper Lumpy mass in epigastric area of upper abdomenabdomen
![Page 31: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/31.jpg)
![Page 32: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/32.jpg)
![Page 33: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/33.jpg)
Renal cell carcinomaRenal cell carcinoma
• Smooth, firm, nontender mass near (usuSmooth, firm, nontender mass near (usually one side)ally one side)
![Page 34: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/34.jpg)
Spleen enlargement (splenomegaSpleen enlargement (splenomegaly)ly)• Edge of enlarged spleen felt in LUQEdge of enlarged spleen felt in LUQ
![Page 35: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/35.jpg)
![Page 36: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/36.jpg)
Stomach cancerStomach cancer
• Mass in epigastric area of left-upper abdMass in epigastric area of left-upper abdomenomen
![Page 37: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/37.jpg)
![Page 38: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/38.jpg)
Uterine leiomyoma (Uterine leiomyoma ( 平滑肌瘤平滑肌瘤 ))
• Round, lumpy mass above pelvis in Round, lumpy mass above pelvis in the lower abdomenthe lower abdomen
![Page 39: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/39.jpg)
![Page 40: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/40.jpg)
Volvulus Volvulus
• A mass anywhere in abdomenA mass anywhere in abdomen
![Page 41: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/41.jpg)
![Page 42: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/42.jpg)
Ureteropelvic junction obstructioUreteropelvic junction obstructionn• A mass in lower abdomenA mass in lower abdomen
![Page 43: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/43.jpg)
signssigns
• 4 quadrants: RUQ, RLQ, LLQ, LUQ4 quadrants: RUQ, RLQ, LLQ, LUQ• PeriunbilicalPeriunbilical• Epigastric: area in the center of abdomeEpigastric: area in the center of abdome
n below the ribcagen below the ribcage
![Page 44: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/44.jpg)
diagnosisdiagnosis
history
location Time pattern other
![Page 45: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/45.jpg)
locationlocation
• Upper abdomen? Upper abdomen? RUQ? LUQ? Upper-RUQ? LUQ? Upper-middle area?middle area?
• Lower abdomen? RLQ? LLQ? Lower abdomen? RLQ? LLQ?
• Around navel?Around navel?
• In the groin? (inguinal)In the groin? (inguinal)
![Page 46: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/46.jpg)
Time patternTime pattern
• How long ago was it noticed?How long ago was it noticed?
• Come and go?Come and go?
• How often have you seen it?How often have you seen it?
![Page 47: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/47.jpg)
otherother
• Changes in size, position, extent of Changes in size, position, extent of discomfort, or in any other way?discomfort, or in any other way?
![Page 48: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/48.jpg)
Differential diagnosisDifferential diagnosis
![Page 49: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/49.jpg)
DifferentiationDifferentiation
• Huge ovarian cystHuge ovarian cyst √√ a large area of a large area of dullness at dullness at
midabdomenmidabdomen √√ tympany at lateralstympany at laterals (bow (bow
els could be pushed to the els could be pushed to the bilateral flanks) bilateral flanks)
√ √ The dullness of ovarian cyThe dullness of ovarian cyst could not shiftst could not shift..
![Page 50: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/50.jpg)
DifferentiationDifferentiation
• Ruler pressing testRuler pressing test √√ to differentiate huge ovariato differentiate huge ovaria
n cyst from real ascitesn cyst from real ascites √√ take the supine position, a htake the supine position, a h
ard ruler on the patient’s aard ruler on the patient’s abdominal wall horizontally, bdominal wall horizontally, presses the ruler downward presses the ruler downward with two handswith two hands
![Page 51: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/51.jpg)
DifferentiationDifferentiation
• If huge ovarian cyst exists, If huge ovarian cyst exists, the pulsation of abdominal the pulsation of abdominal aorta will conduct to the aorta will conduct to the ruler via the cyst, leading to ruler via the cyst, leading to rhythmic pulsation of the rhythmic pulsation of the hard ruler.hard ruler.
• If free fluid, not cyst, exists If free fluid, not cyst, exists in the abdominal cavity, the in the abdominal cavity, the pulsation of abdominal pulsation of abdominal aorta could not conduct, so aorta could not conduct, so the hard ruler has no such the hard ruler has no such rhythmic pulsation.rhythmic pulsation.
![Page 52: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/52.jpg)
DifferentiationDifferentiation
• pregnancypregnancy
√√ breast engorged breast engorged
√√ fetal movement fetal movement and parts may be and parts may be feltfelt , , fetal heart fetal heart should be audibleshould be audible
√ √ cervix softenedcervix softened
![Page 53: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/53.jpg)
DifferentiationDifferentiation
• cecumcecum √√ cecum felt: indistinct soft cecum felt: indistinct soft
mass, slightly tender, fluctmass, slightly tender, fluctuant uant
firmer mass felt:firmer mass felt: √√ tuberculous granulomatuberculous granuloma √ √pericecal or appendiceal apericecal or appendiceal a
bscessbscess √√crohn diseasecrohn disease √ √carcinomacarcinoma
![Page 54: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/54.jpg)
DifferentiationDifferentiation
• fecesfeces √√ irregular plastic irregular plastic
masses of feces may masses of feces may be palpated in be palpated in sigmoidsigmoid
√ √ it can move or it can move or disappear in 1 or 2 disappear in 1 or 2 days days
![Page 55: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/55.jpg)
DifferentiationDifferentiation
• EnlargeEnlarged d
kidneykidney
Enlarged Enlarged kidneykidney
congenitalInflammatory/
immuneMechanical/
traumaneoplastic
![Page 56: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/56.jpg)
DifferentiationDifferentiation
• Enlarged kidney--Enlarged kidney--congenitalcongenital √√ polycystic kidney diseasepolycystic kidney disease √√ horseshoe kidneyhorseshoe kidney √ √compensatory ypertrophy ocompensatory ypertrophy o
pposite absent kidneypposite absent kidney √√idiopathic. Cyst(idiopathic. Cyst( 先天性的,先天性的,
特发的)特发的)
![Page 57: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/57.jpg)
DifferentiationDifferentiation
• Enlarged kidney--Enlarged kidney--Inflammatory/immune
√ √ amyloidosis amyloidosis (( 淀粉样变性)淀粉样变性)
![Page 58: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/58.jpg)
DifferentiationDifferentiation
• Enlarged kidney-- Enlarged kidney-- Mechanical/trauma √ √ hydronephrosis hydronephrosis √√ hematomahematoma
![Page 59: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/59.jpg)
DifferentiationDifferentiation
• Enlarged kidney-- Enlarged kidney-- neoplastic √ √ renal cell carcinomarenal cell carcinoma √√ renal sarcoma (renal sarcoma ( 肉瘤肉瘤 )) √ √transitional cell carcinoma of retransitional cell carcinoma of re
nal pelvis and ureternal pelvis and ureter
![Page 60: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/60.jpg)
DifferentiationDifferentiation
• Enlarged kidneyEnlarged kidney √ √ lacks the sharp edge the spleen and liver malacks the sharp edge the spleen and liver ma
y presenty present √√ lobulation of kidney may be mistaken for splobulation of kidney may be mistaken for sp
enic notchenic notch √ √enlarged kidney may be more often irregulaenlarged kidney may be more often irregula
r than spleenr than spleen √ √renal mass do not move with deep inspiratorrenal mass do not move with deep inspirator
y effort, unlike spleen and liver, because of rey effort, unlike spleen and liver, because of retroperitoneumtroperitoneum
![Page 61: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/61.jpg)
Other abdominal massOther abdominal mass
• VolvulusVolvulus• IntussusceptionIntussusception• AbscessAbscess• Enlarged tender gallbladderEnlarged tender gallbladder• Distended urinary bladderDistended urinary bladder• Abdominal, inguinal, and other herniaAbdominal, inguinal, and other hernia
![Page 62: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/62.jpg)
Enlarged tender gallbladderEnlarged tender gallbladder
• Progressive enlargement of the gallbladder--obstProgressive enlargement of the gallbladder--obstruction of common bile ductruction of common bile duct
• Nontender gallbladder—stones, acalculous choleNontender gallbladder—stones, acalculous cholecystitis, gallbladder hydropscystitis, gallbladder hydrops
• Contracted gallbladder—chronic cystic duct obstContracted gallbladder—chronic cystic duct obstructionruction
• Dilatation of gallbladder—carcinoma of the head Dilatation of gallbladder—carcinoma of the head of pancreas but not with common duct stoneof pancreas but not with common duct stone
• Hard, irregular mass, tender—carcinoma of gallblHard, irregular mass, tender—carcinoma of gallbladderadder
![Page 63: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/63.jpg)
![Page 64: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/64.jpg)
![Page 65: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/65.jpg)
Distended urinary bladderDistended urinary bladder
• In midline, may reach the umbilicusIn midline, may reach the umbilicus
• Dull to percussionDull to percussion
• FluctuantFluctuant
• PainlessPainless
• Disappears wit catheterizationDisappears wit catheterization
![Page 66: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/66.jpg)
Abdominal, inguinal, and other Abdominal, inguinal, and other herniahernia
• Abdominal heaniaAbdominal heania: : Incisional heniaIncisional henia• Operative scarOperative scar• Defect in abdominal wallDefect in abdominal wall• Valsalva maneuver or raise head while sValsalva maneuver or raise head while s
upine: herniation occurs adjacent to the upine: herniation occurs adjacent to the scar scar
![Page 67: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/67.jpg)
![Page 68: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/68.jpg)
![Page 69: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/69.jpg)
![Page 70: Teaching Plan 4](https://reader034.vdocument.in/reader034/viewer/2022051314/55288eb34a7959ce3d8b475a/html5/thumbnails/70.jpg)
Luxembourg