What is an Abdominal Mass?

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Abdominal mass

An abdominal mass is an abnormal mass that can be touched during an abdominal examination. Common causes include organ enlargement, cavity organ expansion, tissue proliferation, inflammatory adhesions, and benign and malignant tumors. Abdominal masses mainly rely on palpation. If palpation is found, attention should be paid to the location, size, shape, quality, tenderness and mobility of the mass. To identify the origin and nature of the mass.

Overview of abdominal mass

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Abdominal mass

abdominal mass

Masses in the abdomen (including the abdominal wall, abdominal cavity, and retroperitoneal space) can be physiological, such as a full bladder, a pregnant uterus, and dry stools; more importantly, they are pathological and are clinical manifestations of some abdominal diseases. Generally speaking, the abdominal mass refers to the latter, whose diagnosis is difficult, and special attention should be paid to distinguish it from "physiological mass".

Classification of abdominal masses

There are many classification methods, which can be roughly divided into six types according to the nature of the mass (Table 1 Classification of abdominal masses).

Some diseases cannot be accurately classified according to the above classification, such as retroperitoneal masses can appear in the abdomen

Abdominal mass In any part of the pancreatic cystadenocarcinoma, it is both a tumor and a cyst. Usually, abdominal mass refers to chronic disease, and the mass manifested by acute abdomen is not included in this list.

A physiological "bulk" is not a true disease, but is sometimes mistaken for a pathological mass. In addition to the uterus, bladder, and feces, the muscles of the developed rectus abdominis tendon, the spine or head of the sacrum, and the spontaneous spasm of the intestines may be misdiagnosed as pathological. Even the abdominal aorta with a soft or weak abdominal wall can be mistaken for a "pulsating mass".

Most inflammatory masses are accompanied by inflammation, local pain, and elevated white blood cell counts. Such as peri-appendicitis mass, mesenteric lymph node tuberculosis, abscesses around the kidney and so on.

Tumorous masses are mostly solid masses. The majority of malignant tumors are characterized by rapid development, with anemia, wasting, and cachexia in the later stages; benign tumors have a long history, large tumors, smooth, and a certain degree of activity.

Cystic masses are mostly round or oval, with smooth surfaces and a sense of undulation. Common congenital polycystic liver, polycystic kidney, and umbilical urinary cysts; retained pancreatic cysts and hydronephrosis; tumorous ovarian cysts; inflammatory gallbladder effusion, hydrosalpinx, encapsulating effusion ; Parasitic hydatid cysts and so on.

Obstructive masses Obstructive masses of the gastrointestinal tract can cause abdominal pain, bloating, vomiting or constipation without venting; etc. Obstructive biliary masses cause painless jaundice and generally do not have fever; obstructive urinary tract masses often cause lumbar pain. Strictly speaking, congestive splenomegaly and biliary hepatomegaly are also obstructive masses.

Traumatic masses such as spleen ruptured hematoma in the left upper abdomen, pseudopancreatic cyst in the upper abdomen, and retroperitoneal hematoma in the lower abdomen or pelvis. See Abdominal trauma.

Key points for abdominal mass diagnosis

The diagnosis of an abdominal mass relies on a detailed medical history, detailed examination, accurate test results and necessary special examinations. It is required to answer questions such as whether the mass is pathological, location of origin, and nature in order to develop a treatment plan.

History of abdominal mass

Ask the medical history to pay attention to the following points: the location, time and accompanying mass

Abdominal mass Symptoms, such as abdominal pain, fever, local discomfort, and history of trauma and family history of tumors. Patients with transient abdominal pain, local peritoneal irritation, and systemic infectious symptoms before the onset of the mass should be suspected of being an inflammatory mass. If the patient has suffered from tuberculosis, chronic low fever, loss of appetite, and abdominal pain, the intra-abdominal mass may be tuberculous. Masses appear for a long time, grow slowly, without other discomforts, and are mostly benign tumors; on the other hand, if they grow rapidly and the patient is significantly thin, they are mostly malignant tumors. Therefore, the changes of inflammatory masses are calculated daily; malignant tumors are calculated monthly; benign tumors are calculated annually. This is not entirely accurate, but it helps to make a preliminary judgment. Whether there are symptoms of digestive tract. Because the digestive system occupies a lot of space in the abdomen, those with these symptoms are mostly caused by compression of the tumor of the digestive tract itself or extra-intestinal mass. For example, repeated vomiting indicates gastric antrum or duodenal disease; vomiting coffee-like residues are more common in gastric cancer; colon masses can cause changes in blood in the stool and defecation habits; right upper quadrant masses are accompanied by jaundice, and are mostly lesions near the liver or biliary tract. other accompanying symptoms. Masses in the urinary system are mostly hematuria, frequent urination and other symptoms, such as kidney cancer is often accompanied by low back pain and gross hematuria. Female genital masses are often accompanied by menstrual changes or vaginal bleeding. For example, patients with uterine fibroids may experience increased menstrual flow or infertility.

Physical examination of abdominal mass

It is necessary to pay attention to the local situation and the whole body situation.

In addition to paying attention to nutrition, anemia, and jaundice during systemic examination, pay attention to whether the lymph nodes are enlarged

Abdominal mass . The left supraclavicular lymphadenopathy is mostly metastasis of gastrointestinal tumors, because the thoracic duct that collects gastrointestinal lymph fluid flows here; systemic lymph nodes, especially those with enlarged neck and axillary lymph nodes, should be suspected of lymph Sarcoma and Hodgkin's disease.

Abdominal examination. If you see a gastrointestinal type or a peristaltic wave in the abdominal wall, most are gastrointestinal masses.

Instrumental examination of abdominal mass

Commonly used examination methods include X-ray 10,000-mode ultrasound CT MRI, endoscope

Abdominal mass Wait

The digestive tract can be examined with barium meal.

B-mode ultrasound CT MRI is suitable for examination of substantial organs to understand the space-occupying lesions in the organs. It is also an important method for diagnosing bladder loss and uterine mass.

Gastrointestinal masses are best examined by gastroscopy and colonoscopy.

Abdominal mass can be examined by laparoscopy. During endoscopic examination, biopsy should be taken for histological examination in order to determine the nature of the mass.

Abdominal mass signs

Abdominal masses mainly rely on palpation. Pay attention to the mass if palpation is found

Abdominal mass Location, size, shape, quality, tenderness and mobility. To identify the origin and nature of the mass.

1. Location of abdominal masses Determine the location of the masses to understand the source of the masses. The mass in a certain part mostly comes from the organs in that part. For example, the mass in the right upper abdomen is mostly from the liver, gallbladder, or hepatic flexure. The location of pedicled masses or mesentery and omentum masses varies. A large mass in the intestinal canal distribution area. If there is obstruction, the mass may be a mass in the intestinal canal. If there is no obstruction, it is mostly from the mesentery, omentum or retroperitoneal organs. Multiple and scattered patients are common in mesenteric lymph node tuberculosis, peritoneal tuberculosis or metastatic cancer of the abdominal cavity.

2. The size of the mass. Touching a small mass around the umbilicus may be an enlarged mesenteric lymph node. Huge masses occur in organs such as liver, spleen, pancreas, kidney, ovary and uterus, and cysts are common. If the size of the mass varies and may even disappear, it may be caused by inflated bowel music. The morphology of the mass was round and smooth, with cysts mostly. Irregular shape, the surface is not smooth and hard, mostly malignant tumors, inflammatory masses or tuberculous masses. Cord-like or tube-like masses with morphological changes within a short period of time may be roundworm or intussusception. The right upper abdomen touches an ovoid mass, which may be smooth as a gallbladder or kidney. The enlarged spleen can touch the spleen notch. The hardness and texture of the mass are more common in tumors, inflammatory or tuberculous masses, such as those formed by gastric cancer, liver cancer, and tuberculous peritonitis. If the mass is cystic, the mass is soft and more common in the cyst. The tender inflammatory mass has marked tenderness. Such as the mass in the right lower abdomen, tenderness is obvious, mostly abscess around the appendix. Significant tenderness in the liver may be liver abscess. Mobility If the mass moves up and down with breathing, it may be a mass of the liver, spleen, kidney, stomach, or these organs. Gallbladder and transverse colon masses can also move up and down with breathing. If the mass can be pushed by hand, it may come from the stomach, bowel, or mesentery. Masses with a wide range of movement and large distances are mostly pedicled masses that swim the spleen and kidneys. The peritoneal tumors and local inflammatory masses generally do not move.

Causes of abdominal masses

Abdominal mass

(1) Hepatomegaly: such as hepatitis, liver abscess, liver tumor, liver cyst and so on.

(2) Gallbladder enlargement: such as acute cholecystitis, hydrocystage, hemorrhage of the gallbladder, cholestasis

Abdominal mass Gallbladder enlargement, congenital common bile duct cyst, primary gallbladder cancer, gallbladder torsion, etc.

(3) Colon cancer of the hepatic flexure.

Epigastric mass

(1) Stomach mass: such as ulcer disease, gastric cancer and other benign and malignant tumors of the stomach, gastric mucosal prolapse, gastrolith.

(2) Pancreatic mass: such as acute pancreatitis, pancreatic cyst, pancreatic cystic adenoma, pancreatic cancer, etc.

(3) left liver lobe enlargement.

(4) Mesenteric and omental masses: such as mesenteric lymph node tuberculosis and mesenteric cysts.

(5) Small bowel tumors: such as small bowel malignant lymphoma, small bowel cancer, and other rare small bowel tumors.

(6) Abdominal aortic aneurysm.

Mass in the left upper abdomen

Common reasons are:

(1) Splenomegaly: liver cirrhosis, migratory spleen, paraspleen, etc.

(2) Pancreatic tumors and cysts.

(3) Colon cancer of the spleen flexure.

Lump in the abdomen

(1) Lumps caused by kidney disease: such as kidney sags and migratory kidneys, congenital renal cysts, hydronephrosis, renal empyema, shoe-shaped kidneys, kidney hydatid cysts, kidney tumors, etc.

(2) Pheochromocytoma and other adrenal tumors.

(3) Primary retroperitoneal tumor.

Mass in the right lower abdomen

(1) Appendiceal diseases: such as abscesses around the appendix, carcinoid appendix, and mucus cysts of the appendix.

(2) Masses in the ileoceccal area: more common in tuberculosis, Crohn's disease, cecum cancer, amoebic granulomatosis, and actinomycosis in the ileoceccal area.

(3) The omentum is twisted.

(4) Right ovarian tumor.

Lower abdomen mass

Can be seen in bladder tumors, bladder diverticula, and uterine tumors. Masses of the left lower abdomen can be seen in ulcerative colitis, rectum, sigmoid colon cancer, rectum, sigmoid schistosomiasis granuloma, left ovarian cyst, and so on. The common causes of extensive and unlocalized masses are tuberculous peritonitis, pneumoconiosis, abdominal hydatid cyst, peritoneal metastatic cancer, intussusception, tapeworm intestinal obstruction, and bowel torsion.

Abdominal mass

Although there are many causes of abdominal masses, the pathogenesis is as follows.

1. Swelling of the organs In the abdomen, parenchymal organs are often enlarged due to inflammation or tumor tissue proliferation. In circulatory disorders, such as chronic congestive heart failure or constrictive pericarditis, the liver can become enlarged due to congestion. Kidneys can become swollen due to hydronephrosis due to blocked, narrowed or compressed ureters. The portal hypertension caused by various reasons causes the splenic vein blood flow to be blocked and causes the spleen to enlarge. Can also be formed due to torsion or ectopic organs.

2. Cavity Organ Expansion Cavity organs can often cause obstruction due to inflammation, swelling, or torsion of the organs. After the obstruction, the effusion and gas in the cavity cause the organs to swell. Such as pyloric obstruction can be seen in the upper abdomen inflated stomach. Intestinal obstruction can be seen in the upper part of the obstruction. Lower urinary tract obstruction causes urinary bladder to cause bladder swelling. Obstructed bile ducts cause poor gallbladder enlargement.

3. Inflammation of the abdominal cavity When inflammation of the abdominal organs or tissues occurs, an inflammatory mass may appear if an abscess is formed. Such as liver abscesses, abscesses around the kidney, abscesses around the appendix. Inflammation of the abdominal cavity can make the organs adhere to each other to form a mass. The most common is tuberculous peritonitis. Abdominal masses Benign and malignant tumors of the abdominal organs, due to abnormal proliferation of tissue, often form a mass at the location, such as gastric cancer, pancreatic cancer, often seen in the upper abdomen. Masses compress nearby organs. For example, pancreatic cancer compresses the common bile duct and causes gallbladder enlargement. Benign masses in the abdominal cavity are more common in cysts. It can be congenital or secondary to inflammation. Generally, the growth rate is slow, but the volume can be large.

Diagnosis of abdominal mass

1. A detailed understanding of the medical history is important for the diagnosis of abdominal diseases. The growth rate of the mass and the accompanying symptoms can provide some clues to the diagnosis. Gastric cancer often has progressive loss of appetite, anemia, and weight loss in the history. Gallbladder enlargement with progressive jaundice without abdominal pain often indicates pancreatic head cancer. Gallbladder enlargement, intermittent jaundice with paroxysmal right upper quadrant pain, and fever are more common in gallstones. Liver enlargement, such as chronic heart failure in the history may be liver congestion. Inflammatory masses often have a history of fever and pain in the corresponding area. A long history, slow growth of the mass without other symptoms, and more suggestive of a benign mass.

Laboratory and other auxiliary inspections. Laboratory tests are important for the diagnosis of abdominal masses. If the lump is tender, the white blood cells rise, and the lump is mostly inflammatory. A huge spleen with a significant increase in leukocytes of tens to tens of thousands, and immature cells, suggesting chronic myelogenous leukemia. Laboratory bone marrow imaging can confirm the diagnosis. A lump in the upper abdomen. If the occult blood test continues to be positive, the lump may be gastric cancer. Hepatomegaly, often accompanied by abnormal liver function. Large liver with elevated alpha-fetoprotein, suggesting primary liver cancer. If accompanied by ascites, routine examination of ascites can identify ascites or exudate. The large liver is accompanied by leaky ascites, which may be liver congestion caused by cirrhosis or circulatory disorders. Can be identified as purulent infection or tuberculosis infection based on the white blood cell classification of ascites. More bloody ascites suggest malignant tumors. If cancer cells are found in the ascites, the cancer has metastasized. Biopsy is taken from the lump puncture and histological examination can often clarify the nature of the lump.

Other auxiliary examinations: In order to find out the exact location of the abdominal cavity mass, the organs and the nature of the mass, it is necessary to select appropriate instruments for examination in order to provide a reliable basis for the surgical treatment plan. Common examination methods include X-ray angiography, B-mode ultrasound, CT, magnetic resonance, and endoscopy.

The digestive tract can be examined with barium meal. B-mode ultrasound, CT, and magnetic resonance are suitable for the examination of substantial organs to understand the space-occupying lesions in the organs. It is also an important method for diagnosing bladder and uterine masses. Gastrointestinal masses are best examined by gastroscopy and colonoscopy. Abdominal mass can be examined by laparoscopy. During endoscopic examination, biopsy should be taken for histological examination in order to determine the nature of the mass. For the selection of the above inspection methods, economical and accurate methods should be selected. Avoid repeated inspections.

Identification of abdominal mass

1. Gastric cancer is more common in middle-aged and older male patients, with clinical manifestations of weight loss, upper abdominal pain and discomfort, and upper gastrointestinal bleeding. When abdominal masses appear, it usually indicates that the lesion is advanced, and the mass is mostly located in the upper abdomen or umbilicus. Hard, irregular surface, ill-defined borders, late stage may be complicated by pyloric obstruction. The diagnosis can be made by X-ray barium meal or gastroscopy and biopsy.

2. Intestinal obstruction Patients with intestinal obstruction have had a history of abdominal surgery, injury or inflammation, manifested as abdominal pain, vomiting, bloating, stopping gas discharge and defecation, etc., abdominal mass due to intestinal swelling may have fixed tenderness or peritoneal irritation. In the case of mechanical intestinal obstruction, inverse peristaltic waves can be seen, auscultation can be heard air sounds or metal sounds, X-ray standing abdominal perspective or plain film can see most liquid levels or flatulence.

3. Pancreatic cancer The abdominal mass caused by pancreatic cancer is often deep and fixed, with a hard texture and unclear edges. Pancreatic head cancer is located in the right middle and upper abdomen, and pancreatic body and tail cancer is located in the left upper abdomen. The main clinical symptom is upper abdominal pain. A small number of patients have severe abdominal pain. The pain is often related to the body position. When the body is leaning forward, the pain is reduced, and the pain is aggravated in the supine position. In addition, there are symptoms such as nausea, vomiting, and abdominal distension; Jaundice is progressively deeper and can enlarge the enlarged gallbladder without tenderness. B-ultrasound showed enlarged cancerous sites and dilated pancreatic ducts; X-ray gas-barium double contrast showed enlarged duodenal curvature; serum carcinoembryonic antigen, sugar antigens CA19-9, CA50, etc. were positive; ERCP, CT, radionuclide Scanning and endoscopic ultrasound and fine-needle aspiration cytology can provide diagnostic evidence. Pancreatic pseudocysts are usually secondary to pancreatitis or pancreatic trauma. Abdominal masses are mostly located in the middle and upper abdomen, of varying sizes, are round or oval, and the surface is smooth. If pseudocysts compress the lower part of the common bile duct, continuous or slow deepening jaundice can occur; B-ultrasound, CT and other examinations can reveal pancreatic sacs Sexual mass.

4. Acute cholecystitis In acute cholecystitis, gallbladder enlargement may occur due to gallbladder empyema due to gallbladder mucosal congestion and edema, vasodilation, and increased exudation. The enlarged gallbladder is generally oval in shape and has a smooth surface that moves up and down with breathing. If the internal pressure of the gallbladder continues to rise, it can cause tissue necrosis, perforation of the cystic wall, and the formation of peri-gallbladder abscesses when the peripheral adhesions are limited. At this time, the gallbladder appears as a large inflammatory mass with unclear edges and marked tenderness and Abdominal muscle tension, jaundice, and systemic symptoms. Abdominal masses are often detected based on medical history, signs, B-ultrasound, and CT.

Clear diagnosis.

5. Intestinal tuberculosis is more common in young adults, often secondary to extraintestinal tuberculosis (lung, ovary, fallopian tube or peritoneal tuberculosis, etc.). Proliferative intestinal tuberculosis can form inflammatory masses in the ileocecal region, with a relatively fixed location, medium hard texture, mild tenderness, clinical manifestations include abdominal pain, diarrhea and constipation alternation, fever, night sweats, etc. X-ray examination revealed irritation in the ileocecal region , Barium filling defect or stenosis and other signs, colonoscopy showed ulcerative lesions. If histological examination reveals caseous granulomatous disease, the diagnosis can be confirmed.

6. Crohn's disease (Crohn's disease) is more common in young people, with chronic recurrent right lower quadrant pain, diarrhea, fever and other symptoms. Due to intestinal adhesions, mesenteric lymphadenopathy, internal fistula or abscess formation, it is often in the right lower abdomen and lumps, the edges of the lumps are unclear, the texture is medium, and there is tenderness. In addition, patients are often accompanied by parenteral manifestations such as arthritis. X-ray signs showed that segmental ileal mucosal folds disappeared and showed a line-like sign; colonoscopy showed groove-like or fissured longitudinal ulcers, and the mucosa between the lesions was normal or paving stone-like changes were seen. A histological examination may establish a diagnosis if non-caseinous granulomas are found.

Abdominal Mass Treatment

Abdominal masses are common symptoms and signs in the clinic and can be caused by a variety of diseases. Therefore, when encountering patients with abdominal masses clinically, they should actively look for the primary disease causing the mass. Zoom out or fade. If it is determined that the mass is caused by inflammation, it is called an inflammatory mass, such as appendix abscess, intra-abdominal tuberculous mass, enlarged lymph nodes, etc., and should be actively anti-infective treatment. After anti-infective treatment, if the patient's pain or tenderness is reduced or disappeared, and the mass is reduced or disappeared, the diagnosis of inflammatory mass is generally established; on the contrary, the mass caused by other reasons should be considered. In addition to inflammatory masses, in general, those who are suspected of being tumorous masses should undergo fine needle puncture and cytological examination if possible. Once a tumor is diagnosed, as long as there is an indication for surgical treatment , Should be treated in a timely manner. As for the substantial mass in the abdominal cavity caused by various diseases, as long as the diagnosis is basically clear, there are surgical indications or the mass has caused intestinal obstruction, it should be surgically treated or surgical exploration.