Makindo Medical Notes

Abdominal masses are a significant clinical finding that may arise from many underlying conditions. A systematic approach — history, examination, investigations — is essential to differentiate between benign and sinister causes. Some masses are incidental; others may signal life-threatening pathology such as an abdominal aortic aneurysm or malignancy.

📝 Patient History

• Onset & duration ⏳: Sudden vs gradual appearance.
• Associated symptoms 🤒: Pain, bowel/urinary changes, nausea, vomiting, weight loss, fatigue.
• Medical history 📚: Malignancies, previous abdominal surgery (adhesions), infections, trauma.
• Family history 👨‍👩‍👦: Genetic predispositions (e.g., polycystic kidney disease, cancers).
• Systemic symptoms 🌡️: Fever, night sweats, anorexia may suggest infection or malignancy.

👩‍⚕️ Physical Examination

• Location 📍: RUQ, LUQ, flank, pelvis, suprapubic.
• Size & shape 📏: Estimate dimensions; smooth vs irregular.
• Consistency 🪨: Hard (tumour), soft (cyst), fluid-filled, nodular.
• Mobility ↔️: Moves with respiration (e.g., liver, spleen) vs fixed (retroperitoneal/attached to bowel wall).
• Pulsatility ❤️: Expansile pulsation suggests abdominal aortic aneurysm.
• Tenderness 🤕: Guarding or rebound indicates peritonitis or infection.

⚠️ Causes of Abdominal Masses

Cause	Clinical Features	Examination Findings
🟤 Liver Enlargement (Hepatomegaly)	RUQ mass, jaundice, ascites, weight loss, alcohol/viral hepatitis history	Palpable liver edge, may be smooth/nodular, percuss for size
🟥 Spleen Enlargement (Splenomegaly)	LUQ mass, fatigue, fever, bleeding, infection/lymphoma history	Palpable under costal margin, moves with respiration, dull percussion
🟦 Kidney Enlargement (Renal Mass)	Flank pain, haematuria, weight loss, fever, PCKD/renal carcinoma	Ballotable flank mass, does not move with respiration
❤️ Aortic Aneurysm	Pulsatile mass, back/abdo pain, HTN/smoking/vascular risk	Midline expansile pulsatile mass, bruit may be heard
💨 Intestinal Obstruction	Cramping pain, vomiting, constipation, distension, post-surgery	Distended, tender abdomen, hyperactive/absent bowel sounds
🟣 Ovarian Cyst/Mass	Pelvic pain, bloating, menstrual irregularities, urinary/bowel pressure	Pelvic/lower abdo mass, mobile, tenderness variable
💧 Bladder Distension	Urinary retention, frequency, BPH/urethral stricture history	Suprapubic tense mass, dull percussion, increases with fluid intake

🔬 Investigations

• Bloods 🧪: FBC, U&E, LFTs, tumour markers (AFP, CA-125, CEA depending on suspicion).
• Urinalysis 🚻: Haematuria or infection (renal/bladder causes).
• Imaging 📸: – Ultrasound → first-line, non-invasive. – CT/MRI → localisation, staging, vascular involvement.
• Endoscopy 🪞: If GI origin suspected.
• Biopsy 🔎: Essential if malignancy suspected.

🧾 Common Causes (by Organ)

• Liver: Cirrhosis, HCC, metastases, abscess.
• Spleen: Malaria, EBV, myeloproliferative disorders, lymphoma.
• Kidney: PCKD, RCC, hydronephrosis, cysts.
• Aorta: Abdominal aortic aneurysm.
• GI tract: Obstruction, Crohn’s, tumours, hernias.
• Reproductive: Ovarian cysts, fibroids, pregnancy masses.
• Bladder: Retention, transitional cell carcinoma.

💊 Management Principles

Treatment depends entirely on the underlying cause:

• 🦠 Infection: Antibiotics, drainage if abscess.
• 🎗️ Tumours: Surgery, chemo, radiotherapy depending on stage.
• 💧 Cysts: Observation if simple; aspiration or resection if symptomatic/large.
• ❤️ AAA: Endovascular repair or open surgery if ≥5.5 cm or symptomatic.
• 🚑 Obstruction: NG tube, IV fluids, surgery if complete/strangulated.
• 🟣 Ovarian masses: Gynae referral, surgery if suspicious/large.
• 💧 Bladder distension: Catheterisation, treat underlying cause (e.g., BPH).

📚 Key Teaching Pearls

• Always assess location + mobility + consistency + pulsatility.
• AAA is the most urgent to rule out — think “expansile pulsatile mass”.
• Use systematic organ-based differential to structure answers in exams.
• Management is often multidisciplinary: surgeons, oncologists, radiologists, urologists, gynaecologists.