Presentation

Abdominal masses are usually detected on physical examination rather than presented by the patient.

Examination^1,2,3

• Examine supraclavicular and inguinal nodes.
• Inspection - scars (especially round the umbilicus for laparoscopy scars), distension, prominent veins, local swelling, pulsation, visible peristalsis, skin lesions, asymmetrical movement at eye level. Exclude lesions of the abdominal wall: the patient raises their head (no good for the lateral abdomen); the patient does straight leg-raising (Carnett's method), 'blowing test' or Valsalva's test; the patient strains as if toileting (Kamath's test).⁴
• Palpation - use warm hands, and examine the tender areas last. Light palpation, then deep. Check for guarding, rigidity and rebound tenderness. Determine for any mass: site, tenderness, size and shape, surface (irregular or smooth), edge (regular or irregular), consistency (soft or hard), mobility, whether pulsatile or ballotable.

Investigations³

Investigations will depend on the site and likely clinical diagnosis The following may be helpful:

• Early ultrasound or CT scan.
• Hollow organs may require the use of a contrast medium (e.g. barium enema, GI series, intravenous pyelogram).
• Full blood count with film, ESR, urea and electrolytes.
• Liver function tests.
• Chest and abdominal X-ray.
• Ultrasound or CT-guided fine needle biopsy.
• Mantoux' test.
• Paracentesis with fluid examination if ascites is present.
• Laparoscopy or laparotomy may ultimately be necessary to achieve a diagnosis.

Document references

1. Longmore M, Wilkinson I, Rajagopalan S; Oxford Handbook of Clinical Medicine, published by Oxford University Press, 2004.
2. Epstein O; Clinical Examination, published by Mosby, 2003.
3. Kahan S, Smith E; Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.; Accessed through the wrongdiagnosis.com website
4. Carnett's test; whonamedit.com 2008

Acknowledgements