Abdominal Masses

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

• Examine supraclavicular and inguinal nodes.
• Inspection - scars (especially round umbilicus for laparoscopy scars), distension, prominent veins, local swelling, pulsation, visible peristalsis, skin lesions, asymmetrical movement at eye level. Exclude lesions of abdominal wall: Patient raises head (no good for lateral abdomen), patient does straight leg-raising (Carnett's method), "blowing test" or valsalva, patient strains as if toileting (Kamath's test).²
• Palpation - use warm hands, 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.

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)
• FBC with film, ESR, U & Es.
• Liver function tests
• Chest and abdominal x-ray
• Ultrasound or CT guided fine needle biopsy
• Mantoux test
• Laparoscopy or laparotomy may ultimately be necessary to achieve a diagnosis