Sandbox:Javaria: Difference between revisions
No edit summary |
No edit summary |
||
Line 22: | Line 22: | ||
{{familytree | | |,|-|-|-|v|-|-|-|+|-|-|-|v|-|-|-|.| }} | {{familytree | | |,|-|-|-|v|-|-|-|+|-|-|-|v|-|-|-|.| }} | ||
{{familytree | | |!| | | |!| | | |!| | | |!| | | |!| |} | {{familytree | | |!| | | |!| | | |!| | | |!| | | |!| |} | ||
{{familytree | | D01 | | D02| | D03 | | D04 | | D05 |D01='''Hepatic mass'''<br>❑[[Hepatitis]] (infectious, [[DILI]], [[Alcoholic liver disease|alcoholic]],<br> [[NASH]], [[autoimmune hepatitis|autoimmune]], [[Wilson's disease]]<br>❑Storage diseases ([[glycogen storage disease]],<br> [[lysosomal storage disease]], [[lipid storage disease]], [[hemochromatosis]]<br>❑[[Tumors]]:❑Primary Benign:[[Hepatic adenoma|adenoma]], [[Focal nodular hyperplasia|FNH]]<br>:❑Primary malignant:[[Hepatocellular carcinoma|HCC]], [[cholangiocarcinoma]]<br>:❑Metastatic: [[Hemangioma]], [[lymphoma]],<br> [[myeloma]] and solid tumors.<br>❑[[Cholestasis]]:[[Primary biliary cirrhosis|PBC]], [[Primary sclerosing cholangitis|PSC]], | D02='''Splenic mass'''<br>❑[[Myeloproliferative disorders]]| D03=Pancreatic mass| D04=[[Retroperitoneal]] mass|D05=Aortic aneurysm|}} | {{familytree | | D01 | | D02| | D03 | | D04 | | D05 |D01='''Hepatic mass'''<br>❑[[Hepatitis]] (infectious, [[DILI]], [[Alcoholic liver disease|alcoholic]],<br> [[NASH]], [[autoimmune hepatitis|autoimmune]], [[Wilson's disease]]<br>❑Storage diseases ([[glycogen storage disease]],<br> [[lysosomal storage disease]], [[lipid storage disease]], [[hemochromatosis]]<br>❑[[Tumors]]:❑Primary Benign:[[Hepatic adenoma|adenoma]], [[Focal nodular hyperplasia|FNH]]<br>:❑Primary malignant:[[Hepatocellular carcinoma|HCC]], [[cholangiocarcinoma]]<br>:❑Metastatic: [[Hemangioma]], [[lymphoma]],<br> [[myeloma]] and solid tumors.<br>❑[[Cholestasis]]:[[Primary biliary cirrhosis|PBC]], [[Primary sclerosing cholangitis|PSC]], | D02='''Splenic mass'''<br>❑[[Myeloproliferative disorders]] ([[lymphoma]]s<br> and [[leukemia]]s)<br>❑Storage: [[Gaucher’s disease|Gaucher's]], [[Niemann-Pick disease]]<br>❑Infiltrative:[[amyloidosis]], [[sarcoidosis]]<br>❑[[Infections|Infectious]]:[[Infectious Mononucleosis|EBV]], [[liver abscess]],<br>[[echinococcosis]]<br>❑Miscellineous:[[Portal hypertension|PH]], [[metastases]] <br>([[lung cancer]] or [[breast cancer]]), [[Felty's syndrome]]| D03='''Pancreatic mass'''<br>❑[[Pancreatic cyst]]<br>:❑[[Pancreatic cancer differential diagnosis|Neoplastic]]: [[Mucinous cystadenocarcinoma differential diagnosis|Mucinous]], [[serous]],<br> [[Intraductal papillary mucinous neoplasm|intraductal papillary]], and solid pseudopapillary<br>:❑Non-neoplastic: True, [[mucinous]] and [[retention cyst]]<br>:❑[[inflammation|Inflammatory]]:[[Pancreatic pseudocyst|pseudocyst]],<br> [[acute]] fluid collection.<br>❑Solid:[[Periampullary tumors]],<br>[[pancreatic neuroendocrine tumor]], [[Lymphoma]]| D04='''[[Retroperitoneal]] mass'''<br>(Majority tumors are [[malignant]])<br>❑[[Liposarcoma]]<br>❑[[Incidentaloma]]<br>❑[[Lymphoma]]|D05=Aortic aneurysm|}} | ||
{{familytree | | | | | | | | | }} | {{familytree | | | | | | | | | }} | ||
{{familytree | | | | | | | | | }} | {{familytree | | | | | | | | | }} |
Revision as of 05:19, 14 August 2020
Shown below is an algorithm summarizing the diagnosis of abdominal mass according the the [...] guidelines.
Abdominal mass | |||||||||||||||||||||||
History and brief physical exam Past medical history | |||||||||||||||||||||||
Hemodynamic instability | Stable | ||||||||||||||||||||||
{{{ ! }}} | {{{ ! }}} | ||||||||||||||||||||||
{{familytree | | |!| | | |!| | | |!| | | |!| | | |!| |}
Abbreviations: ACS: Acute coronary syndrome; AAA: Abdominal aortic aneurysm; RUQ: Right upper quadrant; RLQ: Right lower quadrant; LUQ: Left upper quadrant; LLQ: Left lower quadrant
Characterize the mass:
Associated symptoms
Detailed history:
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Examine the patient: ❑ Vital signs
❑ Skin
❑ Inspection
❑ Auscultation
❑ Palpation
❑ Psoas sign (suggestive of retrocecal appendix) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Consider extraabdominal differential diagnosis: ❑ aaaa | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
❑ Assess hemodynamic stability | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
If the patient is unstable, Stabilize the patient: ❑ Establish two large-bore intravenous peripheral lines ❑ NPO until the patient is stable ❑ Supportive care (fluids and electrolyes as required) ❑ Place nasogastric tube if there is bleeding, obstruction, significant nausea or vomiting ❑ Place foley catheter to monitor volume status ❑ Cardiac monitoring ❑ Supplemental oxygen as needed ❑ Administer early antibiotics if indicated | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
If the patient is stable, Order laboratory tests: ❑ Pregnancy test (required in women of child-bearing age) ❑ CBC ❑ Hematocrit ❑ Urinalysis ❑ Serum electrolytes ❑ ESR ❑ ABG ❑ D dimer ❑ Serum lactate ❑ BUN ❑ Creatinine ❑ Amylase ❑ Lipase ❑ Triglyceride ❑ Total bilirubin ❑ Direct bilirubin ❑ Albumin ❑ AST ❑ ALT ❑ Alkaline phosphatase ❑ GGT ❑ Stool for ova and parasites ❑ C. difficile culture and toxin assay Order imaging studies: *Order the tests to rule in a suspected diagnosis or to assess a case of unclear etiology *In case of elderly patients, immunocompromised or those unable to provide a comprehensive history, order broader range of tests | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Signs of peritonitis or shock ❑ Fever ❑ Abdominal tenderness ❑ Abdominal gaurding ❑ Rebound tenderness (blumberg sign) ❑ Diffuse abdominal rigidity ❑ Confusion ❑ Weakness ❑ Low blood pressure ❑ Decreased urine output ❑ Tachycardia | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
No | Yes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||