Abdominal masses are usually detected on physical examination rather than presented by the patient. Any patient with an unexplained abdominal mass should be referred for urgent specialist assessment.
- Examine supraclavicular and inguinal nodes.
- Inspection - scars (especially around 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' (Valsalva's test); the patient strains as if toileting (Kamath's test).
- 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.
Causes of Abdominal Mass by Location
|Right upper quadrant||Epigastric||Left upper quadrant|
|Right flank ||Periumbilical ||Left flank|
|Right iliac fossa ||Suprapubic ||Left iliac fossa |
(should not be able to palpate below mass)
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 (eg, barium enema, gastrointestinal series, intravenous pyelogram).
- FBC with film, ESR, U&Es.
- CXR 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.
Further reading and references
OMG, this is embarrassing.....i haven’t been able to break wind (sorry Fart), and have pains in my stomach and lower area. Am suffering with all sorts of gut issues and gallstones. Am having a scan...Fit bee
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