Physical signs of abdominal masses
Signs of hepatomegaly
- Mass descending below right costal margin and costal angle
- Moves with respiration and can not get above it
- Dullness to percussion up to the level of the 8th rib in the mid-axillary line
Signs of splenomegaly
- Mass descending below the left 10th rib and enlarging in a line towards the umbilicus
- Often has a palpable notch on the medial border
- Moves with respiration and can not get above it
- Dullness to percussion
- Can be brought forward by lifting the lower ribs
- Can not be felt bimanually or balloted
Signs of a renal mass
- Mass lies in paracolic gutter
- Moves with respiration but usually only lower border is palpable
- Can be felt bimanually or balloted
- Not dull to percussion
Signs of an enlarged gallbladder
- Mass arising from below the tip of the right 9th rib
- Smooth and hemi-ovoid in shape
- Moves with respiration
- Dull to percussion
- Can not feel space between mass and liver
Signs of an enlarged urinary bladder
- Hemi-ovoid smooth mass arising from the pelvis
- Can extend above umbilicus
- Non-mobile and dull to percussion
- Does not bulge into the pelvis
- Can not be felt on rectal examination
Signs of an ovarian cyst
- Smooth mass arising from the pelvis
- Mobile from side-to-side but not up and down
- Dull to percussion
- Palpable fluid thrill
- Lower extremity can be felt on pelvic examination
Causes of hepatomegaly
Smooth generalised enlargement
- Congestion due to cardiac failure
- Micronodular cirrhosis
- Reticuloses
- Hepatic vein obstruction (Budd-Chiari syndrome)
- Infective hepatitis
- Cholangitis
- Portal pyaemia
- Amyloidosis
Knobbly generalised enlargement
- Secondary carcinoma
- Macronodular cirrhosis
- Polycystic disease
Localised swelling
- Riedel's lobe
- Hydatid cyst
- Liver abscess
- Hepatocellular carcinoma
Causes of splenomegaly
Infection
- Bacterial - typhoid, typhus, TB
- Viral - glandular fever
- Protozoal - malaria, kala-azar
Cellular proliferation
- Myeloid and lymphatic leukaemia
- Pernicious anaemia
- Polycythaemia rubra vera
- Spherocytosis
- Thrombocytopenia purpura
- Myelosclerosis
Congestion
- Portal hypertension
- Hepatic vein obstruction
- Congestive heart failure
Others
- Amyloidosis
- Gaucher's disease
- Felty's syndrome
- Angioma
- Lymphosarcoma
Causes of a renal mass
- Hydronephrosis
- Pyonephrosis
- Perinephric abscess
- Hypernephroma
- Nephroblastoma
- Solitary cyst
- Polycystic disease
Causes of a palpable gall bladder
- Obstruction of the cystic duct
- Stone in Hartmann's pouch
- Cholangiocarcinoma
- Obstruction of the common bile duct
- Stone in common bile duct
- Carcinoma of the head of the pancreas
Courvoisier's law
'If in the presence of jaundice the gallbladder is palpable, the obstruction of the bile duct causing the
jaundice is unlikely to be due to a stone.'
Stones causes a thickened non-distensible gall bladder
Causes of a right iliac fossa mass
- Appendicitis
- Tuberculosis
- Carcinoma of the caecum
- Crohn's disease
- Iliac lymphadenopathy
- Psoas abscess
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