Abdominal Masses
Assumptions
The student is familiar with the normal location, size and consistency of the abdominal viscera.
Objectives
1. Describe the causes of hepatomegaly.
 Discuss the role of liver function testing, ultrasound, CT scan and MRI in the evaluation.
 Discuss the most frequently encountered metastatic malignant hepatic tumors and their
management.
 Discuss the role of liver biopsy in the diagnosis and the available techniques.
 Discuss treatment of metastatic hepatic tumors.
2. Describe the causes of splenomegaly.
 Discuss the most common signs and symptoms associated with hypersplenism.
 Compare and contrast hypersplenism with an enlarged and normal sized spleen.
 Discuss the role of splenectomy in the treatment of hypersplenism.
 Discuss the consequences of hyposplenism. How can these be diminished?
 Discuss the short and long term complications associated with surgical removal of the spleen.
3. Describe the differential diagnosis of a pancreatic mass.
 Discuss the most useful diagnostic studies.
 Discuss the relationship of the pancreatic duct to the common bile duct and how this may impact
diagnosis and treatment of pancreatic lesions.
 Discuss the indications and techniques of biopsy the pancreas.
 Discuss the management of cystic lesions of the pancreas.
o How do you differentiate a pseudocyst from a cystadenoma or true cyst?
o Which patients need surgery and when?
o What are the major complications of pancreatic necrosis and pseudocyst formation?
4. Describe the most frequently encountered retroperitoneal masses.
 Discuss the appropriate imaging studies and work up for these tumors.
 Discuss the most frequently encountered lymphomas and their treatment.
 Discuss the most common retroperitoneal sarcomas and their management.
5. Describe the evaluation and management of abdominal aortic aneurysms.
 Discuss appropriate imaging studies for aneurysms.
 Discuss how to determine which patients need surgical repair of the aneurysm.
 Discuss the risks of surgical treatment and the risks of the aneurysm left untreated.
6. Describe the tumors most frequently associated with abdominal carcinomatosis and omental metastasis.
Problems
1. A 32-year-old woman presents with abdominal pain and a right upper quadrant mass. She is on birth
control pills, has known gallstones and a past history of hepatitis B infection.
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What is the most appropriate diagnostic work-up?
How do you differentiate an adenoma of the liver from hepatocellular carcinoma?
Does the presence or absence of cirrhosis impact your therapeutic decisions?
Do you remove an asymptomatic gallbladder with stones?
2. A 45-year-old alcoholic man is admitted with a week of nausea and vomiting. Evaluation reveals a mass
in his epigastrium which is tender. Ultrasound shows a 7 cm. cystic mass.
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What is the differential diagnosis?
Does the patient need antibiotic therapy for a pseudocyst? Why / why not?
What is the initial management of this patient?
How do you decide if he needs operative therapy and when is the appropriate timing?
What are the treatment options for drainage of a pseudocyst?
3. An 82-year-old man is brought to the emergency room with hypotension, back pain and a known history
of aortic aneurysm.
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What are the initial management priorities for this patient?
What, if any, diagnostic studies should be performed?
What is the expected mortality rate if this represents a rupture of the aneurysm?
What are the major complications associated with aneurysm rupture and repair?
Prevention
1.
Appropriate screening for aneurysm disease prior to age 60 in patients with a family history of aortic
aneurysm.
2.
Discuss the short and long term complications associated with surgical removal of the spleen.