A detailed article about Abdominal tumors

Abdominal tumors

Abdominal tumors refer to neoplasms and space-occupying lesions that appear and exist in various parts of the abdominal wall, peritoneal cavity, retroperitoneal cavity and pelvic cavity, and various tissues and organs. Abdominal tumors are usually classified into inflammatory tumors, obstructive tumors, hyperplastic tumors (tumors) and congenital tumors from the perspective of etiology; they are divided into sudden tumors (acute) and slowly growing tumors (chronic) from the perspective of onset; they are divided into solid and cystic tumors from the perspective of tumor characteristics; and they are divided into benign and malignant tumors from the perspective of pathological histology.

The Abdominal tumors involve a wide range of sites, including the abdominal wall, peritoneal cavity, retroperitoneal cavity and pelvic cavity. There are many tissues and organs involved, including hollow organs of the digestive tract, stomach, duodenum, jejunum, ileum, colon and rectum; biliary system, gallbladder and common bile duct; solid organs, liver, pancreas and spleen. There are also mesentery and greater omentum. The kidneys, ureters and bladder of the urinary system behind the peritoneum. The uterus, fallopian tubes and ovaries in the pelvic cavity. Pathological changes of tissues and organs are diverse and complex, and clinical manifestations are easily confuse with each other.

Therefore, it is often difficult to diagnose abdominal tumors. We must be open-mind, collect detailed medical history information and comprehensive physical examination, conduct effective and necessary auxiliary examinations, and make comprehensive analysis and judgments to achieve early diagnosis and treatment, so as to avoid delaying the disease, affecting the treatment effect and life.

Etiology

1. Inflammatory tumors caused by infectious diseases

Infectious abdominal wall abscess, tuberculous abdominal wall abscess, hepatitis-induced liver enlargement, bacterial liver abscess, cholecystitis, cholecystectomy, localized peritonitis due to perforation of gastric and duodenal ulcer, periappendiceal abscess, abdominal abscess, secondary infectious abscess of pancreatic cyst, ileocecal tuberculosis, intestinal Crohn’s disease, peritoneal and mesenteric lymph node tuberculosis, renal tuberculosis, bladder tuberculosis, pelvic tuberculosis, splenomegaly caused by infectious diseases (malaria, schistosomiasis, typhoid fever, kala-azar).

2. Enlarged masses of abdominal organs caused by obstructive diseases

Congestive enlargement of the liver due to hepatic vein obstruction, cholestatic enlargement of the gallbladder and bile duct caused by biliary obstruction, gastric dilatation caused by pyloric obstruction, congestive splenomegaly caused by portal hypertension, ileocecal tumors manifested by intussusception, left lower abdominal tumors caused by sigmoid colon volvulus, and bladder distension caused by urinary retention due to prostatic hypertrophy.

3. Abdominal tumors caused by proliferative diseases

Abdominal wall myofibroma, lipoma, neurofibroma, liver cancer, gallbladder cancer, gastric cancer, gastric sarcoma, splenomegaly due to leukemia, jejunal and ileal tumors, appendix carcinoid, colon cancer, rectal cancer, mesenteric lymphoma, mesenteric lymph node metastasis, bladder cancer, ovarian cancer, uterine body cancer, uterine fibroids, pancreatic cancer, adrenal pheochromocytoma, kidney cancer, retroperitoneal fibroma, lipoma, teratoma, lymphosarcoma, sympathetic neuroblastoma, peritoneal mesothelioma.

4. Congenital tumors

Polycystic liver cyst, hepatic hemangioma, common bile duct cyst, wandering spleen, appendiceal mucocele, mesenteric cyst, omental cyst, giant bladder, ovarian cyst, fallopian tube cyst, pancreatic cyst, adrenal cyst, polycystic kidney, renal ptosis and wandering kidney.

5. Abdominal tumors caused by other factors

Pregnancy: intra-abdominal pregnancy, gravid uterus.

Vascular diseases: abdominal aortic aneurysm, dissecting aneurysm.

Trauma: abdominal wall hematoma, intra-abdominal hematoma and retroperitoneal hematoma.

Diagnostic ideas

Diagnosis of abdominal tumors

Abdominal wallAbdominal cavityRetroperitonealPelvic
InflammatoryInfected abscessViral hepatomegalyRenal tuberculosisBladder tuberculosis
diseaseAbdominal wall tuberculosisBacterial liver abscessSecondary infection of pancreatic cystPelvic tuberculosis
Cholecystitis, cholecystectomy
Perforated gastric and duodenal ulcer
Limited peritonitis
Periappendiceal abscess
Abdominal abscess
Ileocecal tuberculosis
Intestinal Crohn’s disease
Ileocecal tuberculosis
Infectious splenomegaly
ObstructiveCongestive hepatic enlargementUrinary retention and bladder distension
diseaseCholestatic enlargement of the gallbladder and bile ducts
Gastric dilatation
Congestive splenomegaly
Ileocecal intussusception
Sigmoid volvulus
HyperplasticFibromaLiver cancerPancreatic cancerRectal cancer
diseaseLipomaGallbladder cancerAdrenal tumorUterine fibroids
NeurofibromaGastric cancer, gastric sarcomaKidney cancerBladder Cancer
Small Intestinal TumorsRetroperitoneal fibromaOvarian cancer
Appendiceal carcinoidLipomaUterine corpus cancer
Colon cancerTeratoma
Mesenteric lymphomaLymphosarcoma
Mesenteric metastasisSympathetic neuroblastoma
Peritoneal mesothelioma

Continued

Abdominal wallAbdominal cavityRetroperitonealPelvic
CongenitalMulticystic liver cystsPancreatic cystMegacystisOvarian cysts
diseaseHepatic hemangiomaAdrenal cystPolycystic kidney diseaseFallopian tube cyst
Choledochal cystKidney ptosisAppendiceal mucocele
Wandering spleenWandering kidney
Enteric membranous cyst
Omental cyst
otherAbdominal wall hematoma (spontaneous andAbdominal aortic aneurysmRetroperitoneal hematoma (exogenousEctopic pregnancy
diseaseExogenousAbdominal aortic dissectionsex)Pregnant uterus
Intraperitoneal hematoma (exogenous)

1. Onset

Tumors discovered in childhood are mostly congenital cysts and teratomas caused by congenital developmental abnormalities, congenital pyloric hypertrophy, and nephroblastoma.

The onset of the disease during adolescence is common in tuberculous abdominal tumors, mesenteric lymph node tuberculosis, and intestinal tuberculosis.

Malignant tumors, gastric cancer, liver cancer, and intestinal cancer are common diseases among the elderly.

Tumors found in women are often found in reproductive organ tumors, uterine fibroids, ovarian tumors, and pelvic tuberculosis.

2. Course of Disease

Acute onset of abdominal pain, fever and local tenderness accompanied by abdominal mass is an acute intra-abdominal infectious disease.

When abdominal masses appear after abdominal trauma, the first thing to consider is intra-abdominal hematoma or subcapsular hematoma of solid organs.

Tumors that grow slowly and are not accompanied by systemic or local symptoms are mostly benign tumors.

A tumor that grows slowly and is accompanied by symptoms such as low fever, night sweats, and general fatigue is mostly tuberculosis.

Progressive enlargement of the tumor accompanied by weight loss, anemia, and obstructive symptoms should be considered a malignant tumor.

If the swelling changes size and is accompanied by pain, obstruction of hollow abdominal organs should be considered, which is more common in intestinal obstruction, with adhesion being the most common, followed by intussusception and volvulus.

The swelling is sometimes not accompanied by pain and is mostly caused by irritable gastrointestinal syndrome caused by functional disorders.

3. Associated symptoms

1. Gastrointestinal symptoms

Nausea, vomiting, diarrhea, constipation, hematemesis and black stools.

Vomiting often occurs in obstructive diseases, most commonly pyloric obstruction and intestinal obstruction. If the vomitus is bile-like, it indicates that the obstruction is located beyond the duodenal papilla. If the vomitus is free of bile-like substances, it indicates that the obstruction is located at the pylorus proximal to the duodenal papilla.

Nausea is mostly cause by digestive tract diseases and mesenteric diseases.

When diarrhea, constipation and abdominal distension occur, it should be consider that the tumor is related to the lower gastrointestinal tract.

Vomiting blood and black stools mean that the tumor is located in the stomach, duodenum, and jejunum above the ligament of Treitz.

If the blood in the stool is bright red, it should be consider that the lesion comes from the colon or rectum.

2. Abdominal pain

Paroxysmal abdominal pain accompanied by active intestinal motility and hyperactive bowel sounds indicates gastrointestinal obstruction, common of which are intestinal adhesions, intussusception and volvulus.

Persistent abdominal pain radiating to the back indicates that the tumor is located in or invades the retroperitoneum, which is commonly seen in retroperitoneal malignant tumors and posterior wall perforation of gastric and duodenal ulcers.

If persistent abdominal pain worsens intermittently and radiates to the shoulder, the first thing to consider is liver and gallbladder disease. Common diseases include liver cancer, gallbladder and bile duct stones, and cholecystocholangitis.

3. Jaundice

Common jaundice is mostly cause by hepatitis, liver cancer and cholelithiasis. If the jaundice is progressive and severe, you must pay attention to pancreatic cancer and biliary cancer.

4. Hematuria

The Hematuria is an important sign of urinary system disease, especially painless hematuria, which must be note for kidney cancer and bladder cancer. Hematuria can also occur in hydronephrosis.

5. Menstrual disorders

Menstrual changes are a clinical manifestation of gynecological diseases. When there are abdominal tumors and menstrual changes at the same time, attention should be pay to the presence of gynecological diseases. Especially when the tumor is located in the pelvic cavity, which is mostly uterine or ovarian lesions.

4. Physical Examination

1. Part

The location of the tumor is often closely related to the organs in the anatomical part where it is located. Therefore, the abdomen is often divid into nine areas clinically. That is, two straight lines are drawn from the midpoint of the left and right clavicles downward and parallel to the longitudinal axis of the body, and the lower edges of the left and right costal arches are connected to form a horizontal line, and then the left and right iliac crests are connected to form a horizontal line to divide the abdomen into: right upper abdomen, lower part of the xiphoid process, left upper abdomen, umbilicus, right abdomen, left abdomen, suprapubic region, right lower abdomen and left lower abdomen.

When tumors appear in each area, the tissues and organs in this area should be consider first. Tumors in the right upper abdomen are often seen in lesions of the liver, gallbladder, hepatic flexure of the colon, right kidney, and right adrenal gland. Tumors in the lower part of the xiphoid process are often lesions of the liver, stomach, duodenum, transverse colon, greater omentum and pancreas. The Tumors in the left upper abdomen are often see in the left lobe of the liver, spleen, pancreatic tail, stomach, splenic flexure of the colon, left kidney and left adrenal gland. Tumors in the umbilicus are often lesions of the transverse colon, greater omentum, jejunum, ileum, mesentery and abdominal aorta. Tumors on the right side of the umbilicus are seen in lesions of the right kidney, right retroperitoneum, and ascending colon.

More

The Tumors on the left side of the umbilicus are seen in lesions of the left kidney, left retroperitoneum, and descending colon. The Tumors on the right lower abdomen are often seen in lesions of the appendix, ileocecal region, right ovary, and right fallopian tube. Tumors on the left lower abdomen are seen in lesions of the sigmoid colon, left ovary, and left fallopian tube. Tumors above the pubic bone are seen in lesions of the ileum, bladder, uterus, and fallopian tube. In clinical practice, we must consider anatomical characteristics, as well as physiological variations, physiological functions, and pathological characteristics. A specific analysis and comprehensive judgment should be make.

2. Depth

Accurately judging the depth of the tumor is an important prerequisite for determining the diagnosis of the tumor. Superficial tumors on the abdominal wall can be see as obvious bulges, moving with the abdominal wall, and can be clearly touch when the abdominal muscles contract. If the tumor is in the abdominal cavity, the tumor cannot be touche when the abdominal muscles contract. When palpating a retroperitoneal tumor, it feels very deep, relatively fixed, and difficult to move. It is often necessary to use bimanual examination to palpate the tumor.

3. Size and shape

Palpation of the tumor is very important. It can be use to determine the size, shape and number of the tumor. Clinically, tumors that are large, have clear boundaries and smooth surfaces are mostly benign tumors, enlarged organs or cysts. If the tumor is large and has an uneven surface and is irregularly nodular, attention should be paid to the possibility of a malignant tumor. Tumors with unclear boundaries are mostly inflammatory tumors. Multiple tumors in the abdominal cavity that are adher to each other and have unclear boundaries should be consider tuberculous tumors. When the tumors are of different sizes, multiple and scatter, and have a tough feel, attention should be pay to lymphosarcoma.

(IV) Nature

If the tumor is solid and tough, it is likely to be a malignant tumor. If the tumor is soft and medium-hard, it is likely to be a benign tumor. The tumor is soft and elastic, it is likely to be a cyst or an organ with fluid accumulation.

5. Local tenderness

Local tenderness is a very important sign for determining the nature of abdominal tumors. Abdominal tumors with obvious local tenderness, such as abdominal muscle tension and fever, should be consider as abdominal tumors cause by acute infectious lesions. Local tenderness is mild, there is no abdominal muscle tension, and if there is a history of trauma, it should be consider as a possible hematoma. Local mild tenderness should be note as chronic inflammation or malignant tumors. Abdominal tumors without tenderness are mostly benign tumors.

(VI) Activity

Accurately grasping the mobility of the tumor can infer the organ where the tumor occurs. When the tumor moves up and down with the respiratory movement, the tumor is mostly an enlarged liver and spleen. Tumors that move with the respiratory movement are mostly gallbladder, stomach, transverse colon, and greater omentum. If the tumor has a large mobility, it is mostly from the small intestine.

If the tumor moves left and right with the body position, but the up and down movement is limited, it should be consider a mesenteric tumor. When it moves up and down with the body position, pay attention to whether there is visceral prolapse. If the tumor can be push, it is mostly a benign tumor or cyst. If the tumor is fix and cannot be move, attention should be pay to malignant tumors and whether it has infiltrated surrounding tissues and organs, but inflammatory tumors in the abdominal cavity are not easy to move.

(VII) Pulsation

It is important to distinguish between direct pulsation and conductive pulsation of the mass clinically. Abdominal aortic aneurysm or dissecting aneurysm can palpate direct vascular expansile pulsation that is consistent with the heartbeat, while sarcomas with abundant blood supply can also palpate direct vascular pulsation. Conductive vascular pulsation indicates that the mass is closely connect to the abdominal aorta or invades the abdominal aorta and other large arteries.

8. Percussion

Percussion of the tumor is very important for determining whether it is a solid tumor or a hollow organ. If the tumor is percussed with a tympanic sound, it is mostly due to obstruction or dilatation of a hollow organ. If the tumor is percuss with a solid sound, the tumor has little direct relationship with gastrointestinal diseases.

9. Auscultation

If you hear hyperactive bowel sounds and high-pitched sounds of air passing through water on the tumor, it means intestinal obstruction. If you hear friction sounds on the tumor, it means that the tumor is adher to the surrounding tissue. In case you hear vascular murmurs on the tumor, then the tumor may be a hemangioma or the tumor has compressed the blood vessels, causing vascular stenosis and vascular murmurs. If there is a pulsating sound on the tumor, it means that the tumor compresses the blood vessels and transmits the vascular pulsation sound.

10. Digital examination

Digital rectal examination is a simple and easy but important means of diagnosis for abdominal tumors. It can detect rectal cancer, pararectal metastasis, appendiceal abscess, pelvic abscess and female reproductive organ lesions.

Digital vaginal examination can diagnose lesions of the female reproductive organs, but it is only limited to married women.

11. Common abdominal masses and diagnostic ideas

1. The most common disease of gastric tumor is gastric cancer, and less common is gastric sarcoma, both of which are malignant tumors. The clinical manifestations include upper abdominal discomfort, intermittent stomach pain turning into persistent stomach pain, accompanied by weight loss, anemia and black stools. Upper gastrointestinal barium examination and gastroscopy can find the location, size and characteristics of the tumor. At the same time, tissue can be take by tissue forceps for cytological examination to confirm the diagnosis. In addition, localized encapsulated perforation of gastric and duodenal ulcers can form a mass in the upper abdomen. The patient has a history of ulcers and suddenly develops symptoms and signs of acute chemical peritonitis. However, the signs are limited to the local tenderness and rebound pain in the upper abdomen.

B-type ultrasound can find the location of the tumor. Upper gastrointestinal barium contrast or gastroscopy can find the size, depth and characteristics of the ulcer. Intragastric stones are rare, and stone shadows can be see in X-ray abdominal plain films. Upper gastrointestinal contrast and gastroscopy can indirectly or directly reflect the size and activity of stones. Gastric leiomyoma generally has no clinical symptoms. When the tumor is large, it can be feel in the upper abdomen. Upper gastrointestinal tract radiography can indirectly show the image of the tumor. Gastric pyloric obstruction, retention of gastric dilatation, and gastroptosis can all feel the tumor in the upper abdomen, but the tumor is soft and has a gastric shape. Percussion is a tympanic sound, and gastrointestinal peristalsis can be hear. X-ray gastrointestinal tract radiography can confirm the diagnosis.

2. Liver tumors Liver tumors include enlargement of the liver itself and space-occupying lesions in the liver. Liver enlargement is divided into infectious hepatomegaly, which is more common in viral hepatitis, sepsis and bacterial liver abscess. There is also congestive hepatomegaly, which occurs in portal hypertension, hepatic vein obstruction, Budd-Chiari syndrome, heart failure due to heart disease, constrictive pericarditis and cardiomyopathy. There is also cholestatic hepatomegaly, which may be caused by hepatobiliary stones, ampulla of Vater’s carcinoma, hepatitis and bile duct cancer. Metabolic hepatomegaly includes fatty liver, malnutrition hepatomegaly, diabetes and drug-induced hepatitis. Space-occupying lesions in the liver include primary liver cancer, liver metastasis, liver sarcoma and carcinoid. Benign tumors in the liver are more common in hemangiomas, capillary hemangiomas, teratomas, hamartomas and cysts. Ultrasound and CT have very important clinical value in the diagnosis of liver tumors.

3. Splenic tumors Splenic tumors are most common in clinical practice, and splenomegaly is mostly secondary to other diseases. Clinically, it is divided into infectious splenomegaly, which is more common in acute infectious diseases, with fever, rash, skin ecchymosis, hepatomegaly and lymphadenopathy. Common diseases include viral hepatitis, typhoid fever, paratyphoid fever, sepsis, tuberculosis, and bacterial endocarditis. Chronic infectious diseases such as malaria, kala-azar, schistosomiasis, and brucellosis also have clinical manifestations of splenomegaly.

There is also congestive splenomegaly, which is mostly caused by splenic congestion caused by obstruction of vena cava return such as nodular cirrhosis, portal hypertension, hepatic vein obstruction, chronic heart failure, and constrictive pericarditis. Compensatory splenomegaly caused by blood diseases should also be taken seriously. Common diseases include hemolytic anemia, acute leukemia, chronic myeloid leukemia, malignant lymphoma, histiocytoma, and myeloproliferative disease, all of which have clinical manifestations of splenomegaly. In addition, less common splenic tumors include hemangioma, lymphangioma, malignant tumors, splenic cysts and echinococcosis, which should also receive clinical attention.

4. Common diseases of pancreatic tumors include pancreatic cancer, pancreatic pseudocysts and pancreatic cystadenoma. Clinically, there is often dull pain in the upper abdomen, accompanied by indigestion and weight loss. Blood pancreatic amylase detection and B-type ultrasound examination can provide a basis for judging the existence, solidity and cysticity of pancreatic tumors. Abdominal CT examination can show the shape, size and location of pancreatic space-occupying lesions, thereby confirming the diagnosis.

5. Common diseases of gallbladder tumors include gallbladder cancer, gallbladder empyema, and peri-cholecystic abscess. If gallbladder tumors are accompanied by symptoms of infection and poisoning, gallbladder empyema or peri-cholecystic abscess should be considered. Localized painless tumors in the gallbladder should be noted as a possible gallbladder cancer. B-ultrasound examination can provide a definite basis for the diagnosis of gallbladder and biliary diseases. CT examination can make a definitive diagnosis.

6. The most common disease for colon tumors is colon cancer, followed by sigmoid diverticulitis and fecal masses in the sigmoid colon. Tumors in the colon accompanied by changes in bowel habits and nature, bloody stools, weight loss and anemia should be considered as colon cancer. X-ray barium enema examination can show colon stenosis and barium filling defects, mucosal destruction and intestinal irritation. Colonoscopy can directly observe the location, size, shape and mucosal condition of tumors in the intestinal cavity, and at the same time, tissue can be clamped for pathological cytological examination to confirm the diagnosis. Sigmoid diverticulitis is mainly caused by inflammation stimulating the intestinal tract to cause spasmodic tumors.

The tumors are sometimes large and sometimes small, with local tenderness and changes in the frequency of bowel movements. X-ray barium enema can show the presence of diverticula, and multiple diverticula can also exist at the same time. Colonoscopy can show the location and size of the diverticula and the inflammation around the diverticula. The mass manifested by fecal masses in the sigmoid colon is more common in the elderly, often with habitual constipation. Clinically, a hard mass can be felt in the left lower abdomen, which can move with the intestine and has no local tenderness. X-ray barium examination or colonoscopy can show the presence of fecal stones in the intestinal cavity.

7. Common diseases of small intestine and mesenteric tumors include small intestine cancer, mesenteric lymphoma, mesenteric lymph tuberculosis, mesenteric cysts and omental cysts. Small intestine, omental and mesenteric tumors are difficult to diagnose clinically, but the tumors are mostly located around the umbilicus, are relatively mobile or can be moved. Small intestine cancer often presents with intestinal obstruction, with intestinal type, hyperactive bowel sounds, and sounds of air passing through water visible in the abdomen. Mesenteric lymph tuberculosis is more common in young women, with localized tenderness and peritoneal irritation signs in the abdomen, as well as systemic tuberculosis poisoning symptoms, low fever, night sweats, fatigue and weight loss. B-ultrasound can reveal the presence of mesenteric lymphoma and mesenteric and omental cysts. CT examination can confirm the diagnosis of the tumor.

8. Common diseases of ileocecal tumors include ileocecal tuberculosis, which is more common in young and middle-aged people. There is localized tenderness in the right lower abdomen, the tumor is of medium hardness and is relatively fixed, and there are manifestations of incomplete intestinal obstruction. At the same time, there are alternating defecation characteristics of diarrhea and constipation. X-ray barium enema can show stenosis of the ileocecal lumen and mucosal destruction. Blood tests show an increased erythrocyte sedimentation rate and a strongly positive tuberculin test.

There is also ileocecal Crohn’s disease, which has clinical symptoms such as abdominal pain, diarrhea and low fever. The main clinical manifestations are abdominal tumors accompanied by intestinal stenosis and incomplete intestinal obstruction. X-ray barium enema examination can show narrow intestinal segments. Colonoscopy can directly see the presence of lesions, and pathological tissue can be take for cytological examination to confirm the diagnosis. Clinically, there are also appendix carcinoids and appendix mucoceles that appear in the right lower abdomen. B-ultrasound examination can reveal the presence of lesions in the appendix. Peri-appendix abscesses often have typical acute appendicitis pathogenesis and clinical manifestations of acute inflammation.

9. Retroperitoneal tumors are most common in clinical practice. Renal cancer often occurs in patients over 50 years old. The main symptoms are painless hematuria, and the tumor in the kidney area is not smooth, hard, and inactive. Nephroblastoma and Wilras tumor are more common in infants. Renal sarcoma is more common in young people, with painless hematuria as a common symptom. Polycystic kidney disease is more common in both sides and multiple, accompanied by cysts in other organs. Clinically, there are symptoms of low back pain, hematuria, hypertension, and a history of repeated infections.

Pyelonephritis can be palpate with kidney enlargement, soft and tough texture, local tenderness, and easy infection to form renal pyonephrosis, high fever, weight loss, anemia, renal tenderness, kidney enlargement, and pyuria. Kidney ptosis, wandering kidney, ectopic kidney, kidney can be palpate by bimanual examination. Kidney tumors can reflect the size, shape, and location of the kidney during B-ultrasound examination. CT examination can determine the presence and nature of kidney tumors. Tumors and benign tumors of the retroperitoneal mesenchymal tissue are commonly lipomas, ganglioneuromas, fibromas, and teratomas. Malignant tumors include fibrosarcomas, liposarcoma, lymphosarcoma, teratomas, etc. Retroperitoneal tumors often cause related symptoms due to their compression of surrounding organs, digestive tract, blood vessels, and nerves. Ultrasound and CT examinations are very important and necessary for the diagnosis of retroperitoneal tumors.

10. Uterine and ovarian tumors are more common clinically as uterine fibroids, which often occur in middle-aged people and often present as menorrhagia or vaginal bleeding. Endometrial adenocarcinoma is more common in the elderly, with symptoms of postmenopausal vaginal bleeding and foul-smelling leucorrhea, accompanied by abdominal pain. Ovarian cysts are benign tumors, generally asymptomatic, and are often discover during physical examinations. Ovarian cancer often occurs on one side, often with symptoms of bloody ascites, abdominal distension, and uterine bleeding. Gynecological and B-ultrasound examinations can reveal the presence of uterine and ovarian tumors, and pelvic CT examinations are helpful for diagnosis.

11. Bladder tumors are common clinically in bladder cancer, which often presents as painless hematuria. B-ultrasound and cystoscopy can indirectly or directly observe the size, location, number and morphology of lesions in the bladder, and tissue can be take for pathological cytology examination. A swollen bladder cause by acute urinary retention can also be treat as a bladder tumor. The most common cause of acute urinary retention is an enlarged prostate, which causes dysuria, weak urination and bladder swelling.

An enlarged prostate can be detect during rectal examination. Tuberculous cystitis causes bladder contracture, which can also be treat as a tumor, but the patient has symptoms of tuberculous cystitis such as urgency, frequent urination and painful urination, as well as systemic tuberculosis poisoning symptoms, night sweats, low fever and fatigue, and increased erythrocyte sedimentation rate. B-ultrasound and cystoscopy can observe the condition of the bladder lining and obtain pathological histological confirmation.

12. Abdominal abscesses All organs in the abdomen can form abdominal abscesses under infection. Common abscesses include appendiceal abscesses, pelvic abscesses, subphrenic abscesses, iliac fossa abscesses and perirenal abscesses. When an intra-abdominal mass appears during an infectious disease or during an infection, attention should be pay to the possibility of an abdominal abscess. The mass is palpable and fluctuating, tender, and has symptoms of systemic infection and poisoning as well as local infection. B-ultrasound examination can determine the location and size of the abscess. At the same time, under the guidance of B-ultrasound, puncture and extraction of pus can be perform to confirm the diagnosis and inject antibiotics for treatment after the pus is completely extract. CT examination can clarify the specific scope of the abscess and its correlation with the surrounding tissues and organs, and determine the diagnosis to guide treatment.

Emergency treatment

1. Emergency diagnostic treatment

1. Routine examination of blood, urine and stool

It is the most basic and indispensable examination item in the diagnosis of abdominal tumors. In the routine blood test, pay attention to hemoglobin, white blood cell count and its classification ratio, erythrocyte sedimentation rate and platelet count. The routine urine test, pay attention to urine specific gravity, urine red blood cell count, white blood cell count and urine protein qualitative analysis. In the routine stool test, pay attention to the shape of stool and the qualitative analysis of bacteria in stool and their bacterial genus ratio.

2. X-ray examination

It is the primary means of emergency examination for diagnosing abdominal tumors. Plain abdominal X-rays can observe intestinal flatulence, subdiaphragmatic gas, intestinal gas-fluid level, gastric type, intestinal type, stone images, and abdominal aorta morphology images.

(III) B-ultrasound examination

It is a simple, easy and effective examination method for diagnosing abdominal tumors. The examination must include the shape, size, internal and external space-occupying lesions, nature and range of various organs. Such as the liver, spleen, pancreas, kidney, gallbladder and abdominal blood vessels. The relationship between the abdominal tumor and its adjacent organs.

4. CT examination

It is a reliable examination method to determine the presence and size of abdominal tumors. And their correlation with adjacent organs.

2. Emergency symptomatic treatment

1. Fever

For patients with abdominal masses accompanied by fever, the first consideration should be the presence of inflammatory abdominal masses. It is very necessary to give anti-infection treatment first while making a diagnosis.

2. Abdominal pain, vomiting or bloating

Patients with abdominal pain, vomiting, or abdominal distension should be consider to have obstructive abdominal masses and should be treat as acute abdomen. While clarifying the cause, gastrointestinal decompression, fluid replacement, and regulation of water and electrolyte balance should be perform.

(III) Vomiting blood and black stools

Patients with hematemesis and melena have gastrointestinal bleeding abdominal masses and should be give hemostatic treatment first. Including local measures and systemic medication. At the same time, the cause of bleeding should be found and diagnose as soon as possible.

4. Hematuria

Patients with abdominal masses and hematuria, especially painless hematuria, should be aware of urinary tract tumors, which are more common in the kidney and bladder. They should be give hemostatic treatment and the kidneys and bladder should be examin at the same time.

5. Difficulty urinating

Patients with abdominal masses and dysuria should be consider to have acute urinary retention and undergo catheterization while their cause is sought.

6. Vaginal bleeding

Patients with abdominal masses and vaginal bleeding should be consider to have gynecological diseases. That should be give hemostatic treatment and undergo gynecological specialist examinations.

3. Subsequent processing

1. Diagnostic treatment

1. Laboratory biochemical index testing Laboratory biochemical index testing of all body systems, including liver function, kidney function, pancreatic amylase, sugar metabolism, lipid metabolism, and protein metabolism.

2. Tumor biochemical marker detection Tumor biochemical marker detection of various systems in the body, including alpha-fetoprotein (AFP) and carcinoembryonic antigen (CEA).

3. CT and MRI examinations are very important for the diagnosis of abdominal tumors. Especially retroperitoneal tumors, nervous system lesions and large blood vessel tumors. MRI examinations have their unique diagnostic value.

4. Laparoscopic examination includes laparoscopy and pelvic examination, which can directly observe the presence, location, shape, size and relationship of abdominal tumors with adjacent tissues and organs. At the same time, tissues can be take for pathological cytological diagnosis, and tumors can be remove through endoscopy.

5. Biopsy: Pathological cytological examination of local puncture needle aspiration tissue of the tumor, puncture or surgical resection of superficial swollen lymph nodes throughout the body, to confirm the diagnosis.

2. Therapeutic treatment

1. Selection of surgical indications: Proliferative abdominal masses, i.e. tumors, should be treat surgically first. Obstructive abdominal masses should be treat surgically to relieve the obstruction as an emergency. When inflammatory abdominal masses form abscesses, surgery should be perform as an emergency to drain or discharge the pus; congenital cysts that impede physiological functions or affect the overall condition should be surgically remove; hemangiomas with symptoms of enlargement and compression and the risk of rupture should be surgically remove and replace with artificial blood vessels.

2. Drug treatment: Anti-infection treatment should be use for inflammatory abdominal masses. Penicillin, gentamicin, erythromycin and cephalosporin antibiotics are commonly use for non-specific infections. Anti-tuberculosis drugs for specific infections are commonly use, including isoniazid, streptomycin, rifampicin, ethambutol and sodium para-aminosalicylate (PAS). In addition, corresponding antiviral drugs, antiparasitic drugs and anti-infectious drugs are use for different specific infections. Proliferative abdominal masses and malignant tumors of various organs should be treat with drugs. At the same time as surgical treatment. Commonly used anti-tumor drugs include sulfaphosphamide, 5-fluorouracil (5-Fu), doxorubicin, vincristine, carboplatin, cisplatin, paclitaxel, etc. Immune preparations include thymosin, transfer factor, ribonucleic acid, interleukin 2, etc.

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