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Right Iliac Fossa Mass (Viva (Hx (Duration of mass and how it has changed,…
Right Iliac Fossa Mass
Examination
Auscultation
Bruits
Bowel sounds
Percussion
Resonant: e.g. bowel or retroperitoneal
Dull
Palpation
Differentiate mass before continuing w/ rest of exam
Site, size, shape
Consistency: firm, soft
Edge: well or poorly defined
Surface: smooth, irregular, nodular
Relations
Can you get above and below it?
Does it move w/ respiration?
Attachment to skin
Attachment to abdominal muscles
Ask pt. to lift head while palpating
Cough impulse
Inguinal nodes
Inspection
Peripheral
Hands and Arms
Clubbing
AV fistula
Eyes
Pallor
Jaundice
Neck
LNs: e.g. Virchow’s node
Abdominal
Asymmetry
Scars: esp. Rutherford Morrison
Viva
Hx
Duration of mass and how it has changed
Abdominal symptoms
Gynae symptoms
Systemic symptoms
Co-morbidities and previous operations
Radiological Ix
US
1st line
Distinguish bowel mass from pelvic mass
ID any LNs and abnormal blood vessels
CT
Best to view abdominal wall masses
Good to assess extent of intra-abdominal malignancy
MRI
Good for pelvic masses
Other Ix
Bloods
FBC, U+E, LFT
Mantoux
CXR, AXR
US / CT guided [biopsy]
Commonest
Transplanted kidney
Crohn’s or Appendix mass or abscess
Caecal Ca
Incisional hernia (mass w/ scar)
Skin and Soft Tissues
Sebaceous cyst
Lipoma
Sarcoma
Gynaecological
Ovarian tumour
Fibroid uterus
Male Reproductive System
Undescended or ectopic testis ± tumour
Urological System
Ectopic kidney
Bladder diverticulum
Blood Vessels
External iliac or common iliac artery aneurysm
LNs
Differential of RIF Mass