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    Mass in Epigastrium-2

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    brown_chocolate87643
    This document discusses several causes of masses in the epigastrium region including stomach cancer, carcinoma of the transverse colon, aortic aneurysm, and pancreatic pseudocyst. Stomach cancer is the fifth most common cancer worldwide and is often associated with H. pylori infection. Carcinoma of the transverse colon is the third most common cancer in the US and arises from pre-existing conditions or dietary factors. Abdominal aortic aneurysm most commonly occurs in the infrarenal region and is usually caused by hypertension. Pancreatic pseudocyst is a fluid collection that can occur after pancreatitis or trauma. Clinical evaluation and various imaging tests are used to diagnose these conditions.

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    Mass in Epigastrium-2

    Uploaded by

    brown_chocolate87643
    448 views37 pages
    This document discusses several causes of masses in the epigastrium region including stomach cancer, carcinoma of the transverse colon, aortic aneurysm, and pancreatic pseudocyst. Stomach cancer is the fifth most common cancer worldwide and is often associated with H. pylori infection. Carcinoma of the transverse colon is the third most common cancer in the US and arises from pre-existing conditions or dietary factors. Abdominal aortic aneurysm most commonly occurs in the infrarenal region and is usually caused by hypertension. Pancreatic pseudocyst is a fluid collection that can occur after pancreatitis or trauma. Clinical evaluation and various imaging tests are used to diagnose these conditions.

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    differential diagnosis of mass in epigastrium

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    This document discusses several causes of masses in the epigastrium region including stomach cancer, carcinoma of the transverse colon, aortic aneurysm, and pancreatic pseudocyst. Stomach cancer is the fifth most common cancer worldwide and is often associated with H. pylori infection. Carcinoma of the transverse colon is the third most common cancer in the US and arises from pre-existing conditions or dietary factors. Abdominal aortic aneurysm most commonly occurs in the infrarenal region and is usually caused by hypertension. Pancreatic pseudocyst is a fluid collection that can occur after pancreatitis or trauma. Clinical evaluation and various imaging tests are used to diagnose these conditions.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    448 views37 pages

    Mass in Epigastrium-2

    Uploaded by

    brown_chocolate87643
    This document discusses several causes of masses in the epigastrium region including stomach cancer, carcinoma of the transverse colon, aortic aneurysm, and pancreatic pseudocyst. Stomach cancer is the fifth most common cancer worldwide and is often associated with H. pylori infection. Carcinoma of the transverse colon is the third most common cancer in the US and arises from pre-existing conditions or dietary factors. Abdominal aortic aneurysm most commonly occurs in the infrarenal region and is usually caused by hypertension. Pancreatic pseudocyst is a fluid collection that can occur after pancreatitis or trauma. Clinical evaluation and various imaging tests are used to diagnose these conditions.

    Copyright:

    © All Rights Reserved
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    Download as pptx, pdf, or txt
    of 37

    MASS IN EPIGASTRIUM

    Rowan Newman
    Moya McLeod
    Edgar Muganzi

    OBJECTIVES
    Discuss causes of mass in epigastrium, with

    special reference to:


    Stomach Cancer
    Carcinoma of Transverse Colon
    Aortic Aneurysm
    Pancreatic Pseudo-cyst

    Discuss causes of retroperitoneal

    lymphadenopathy
    Understand clinical investigations used to
    diagnose these conditions
    Relate conditions to USMLE high yield
    information

    CAUSES OF MASS
    Consider whether the mass is as a result of:

    - Trauma
    - Infection/ Inflammation
    - Neoplasm
    - Blood
    - Endocrine
    - Degenerative
    - Congenital
    -Autoimmune
    - Metabolic

    CLINICAL EVALUATION OF
    MASS
    History
    Physical Examination
    Location
    Motility
    Pulsatile
    Firmness
    Texture
    Pain

    Clinical Investigations

    CARCINOMA OF STOMACH
    Fifth most common cancer world-wide
    Most common; adeno-carcinoma
    May be sarcoma or lymphoma

    Prevalent among Japanese, alcoholics, pernicious

    anemia
    Higher risk in males and individuals over 50 years
    old
    60-90% of stomach carcinomas are attributed to
    H. pylori infection
    H. pylori often causes MALT ( Mucosa Associated

    Lymphoid Tissue) lymphoma.


    MALT lymphoma accounts for 5% of gastric tumours

    PRESENTATION
    Histology
    Signet ring appearance of cells

    Cancer in most common in lesser curvature of

    stomach
    Symptoms:
    Stomach pain
    Blood in stool
    Rapid weight loss for no reason
    Jaundice
    Heart burn

    Similar to PUD and GERD


    Virchows nodes

    SIGNET-RING CELLS

    CARCINOMA OF STOMACH
    Diagnosis
    Gastroscopy and biopsy
    CT- Scan
    PET- Scan
    Endoscopic ultrasound

    USMLE QUES. HINTS


    50 yr old man with 6 month history of

    abdominal pain which is associated with


    nausea and bloating, not related to
    meals. He has no retro-sternal burning
    sensation, however he has loss of
    appetite, 10 lbs weight loss in the past
    3 months with enlarged left supraclavicular lymph nodes.

    CT- SCAN OF STOMACH CARCINOMA

    CARCINOMA OF TRANSVERSE COLON


    Third most common cancer in US
    Mainly adeno-carcinoma with polyps at

    early stage
    High incidence in 60-79 yrs age group
    Arises from pre-existing ulcerative colitis,
    polyposis syndrome, excess CHO, fat and
    red-meat intake and decrease protective
    micronutrient intake:
    Selenium, vitamin E, vitamin C, lycopene
    Folate, methionine, vitamin B6, vitamin B12

    Characterised by perforation, fistulation

    and obstruction

    COLONIC POLYP

    CARCINOMA OF TRANSVERSE
    COLON
    Screening
    Screening begins at different ages
    depending on the risk level of the
    individual:
    Average risk: 50 yrs
    Moderate risk: 40 yrs
    High risk: 20-25 yrs (HNCPP gene carrier)

    Colon cancer cells of origin


    Tubular < tubulovillous < villous

    Symptoms
    Blood smeared stool, mucous in stool,
    abdominal pain

    COLONIC TUMOUR OF
    VILLOUS ARCHITECTURE

    NORMAL
    VILLOUS
    TISSUE

    CARCINOMA OF TRANSVERSE COLON


    Diagnosis
    Abdominal CT- Scan
    Colonoscopy
    Barium enema

    ABDOMINAL CT-SCAN OF
    CARCINOMA

    ANEURYSM OF ABDOMINAL
    AORTA
    Most common location is infra-renal
    Pulsatile mass palpated superior to

    umbilicus
    Mainly caused by hypertension or
    secondary to bacterial (salmonella)
    infection
    Associated with emphysema which
    increases MMP causing decrease in
    collagen levels

    ANEURYSM OF ABDOMINAL
    AORTA
    More common in males > 60 yrs
    Major complication is aortic dissection

    (tears in the wall of aorta)


    Rupture triad of AAA are severe left plank
    pain followed by hypotension from internal
    blood loss into the retroperitoneum and a
    pulsatile mass on PE
    Atherosclerotic plaque can embolize

    ANEURYSM OF ABDOMINAL
    AORTA
    Diagnosis
    Abdominal Ultrasound
    CT- Scan
    MRI

    ULTRASOUND

    ABDOMINAL CT-SCAN

    MRI OF ABDOMINAL AORTIC ANEURYSM

    STENTING OF ANEURYSM

    USMLE QUES. HINTS


    59 yr old male presents to ER with

    sudden, severe and constant lower


    back pain, with a history of
    hypertension, hyperlipidemia and
    emphysema. On P/E a pulsatile mass
    was palpated superior to the umbilicus
    and a BP reading of 150/90 mmHg was
    recorded.

    PANCREATIC PSEUDO-CYST
    Collection of fluid in the lesser

    sac of the peritoneal cavity.


    There is no epithelial lining
    hence is not a true cyst
    Normally occurs after
    pancreatitis or trauma
    Contains necrotic tissue, blood,
    pancreatic secretions with walls
    of surrounding stroma.

    PANCREATIC PSEUDOCYST
    1/3 occur at the head of the

    pancreas
    Occurs in all age groups:
    children after trauma and high
    in men
    75-85% related to gall stone of
    alcohol

    SYMPTOMS
    Bloating of abdomen
    Fever
    Palpable mass
    Scleral icterus
    Pleural effusion
    Jaundice (increase with size

    of pseudocyst)

    PHYSICAL EXAMINATION
    Tender abdomen
    Palpable mass
    Difficulty eating and digesting food

    DIAGNOSIS
    Serum amylase- may be normal or raised
    Serum bilirubin and liver function- raised
    Cystic fluid analysis: decreased CEA;

    decreased fluid viscosity; increased


    amylase
    Fluctuation test- Positive
    X-Ray with barium meal to show position
    Prognosis is good

    IMAGING
    Abdominal CT: large cyst cavity in

    and around pancreas


    MRI: differentiate between
    organized necrosis and pseudocystdetect solid component
    Ultra Sound
    Endoscopy: planningn therapy and
    drainage

    Complications and treatment


    Pancreatic abscess
    Rupture- shock and hemorrhage
    Compress other organs
    Treatment: may go away by itself

    or needs needle or surgical


    drainage under laparascope.

    CT-SCAN OF PANCREATIC PSEUDOCYST

    RETROPERITONEAL LYMPHADENOPATHY
    Retroperitoneal space contains kidneys,

    adrenal glands, pancreas, nerve roots,


    lymph nodes, abdominal aorta and IVC
    Lymph nodes drain the organs in the space
    and also the testes, ovaries, fallopian tubes
    and uterus
    Malignancies of any of these organs can
    cause retroperitoneal lymphadenopathy
    Lymphoma of the nodes also

    CT-SCAN OF R.P. LYMPHADENOPATHY

    USMLE QUESTION
    A 28-year-old man presents complaining of heaviness in his

    testicle for 2 weeks. He states that he feels as though his testicle


    is enlarged. The man has a temperature of 37.2C (98.9F), a
    heart rate of 60/min, and a blood pressure of 115/70 mm Hg. He
    has a normal abdominal examination with no palpable masses.
    The right testicle is noticeably larger than the left testicle. There
    are no discrete nodules. Testicular ultrasound is performed,
    followed by an orchiectomy. He is found to have a seminoma and a
    retroperitoneal lymph node that is enlarged at 1.8 cm. He is given
    a diagnosis of stage IIA testicular seminoma (T2N1M0). What
    additional treatment is needed?
    (A) Contralateral orchiectomy
    (B) Platinum-based chemotherapy and bilateral orchiectomy
    (C) Prophylactic mediastinal radiation
    (D) Retroperitoneal lymph node dissection
    (E) Retroperitoneal radiation

    REFERENCES
    Medbullets team. 2015,Feb 04. Abdominal aortic

    aneurysm. Retrieved from medbullet website


    http://www.medbullets.com/step2-3cardiovascular/20031/abdominal-aortic-aneurysm
    (Goljan, 2014) intext ref
    Abdominal aortic aneurysms images Retrieved from
    https://www.google.com.jm/search
    http://emedicine.medscape.com/article/184237-overview
    http://www.surgery.usc.edu/divisions/tumor/pancreasdise
    ases/web%20pages/PANCREATITIS/pancreatic
    %20pseudocys1.html
    http://my.clevelandclinic.org/health/diseases_conditions/
    hic_Pancreatitis/hic-pancreatic-cysts-and-pseudocysts

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