CASE PRESENTATION OF ABDOMINAL LUMP IN DEPARTMENT OF SURGERY @ NSCBMCH JABALPUR MP INDIA.

1. ABDOMINAL LUMP
-Dr. Ayush Khati
PG-3
Departement Of Surgery
Netaji Subhash Chandra Bose Medical College &
Hospital ,Jabalpur Madhya Pradesh

2. HISTORY
01

3. PATIENT DETAILS
Name – ABC
Age – X years
Sex – Male
Occupation-Farmer
Residence-MP

4. PRESENTING COMPLAINTS
• Lump in abdomen 7 months
• Weight loss & decrease in appetite 3 months
• Passing loose stools 2 months
• Abdominal fullness & distension 2 months

5. • Patient was apparently well 7 months back when he noticed a lump in the central part of abdomen above
umbilicus which was initially 4*4cm in size and its size gradually increased for the first two months and for
the last one month size of lump is same to the current size .
20-25 days later he noticed 4 more lumps in the abdomen located in right hypochondrium region measuring
4*5cm, in right paraumbilical area measuring 4*4cm, in left paraumbilical region measuring 5*4cm and in left
hypochondrium measuring 4*4cm.size of these lumps increased for the first two months and for the last one
month the size is same to the current size.
Lumps were not associated with pain.
• Patient gives history of decrease in appetite since 3 months earlier he used to eat 6 chapatis in a day which
has decreased to 2 chapatis per day.
• Patient also complains of weight loss since 3 months which was elicited by loosening of clothes.
HISTORY OF PRESENTING ILLNESS

6. satiety 2 months
• Patient complains of passing loose stools since 2 months once a day not mixed with blood or
mucous. Not associated with increase in frequency or tenesmus.
• Patient also complains of abdominal fullness & distension since 2 months not associated with
pain & vomiting.
HISTORY OF PRESENTING ILLNESS

7.  No history of discharge or bleeding per rectum
 No h/o pain while defecation
 No h/o vomiting,fever,chronic cough
 No h/o yellowish discolouration of sclera or skin
 No symptoms of intestinal obstruction
 No h/o hematemesis,melena
 No h/o haemoptysis ,bony pain
NEGATIVE HISTORY

8. • No history of Hypertension,Tuberculosis,Bronchial Asthma, Diabetes
mellitus,Epilepsy.
• No history of other chronic medical/surgical illness.
PAST HISTORY

9. • Patient is married since 23yrs
• Belongs to low socioeconomic status
• Patient is non alcoholic, non smoker, eats mixed diet & has normal sleep
pattern.
PERSONAL HISTORY

10. • No history of similar complains in the family
FAMILY HISTORY
TREATMENT HISTORY
• No history of hospital admissions and treatment.

11. GENERAL
PHYSICAL
EXAMINATION
02

12. Patient was examined in adequate light with implied consent and with proper privacy. He was
conscious, cooperative, well oriented to time, place and person.
He was having an ectomorphic built.
NO SIGNS OF
ICTERUS
CYANOSIS
CLUBBING
EDEMA
No CERVICAL ,AXILLARY
INGUINAL LYMPHADENOPATHY
WEIGHT
HEIGHT
BMI
50KG
147cms
23
PALLOR -PRESENT

13. VITALS
Pulse rate - 80 bpm Regular rhythm
Blood pressure - 120/70mmhg measured in right brachial artery in supine
position
Respiratory rate – 24 per minute regular
Temperature- afebrile

14. SYSTEMIC
EXAMINATION 03

15. PER-ABDOMINAL EXAMINATION
INSPECTION
Patient was examined in supine position with body exposed from nipple till mid thigh.
• Abdomen is normal in shape.
• Two abdominal lumps of size 5*5 cm & 4*4 cm present on epigastrium and right
paraumbilical region respectively .
• Moving with respiration
• Overlying skin appears normal in colour and non pigmented
• Umbilicus is in center and transversely stretched.
• All corresponding quadrants move proportionately with respiration.
• No scars/ dilated veins/ peristalsis / pulsations seen.
• The lumps became less appreciable on leg raising . (Carnett’s Test)
• Hernial sites and external genitalia are normal.

16. PER-ABDOMINAL EXAMINATION
PALPATION
Findings of inspection were confirmed.
• No rise of temperature, tenderness ,guarding, rigidity
• Plane is intraabdominal and intraperitoneal.
• Five lumps were palpated.
lump palpable in epigastric region measuring 7*6cm ,
lump palpable in right hypochondrium region measuring 6*5cm
lump palpable in right paraumbilical area measuring 5*4cm
lump palpable in left paraumbilical region measuring 6*4cm
lump palpable in left hypochondrium measuring 6*4cm
• Lumps are non tender, irregular in shape, hard in consistency with distinct margins
and irregular surface, with movement during respiration present ,not pulsatile & having
limited mobility in horizontal and vertical planes not fixed anteriorly or posteriorly or to
each other.

17. PER-ABDOMINAL EXAMINATION
• PALPATION
• No evidence of hepatosplenomegaly
• Hernial sites and external genitalia (testis) are normal.

18. PER-ABDOMINAL EXAMINATION
PERCUSSION
• Resonant note all over the abdomen and dull note over the lumps.
• Shifting dullness present

19. PER-ABDOMINAL EXAMINATION
AUSCULTATION
• Normal bowel sounds heard.
• No bruits/hum heard over the lumps or elsewhere.
DIGITAL RECTAL EXAMINATION
• Normal anal tone present with soft faecal matter.
• Hard deposits present in rectovesical pouch at 11,12 & 1 o’clock
position(Blumer’s Shelf)
• Rectal mucosa circumferentially smooth
• No bleeding & discharge.

20. RS
Air entry bilaterally
equal
no added sounds
CVS
Heart sounds S1 and
S2 are heard
no murmurs
CNS
Conscious
oriented
OTHER SYSTEMS EXAMINATION

21. CASE SUMMARY
04

22. • A 45yr male with multiple omental deposits which are hard in consistency,irregular in shape associated with weight
loss ,decrease in appetite, ascites ,blumer’s shelf deposits with no history of tuberculosis,bleeding per rectum,melena
and with no organomegaly.
CASE SUMMARY

23.  CARCINOMA OF UNKNOWN PRIMARY WITH OMENTAL
METASTASIS AND ASCITES
PROVISIONAL DIAGNOSIS

25. Attachments -FNAC & CECT
ABDOMEN
a

26. FNAC