CASE

PRESENTATION
ON ABDOMINAL
LUMP
Dr Ritesh Karwaria
Patient Details
◦ UHID: 1916930
◦ NAME: ARMINDER YADAV
◦ AGE/SEX: 30Y/MALE
◦ R/O POKHARA, NEPAL
◦ LOCAL RESIDENCE: SHASTRI NAGAR, SEEMA DWAR, DEHRADUN
◦ RELIGION : HINDU
◦ OCCUPATION : SKILLED LABOUR
CHIEF COMPLAINTS
◦ SWELLING IN ABDOMEN X 2 MONTHS
◦ FULLNESS IN UPPER ABDOMEN X 2 MONTHS
◦ EARLY SATIETY X 2 MONTHS
HISTORY OF PRESENT ILLNESS
◦ PATIENT WAS APPARENTLY ASYMPTOMATIC 4 MONTHS BACK WHEN HE DEVELOPED

-PAIN IN ABDOMEN, SUDDEN IN ONSET, MILD IN SEVERITY, DULL ACHING IN CHARACTER,

GRADUALLY PROGRESSIVE, CONTINUOUS, NO AGGRAVATING FACTORS, RELIEVED ON
TAKING MEDICATIONS AND BENDING FORWARDS, RADIATING TO BACK,NO REFFERAL OF
PAIN, NO RELATION WITH FOOD

A/W VOMITING, MULTIPLE EPISODES, MODERATE AMOUNT, NON BLOOD/BILE STAINED,

NON PROJECTILE, CONTAINED FOOD PARTICLES,
FOR THE ABOVE COMPLAINTS, PATIENT WAS ADMITTED IN A LOCAL HOSPITAL IN
MUZZAFARPUR,BIHAR FOR 5 DAYS AND LATER DISCHARGED
◦ 2 MONTHS BACK, PATIENT NOTICED A SWELLING IN THE UPPER ABDOMEN, INSIDIOUS IN
ONSET, GRADUALLY PROGRESSIVE (INITIALLY OF THE SIZE OF A TENNIS BALL, NOW
ATTAINED THE SIZE OF SMALL FOOTBALL), NO AGGRAVATING OR RELIEVING FACTORS,
NO POSTURAL/POSITIONAL CHANGE IN SIZE OF SWELLING

◦ H/O EARLY SATIETY +

◦ NAUSEA +
- FULLNESS IN THE UPPER ABDOMEN +
- CONSTIPATION +
- SIGNIFICANT LOSS OF WEIGHT +
NEGATIVE HISTORY

NO HISTORY OF
◦ TRAUMA
◦ FEVER
◦ YELLOWISH DISCOLORATION OF EYES/FACE/URINE
◦ CLAY COLORED STOOLS
◦ BLOOD IN STOOLS
◦ DYSURIA
◦ CHRONIC COUGH
PAST HISTORY

◦ HISTORY OF TREATMENT FOR ACUTE ABDOMINAL PAIN X 4 MONTHS BACK

(HOSPITALIZED, TREATED WITH INJECTABLE MEDICATIONS FOR 5 DAYS; DOCUMENTS
UNAVAILABLE))

◦ NO HISTORY OF TB, T2DM, HTN OR ANY OTHER CHRONIC ILLNESS

◦ NO RELEVANT DRUG HISTORY

◦ NO PAST SURGICAL HISTORY

PERSONAL HISTORY
◦ H/O CHRONIC ALCOHOL INTAKE PRESENT
◦ H/O CHRONIC SMOKING PRESENT (1/2 BUNDLE /DAY)

◦ MIXED DIET, NORMAL BLADDER / BOWEL HABITS ( CONSTIPATION FOR LAST 2 MONTHS)
FAMILY HISTORY
◦ NO SIGNIFICANT FAMILY HISTORY
EXAMINATION
GENERAL PHYSICAL EXAMINATION:

CONSCIOUS, ORIENTED TO TIME PLACE AND PERSON , CO-OPERATIVE, THIN BUILT,

P+ I- C- C- L- E- D-

(LEFT SUPRACLAVICULAR LYMPH NODES NOT ENLARGED)

PR:94/MIN REGULAR, NORMOVOLEMIC, IN RIGHT RADIAL PULSE

BP: 120/80 MM OF HG IN RIGHT ARM IN SUPINE POSITION
RR: 20 /MIN
AFEBRILE
PER ABDOMEN
INSPECTION:
UMBLICUS IS SLIGHTLY PUSHED DOWNWARDS, INVERTED
VISIBLE SWELLING, GLOBULAR IN SHAPE, PRESENT EXTENDING FROM THE EPIGASTRIUM
INTO THE LEFT HYPOCHONDRIUM, RIGHT HYPOCHONDRIUM, UMBLICAL AND LEFT
LUMBAR REGION ~ 20X 15 CM
NO VISIBLE PULSATIONS, ENGORGED VEINS, VISIBLE PERISTALSIS OVER SWELLING
NO SKIN CHANGES OVER THE SWELLING
ALL HERNIAL ORIFICES APPEAR TO BE INTACT
SCROTUM : APPEARS TO BE NORMAL
PALPATION:
LOCAL TEMPERATURE NOT RAISED OVER THE SWELLING,
UMBLICUS, SLIGHTLY PUSHED DOWNWARDS,
SOFT
A SINGLE LARGE LUMP , ~20 CM X 16 CM PRESENT IN THE UPPER ABDOMEN, GLOBULAR IN
SHAPE, ARISING FROM THE EPIGASTRIUM, EXTENDING INTO THE LEFT HYPOCHONDRIUM, LEFT
LUMBAR REGION, UMBLICAL REGION , RIGHT HYPOCHONDRIUM
MILD TENDERNESS PRESENT OVER THE SWELLING
WELL DEFINED LOWER MARGINS UPTO 2 CM BELOW UMBLICUS, UPPER MARGIN CANNOT BE
REACHED, SMOOTH SURFACE, REGULAR MARGINS
CYSTIC IN CONSISTENCY
MINIMAL MOVEMENTS WITH RESPIRATION NOTED
NON MOBILE, NON BALLOTABLE
SWELLING IS INTRA-ABDOMINAL
NON PULSATILE
ALL HERNIAL ORIFICES INTACT, NO HEPATOMEGALY
SPLEEN –COULD NOT BE PALPATED
SCROTUM : NO SKIN CHANGES, B/L TESTIS PALPABLE SEPERATELY, NO SWELLING PALPATED
◦ PERCUSSION :
REASONANT NOTE PRESENT OVER THE SWELLING
LIVER DULLNESS NOTED; LIVER SPAN 14 CM IN MIDCLAVICULAR LINE
NORMAL TYMPANIC TONE OVER REST OF THE ABDOMEN

ASUCULTATION:
BS + 3-4/MIN
NO ARTERIAL BRUIT OVER THE SWELLING

DRE: NO FISSURE/FISTULA, NORMAL ANAL TONE, NO BALLOONING, FECAL STAINING

PRESENT
CASE SUMMARY
◦ 30 YEAR OLD MALE, CHRONIC ALCOHOLIC, CHRONIC SMOKER WITH HISTORY OD ACUTE
ABDOMINAL PAIN 4 MONTHS BACK, PRESENTED WITH C/O SWELLING IN UPPER
ABDOMEN FOR 2 MONTHS, INSIDIOUS ONSET, GRADUALLY PROGRESSIVE, ASSOCIATED
WITH EPIGASTRIC FULLNESS, EARLY SATIETY,NAUSEA AND CONSTIPATION WITH NO
OTHER SYSTEMIC SYMPTOMS
◦ O/E GENERAL SURVEY IS WNL
P/A UMBLICUS IS PUSHED SLIGHTLY DOWNWARDS AND THERE IS A LARGE LUMP
PALPABLE IN THE EPIGASTRIUM EXTENDING INTO THE LEFT HYPOCHONDRIUM, LEFT
LUMBAR REGION, UMBLICAL REGION , RIGHT HYPOCHONDRIUM; MILD TENDERNESS
PRESENT OVER THE SWELLING; WELL DEFINED LOWER MARGINS UPTO 2 CM BELOW
UMBLICUS, UPPER MARGIN CANNOT BE REACHED, SMOOTH SURFACE, REGULAR
MARGINS ;CYSTIC IN CONSISTENCY; MINIMAL MOVEMENTS WITH RESPIRATION NOTED;
NON MOBILE, NON BALLOTABLE; SWELLING IS INTRA-ABDOMINAL ; NON PULSATILE
INVESTIGATIONS
◦ HB: 11.1 TLC 4900
◦ DLC: N56 L35 M4 E5
◦ PLAT COUNT : 4.07 LAC /CU.MM

LFT
T.BIL:0.5 SGOT 16 SGPT 23 ALP 145
T.PROTEIN: 6.5
AMYLASE 300 LIPASE 90

RFT AND ELECTROLYTES: WNL VIRAL MARKERS: NR

◦ USG W/A : S/O LARGE CYSTIC LESION ~16X 17 CM WITH FEW ECHOES AND SEPTATIONS IN
CENTRAL AND LEFT SIDE ABDOMEN; WALL THICKNESS 1.7 CM
?PANCREATIC PSEUDOCYST