April 9, 2022

Health Disorder Empowerment 1400H - 1500H

Course– objective - for Via Zoom
Fundamentals laypeople to have an
and understanding of the
Generalities in FUNDAMENTALS
Medical and GENERALITIES in
Management the MEDICAL
of MANAGEMENT of
ABDOMINAL ABDOMINAL MASS.
MASS
[OVERVIEW]
Health Disorder Empowerment
Course– objective - for ROJoson PEP Talk
Fundamentals laypeople to have an
and understanding of the I have a Patient
Generalities in FUNDAMENTALS Empowerment
Medical Program in which I
and GENERALITIES in
Management like to empower the
the MEDICAL lay people or
of MANAGEMENT of patients to take
ABDOMINAL ABDOMINAL MASS. control in the
MASS management of
[OVERVIEW] their health.
 There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.
 From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer.
 Fundamentals Contents of ABDOMINAL DISORDERS March 19, 2022
1400H - 1500H
and Generalities [OVERVIEW] Via Zoom
in Medical • What is an abdominal disorder?
Management of • What are the different types of abdominal
ABDOMINAL disorders?
MASS • What are the causes of abdominal disorders?
• How common are the abdominal disorders?
• Clinical diagnosis of abdominal disorders?
• Paraclinical diagnostic procedures for • Abdominal Pain
abdominal disorders? • Abdominal Mass
• Basic treatment modalities for abdominal • Abdominal Obstruction
disorders? • Abdominal Bleeding
• Jaundice
Health Disorder Empowerment My PEP TALK today
Course– objective - for is entitled:
Fundamentals laypeople to have an Fundamentals and
and Generalities in
understanding of the
Generalities in Medical
FUNDAMENTALS Management of
Medical and GENERALITIES in ABDOMINAL MASS
Management the MEDICAL [AN OVERVIEW].
of MANAGEMENT of This is part of the
ABDOMINAL ABDOMINAL MASS. Health Disorder
MASS Course.
[OVERVIEW]
 Definition of Terms in Title AND Delimitation of
Fundamentals
Coverage of Talk:
and Generalities
in Medical
Fundamentals – simplest and essential facts and
Management of
theories which can serve as a basis or foundation
ABDOMINAL
and support for advanced information
MASS
Generalities – general statements of info, not
covering specifics and details

Medical Management – diagnosis and treatment

by physicians
 Fundamentals Contents of PEP TALK on ABDOMINAL
and Generalities MASS
in Medical • What is an abdominal mass?
Management of • What are the different types of abdominal
ABDOMINAL mass?
MASS • What are the causes of abdominal mass?
• How common are the abdominal mass?
• Clinical diagnosis of abdominal mass?
• Paraclinical diagnostic procedures for
abdominal mass?
• Basic treatment modalities for abdominal
mass?
 • What is an abdominal MASS?
Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
MASS
 • What is an abdominal MASS?
Fundamentals
and Generalities
MASS is an unusual collection of tissues occupying
in Medical
a space in any area or part of the human body.
Management of
ABDOMINAL
ABDOMINAL MASS is an unusual collection of
MASS
tissues occupying a space in the belly.

It can be in the abdominal wall; peritoneal lining

of the abdominal cavity; or in any organ inside the
cavity.
Other terminologies:
BUKOL SA TIYAN
MASS OR TUMOR OR LUMP IN THE BELLY
 • What is an abdominal MASS?
Fundamentals
and Generalities
BUKOL SA TIYAN
in Medical MASS OR TUMOR OR LUMP IN THE BELLY
Management of
ABDOMINAL • It may be of any size or shape.
MASS • It may be of any consistency.
• It may be cystic, solid or complex.
• By itself, it can be of any etiology, either cancer
or not cancer, until determined by further
assessment.
 • What are the different types of abdominal
Fundamentals
MASS?
and Generalities
in Medical
Management of
ABDOMINAL
MASS
 • What are the different types of abdominal
Fundamentals
MASS?
and Generalities
in Medical Essentially, the different types will be based on
Management of the origin of the MASS:
ABDOMINAL
MASS • abdominal wall
• lining of the abdominal cavity or
peritoneum
• solid organs*
• hollow organs* inside the abdominal
cavity

*with names of specific organs.

 • What are the different causes of abdominal
Fundamentals
MASS?
and Generalities
in Medical
Management of
ABDOMINAL
MASS
 • What are the different causes of abdominal
Fundamentals
MASS?
and Generalities GENERAL CAUSES
in Medical TRAUMA
Management of • Hematomas
ABDOMINAL
MASS NON-TRAUMA
• Cancers
• Non-cancers
• Benign tumors
• Cysts
• Congenital abnormalities
• Degenerative tumors
• Infections (abscesses)
 • What are the different causes of abdominal
Fundamentals
MASS?
and Generalities
in Medical NON-TRAUMA CAUSES
• Cancers
Specific causes:
Management of
• Non-cancers • Genetic predisposition
ABDOMINAL
MASS • Benign tumors • Environmental factors –
• Cysts foods, alcohol, smoking,
• Congenital abnormalities hygiene, atmosphere,
• Degenerative tumors etc.
• Infections (abscesses)
 • How common are the abdominal MASSES?
Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
MASS
 • How common are the abdominal MASSES?
Fundamentals
and Generalities
in Medical VERY COMMON
Management of
ABDOMINAL
MASS • Cancers
• Non-cancers – more common
 • Clinical diagnosis of abdominal MASS?
Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
MASS
 • Clinical diagnosis of abdominal MASS?
Fundamentals
and Generalities Starting point in evaluation: patient has
in Medical unpleasant sensation in the abdomen or
Management of pain. No history of trauma.
ABDOMINAL
MASS
LOOK and PALPATE the abdomen!

Possible findings:
• NO palpable mass but with suspicion
for possible abdominal mass
• POSITIVE palpable mass
 • Clinical diagnosis of abdominal MASS? Symptom cues for
Fundamentals gastrointestinal
and Generalities Scenario 1: obstruction –
in Medical • NO palpable mass but with suspicion for vomiting, abdominal
Management of possible abdominal mass distention, no
ABDOMINAL What are the symptoms that will make one passage of stools per
MASS suspect a non-palpable abdominal mass as the anus
cause of the abdominal discomfort?
• If there are symptoms of abdominal Symptom cues for
obstruction. gastrointestinal
• If there are symptoms of abdominal bleeding. bleeding – vomiting
• If there is jaundice. of blood; blood per
anus; black stools
An ABDOMINAL MASS could be present!
 • Clinical diagnosis of abdominal MASS?
Fundamentals
and Generalities Scenario 1:
in Medical • NO palpable mass but with suspicion for
Management of possible abdominal mass
ABDOMINAL What are the symptoms that will make one
MASS suspect a non-palpable abdominal mass as the
cause of the abdominal discomfort?
• If there are symptoms of abdominal
obstruction.
• If there are symptoms of abdominal bleeding. May have to do a
• If there is jaundice. paraclinical
diagnostic
An ABDOMINAL MASS could be present! procedure!
 • Clinical diagnosis of abdominal MASS?
Fundamentals
and Generalities Scenario 2:
in Medical • POSITIVE palpable mass
Management of
ABDOMINAL • Determine the location of the palpable mass
MASS on the abdomen. Use LOCATION to suspect the
possible origin of the mass.
 • Clinical diagnosis of abdominal MASS?
Fundamentals • Determine the
and Generalities location of the
in Medical palpable mass on
Management of the abdomen.
ABDOMINAL Use LOCATION to
MASS suspect the
possible origin of
the mass.
 • Clinical diagnosis of abdominal MASS?
Fundamentals
and Generalities Scenario 2:
in Medical • POSITIVE palpable mass
Management of
ABDOMINAL • Palpate for the characteristics of the palpable
MASS mass such as size, shape, consistency (hard or
not hard), nature (cystic or solid), mobility,
presence or absence of tenderness, etc. This
may give further clues as to specific origin of
the mass and its cause, whether cancer or not
cancer.
 • Clinical diagnosis of abdominal MASS?
Fundamentals
and Generalities Scenario 2:
in Medical • POSITIVE palpable mass
Management of
ABDOMINAL • Analyze any associated symptoms present like
MASS vomiting, distention, no passage of stools,
bleeding and jaundice and see if they are
consistent with a MASS in a suspected organ
just based on location.
 • Clinical diagnosis of abdominal MASS?
Fundamentals
and Generalities Scenario 2:
in Medical • POSITIVE palpable mass
Management of
ABDOMINAL • Once the origin of the abdominal mass is
MASS somehow clear, then use symptoms and signs
to determine the specific diagnosis in terms of
whether it is a cancer or not cancer. Determine
also if the mass is an abscess or not.
 • Clinical diagnosis of abdominal MASS?
Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
MASS
CASE ILLUSTRATIONS
 ILLUSTRATIONS OF
• Clinical diagnosis of abdominal MASS? USE OF CUES TO
Fundamentals ANALYZE FOR
and Generalities Case Illustration: ORIGIN OF MASS
in Medical A patient presenting with epigastric mass.
Management of Based on location, possible common organs of
ABDOMINAL involvement: stomach, pancreas, liver, and If JAUNDICE is an
MASS intestines (small and large). associated
symptom, a LIVER
mass should be
suspected.
 ILLUSTRATIONS OF
• Clinical diagnosis of abdominal MASS? USE OF CUES TO
Fundamentals ANALYZE FOR
and Generalities Case Illustration: ORIGIN OF MASS
in Medical A patient presenting with epigastric mass.
Management of Based on location, possible common organs of If NO JAUNDICE,
ABDOMINAL involvement: stomach, pancreas, liver, and STOMACH and
MASS intestines (small and large). LARGE INTESTINE
should be suspected
as the possible
source of mass.
 ILLUSTRATIONS OF
• Clinical diagnosis of abdominal MASS? USE OF CUES TO
Fundamentals ANALYZE FOR
and Generalities Case Illustration: ORIGIN OF MASS
in Medical A patient presenting with epigastric mass.
Management of Based on location, possible common organs of If there is vomiting
ABDOMINAL involvement: stomach, pancreas, liver, and of fresh blood
MASS intestines (small and large). and/or black stool,
STOMACH should be
suspected as the
possible source of
mass.
 ILLUSTRATIONS OF
• Clinical diagnosis of abdominal MASS? USE OF CUES TO
Fundamentals ANALYZE FOR
and Generalities Case Illustration: ORIGIN OF MASS
in Medical A patient presenting with epigastric mass.
Management of Based on location, possible common organs of
If there is
ABDOMINAL involvement: stomach, pancreas, liver, and
constipation, LARGE
MASS intestines (small and large).
INTESTINE should be
suspected as the
possible source of
mass.
 • Clinical diagnosis of abdominal MASS?
Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
MASS
CASE ILLUSTRATIONS
 ILLUSTRATIONS OF
• Clinical diagnosis of abdominal MASS? USE OF CUES TO
Fundamentals ANALYZE FOR
and Generalities Case Illustration: ORIGIN OF MASS
in Medical A patient presenting with right upper quadrant
Management of pain.
ABDOMINAL Based on location, possible common organs of If JAUNDICE is an
MASS involvement: liver, gallbladder, and intestines. associated
symptom, a mass in
the LIVER (most
common),
PANCREAS and
GALLBLADDER
should be suspected.
 ILLUSTRATIONS OF
• Clinical diagnosis of abdominal MASS? USE OF CUES TO
Fundamentals ANALYZE FOR
and Generalities Case Illustration: ORIGIN OF MASS
in Medical A patient presenting with right upper quadrant
Management of pain.
ABDOMINAL Based on location, possible common organs of If NO JAUNDICE, a
MASS involvement: liver, gallbladder, and intestines. mass in the LIVER
(most common),
PANCREAS and
GALLBLADDER
should still be
suspected (as it may
be the jaundice has
not set in.
 ILLUSTRATIONS OF
• Clinical diagnosis of abdominal MASS? USE OF CUES TO
Fundamentals ANALYZE FOR
and Generalities Case Illustration: ORIGIN OF MASS
in Medical A patient presenting with right upper quadrant
Management of pain.
ABDOMINAL Based on location, possible common organs of If NO JAUNDICE and
MASS involvement: liver, gallbladder, and intestines. there are intestinal
symptoms, then
MASS in the
intestines should be
suspected.
 • Clinical diagnosis of abdominal MASS?
Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
MASS
CASE ILLUSTRATIONS
 ILLUSTRATIONS OF
• Clinical diagnosis of abdominal MASS? USE OF CUES TO
Fundamentals ANALYZE FOR
and Generalities Case Illustration: ORIGIN OF MASS
in Medical A patient presenting with right lower quadrant
Management of pain.
ABDOMINAL Based on location, possible common organs of If there are
MASS involvement: appendix, intestines, ovary (female) intestinal symptoms,
then MASS in the
intestines should be
suspected.
 ILLUSTRATIONS OF
• Clinical diagnosis of abdominal MASS? USE OF CUES TO
Fundamentals ANALYZE FOR
and Generalities Case Illustration: ORIGIN OF MASS
in Medical A patient presenting with right lower quadrant
Management of pain.
ABDOMINAL Based on location, possible common organs of If there are
MASS involvement: appendix, intestines, ovary (female) gynecological
symptoms, then
MASS in the
gynecologic organs
(such as uterus and
right ovary) should
be suspected.
 • Clinical diagnosis of abdominal MASS?
Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
MASS
CASE ILLUSTRATIONS
 ILLUSTRATIONS OF
• Clinical diagnosis of abdominal MASS? USE OF CUES TO
Fundamentals ANALYZE FOR
and Generalities Case Illustration: ORIGIN OF MASS
in Medical A patient presenting with left lower quadrant
Management of pain.
ABDOMINAL Based on location, possible common organs of If there are
MASS involvement: intestines, ovary (female) intestinal symptoms,
then MASS in the
intestines should be
suspected.
 ILLUSTRATIONS OF
• Clinical diagnosis of abdominal MASS? USE OF CUES TO
Fundamentals ANALYZE FOR
and Generalities Case Illustration: ORIGIN OF MASS
in Medical A patient presenting with left lower quadrant
Management of pain.
ABDOMINAL Based on location, possible common organs of If there are
MASS involvement: intestines, ovary (female) gynecological
symptoms, then
MASS in the
gynecologic organs
(such as uterus and
left ovary) should be
suspected.
 • Clinical diagnosis of abdominal MASS?
Fundamentals
and Generalities TIPS:
in Medical SYMPTOM-BASED
Management of BASIC EVALUATION METHODS: EVALUATION
ABDOMINAL
MASS • HISTORY TAKING – TO GET SYMPTOMS
• PHYSICAL EXAMINATION – TO GET SIGNS SIGN-BASED
EVALUATION

CLINICAL DIAGNOSIS
CLINICAL DIAGNOSIS
 • Clinical diagnosis of abdominal MASS?
Fundamentals
and Generalities TIPS in evaluating / diagnosing ABDOMINAL
in Medical MASS
Management of
ABDOMINAL PHYSICAL EXAMINATION
MASS
LOOK AND PALPATE
 • Clinical diagnosis of abdominal MASS?
Fundamentals
and Generalities TIPS:
in Medical BASIC EXAMINATION OF THE ABDOMEN for MASS
Management of LOOK AND PALPATE
ABDOMINAL
MASS • LOOK for unusual bulge that may suggest mass.
• LOOK for abdominal distention that may
suggest intestinal obstruction, mass or fluid.
• PALPATE for possible presence of mass.
• PALPATE for presence of tenderness (pain on
pressure) – if present, evaluate further.
 • Clinical diagnosis of abdominal MASS? BASIC PROCESSES
Fundamentals
and Generalities Processes used in clinical diagnosis of
in Medical abdominal MASS:
Management of • Pattern recognition process means realization
ABDOMINAL that the patient’s presentation conforms to a
MASS
previously learned picture or pattern of
disease.
• Prevalence process means choice of a diagnosis
is based on the frequency of occurrence of the
disease in a certain locality, in a certain age and
sex group, and in the affected organ and
system.
 • Clinical diagnosis of abdominal pain?
Fundamentals
and Generalities TIPS:
in Medical In looking for the SPECIFIC CAUSE of ABDOMINAL
Management of MASS,
ABDOMINAL use PATTERN RECOGNITION of a particular
MASS medical condition or disease and PREVALENCE
process in those with similar presentation of
symptoms and signs.

• Primary clinical diagnosis: Most probable

• Secondary clinical diagnosis: Second most
probable
 • Clinical diagnosis of abdominal MASS?
Fundamentals
and Generalities Aids in clinical diagnosis:
in Medical • Location of mass
Management of • Other symptoms and signs of abdominal
ABDOMINAL disorders such as
MASS • Abdominal obstruction
• Abdominal bleeding
• Jaundice
• Other symptoms and signs of specific organ
disease
 • Clinical
Paraclinical
diagnosis
diagnostic
of abdominal
procedures
pain?
for
Fundamentals
abdominal MASS?
and Generalities
in Medical
Management of
ABDOMINAL
MASS
 • Clinical
Paraclinical
diagnosis
diagnostic
of abdominal
procedures
pain?
for
Fundamentals
abdominal MASS?
and Generalities
in Medical Common instrumental and laboratory diagnostic
Management of procedures for ABDOMINAL MASS:
ABDOMINAL
MASS • Imaging procedures (x-rays – plain / with
barium dye; ultrasound; CT scan; MRI; PET
scan; etc.)
• Endoscopy (upper - esophagogastroscopy /
lower – colonoscopy, sigmoidoscopy,
proctoscopy)
• Blood tests (CBC; liver function tests; tumor
markers; etc.)
 • Clinical
Paraclinical
diagnosis
diagnostic
of abdominal
procedures
pain?
for
Fundamentals
abdominal MASS?
and Generalities
in Medical
Management of The foremost indication for a paraclinical
ABDOMINAL diagnostic procedure can be stated this
MASS way:

if you are not certain on the primary

clinical diagnosis and you need to be
certain or be more certain before
treatment, then go for a paraclinical
diagnostic procedure.
 • Clinical
Paraclinical
diagnosis
diagnostic
of abdominal
procedures
pain?
for
Fundamentals As a rule, there is no need
abdominal MASS?
and Generalities for a paraclinical
in Medical diagnostic procedure if:
Management of
To decide on indication of the paraclinical
• you are quite
ABDOMINAL diagnostic procedure,
certain of your
MASS the physician uses two processes – primary clinical
- degree of certainty on the primary diagnosis.
clinical diagnosis and • treatment plans for
primary and
- comparison of the treatment plans for secondary
the primary and secondary clinical diagnoses are the
diagnoses. same.
 • Clinical
Paraclinical
diagnosis
diagnostic
of abdominal
procedures
pain?
for
Fundamentals
abdominal MASS?
and Generalities
in Medical
Competencies required of physicians managing
Management of
abdominal MASS:
ABDOMINAL
MASS • Know the uses and indications of all known
instrumental and laboratory diagnostic
procedures for abdominal mass.
• Use as needed and indicated.
• Select the most cost-effective one using the
BRCA process.
• Know how to interpret the results.
 • Clinical
Paraclinical
diagnosis
diagnostic
of abdominal
procedures
pain?
for
Fundamentals
abdominal MASS?
and Generalities
in Medical
BRCA Process in selecting diagnostic procedures
Management of
ABDOMINAL Procedures Benefit Risk Cost Availability
MASS (goal – to
be more
definite on
the
diagnosis)

Option1        
Option2        
Option3        
 • Clinical
Basic treatment
diagnosismodalities
of abdominal
for abdominal
pain?
Fundamentals
MASS?
and Generalities
in Medical
Management of
ABDOMINAL
MASS
 • Clinical
Basic treatment
diagnosismodalities
of abdominal
for abdominal
pain?
Fundamentals
MASS?
and Generalities
in Medical SPECIFIC DISEASE SURGICAL / POTENTIALLY SURGICAL / NON-SURGICAL
Management of
ABDOMINAL W
MASS X
Y
Z

• Surgical – outright surgical

• Non-surgical – non-surgical at all times (no OPERATION)
• Potentially surgical – surgical only when needed
 • Clinical
Basic treatment
diagnosismodalities
of abdominal
for abdominal
pain? Surgical Treatment:
Fundamentals
MASS? • Drainage of
and Generalities
infections
in Medical Examples of OUTRIGHT SURGICAL ABDOMEN (abscesses)
Management of • Mass causing complete intestinal obstruction • Removal (-ectomy
ABDOMINAL • Resectable cancers such as
MASS • Resectable non-cancers causing symptoms gastrectomy and
pancreatectomy)

• Surgical – outright surgical

• Non-surgical – non-surgical at all times (no OPERATION)
• Potentially surgical – surgical only when needed
 • Clinical
Basic treatment
diagnosismodalities
of abdominal
for abdominal
pain?
Fundamentals
MASS?
and Generalities
in Medical Examples of POTENTIALLY SURGICAL ABDOMEN
Management of • Asymptomatic polyps
ABDOMINAL • Asymptomatic chronic abscess
MASS • Asymptomatic benign tumors

• Surgical – outright surgical

• Non-surgical – non-surgical at all times (no OPERATION)
• Potentially surgical – surgical only when needed
 • Clinical
Basic treatment
diagnosismodalities
of abdominal
for abdominal
pain?
Fundamentals
MASS?
and Generalities
in Medical Examples of OUTRIGHT NON-SURGICAL
Management of ABDOMEN
ABDOMINAL • Degenerative disorders like cysts
MASS • Hormonal changes Non-Surgical Treatment:
• Medicines
• NO medicines (watchful waiting;
natural support management; etc.)
• Surgical – outright surgical
• Non-surgical – non-surgical at all times (no OPERATION)
• Potentially surgical – surgical only when needed
 • Clinical
Basic treatment
diagnosismodalities
of abdominal
for abdominal
pain?
Fundamentals
MASS?
and Generalities
in Medical
BRCA Process in selecting cost-effective treatment
Management of
modality.
ABDOMINAL
MASS
 Fundamentals Contents of PEP TALK on ABDOMINAL
and Generalities MASS
in Medical • What is an abdominal mass?
Management of • What are the different types of abdominal Summary
ABDOMINAL mass? Take Away
MASS • What are the causes of abdominal mass?
• How common are the abdominal mass?
• Clinical diagnosis of abdominal mass?
• Paraclinical diagnostic procedures for
abdominal mass?
• Basic treatment modalities for abdominal
mass?
 Fundamentals Be always in touch with reliable medical Take Away in
and Generalities information on fundamentals and relation to
in Medical generalities in medical management of Patient
Management of ABDOMINAL MASS.
ABDOMINAL
Empowerment
MASS Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
medical management of ABDOMINAL
MASS.
Health Disorder Empowerment
Course– objective - for
Fundamentals laypeople to have an
and understanding of the
Generalities in FUNDAMENTALS
Medical and GENERALITIES in
Management the MEDICAL
of MANAGEMENT of
ABDOMINAL ABDOMINAL MASS.
MASS
[OVERVIEW]