Churchills Pocketbook of Differential Diagnosis

Abdominal Swellings 11
mass, which may be mobile or fixed. A diverticular mass is usually
tender and ill-defined, unless there is a large paracolic abscess. With
caecal volvulus, there is a tympanitic mass which may be tender with
impending infarction. With intussusception, there will be a smooth,
mobile tender sausage-shaped mass in the right hypochondrium. The
mass may move as the intussusception progresses.
Right kidney
See kidney swellings, p. 282.
GENERAL INVESTIGATIONS
SUBASH KC/NMC-15TH/2014
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FBC, ESR
Hb anaemia, e.g. carcinoma of the colon, haematuria with
renal lesions. Hb , e.g. hypernephroma (polycythaemia
associated with hypernephroma). WCC , e.g. empyema,
diverticular mass. ESR , malignancy.
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U&Es
Vomiting and dehydration, e.g. gall bladder and bowel lesions.
Ureteric obstruction with renal lesions leading to uraemia.
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LFTs
Liver lesions. Secondary deposits in liver.
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MSU
Renal lesions – red blood cells, pus cells, malignant cells. C&S.
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AXR
Intestinal obstruction due to carcinoma of the large bowel.
Gallstones (10% are radio-opaque). Caecal volvulus.
Constipation. Calcification in renal lesions.
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US
Liver lesions. Gallstones. Mucocele. Empyema. Bile duct dilatation.
SPECIFIC INVESTIGATIONS
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Barium enema
Carcinoma of the colon. Diverticular disease. Intussusception.
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Colonoscopy
Carcinoma of the colon. Diverticular disease.
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CT
Liver lesions. Gall bladder lesions. Renal lesions.
LEFT UPPER QUADRANT
CAUSES
SPLEEN
See splenomegaly, p. 410.
Section A