Churchills Pocketbook of Differential Diagnosis

Abdominal Swellings 23
BOWEL
•
Diverticular mass
Crohn’s disease
• Carcinoma
OTHER
Urachal cyst.
•
HISTORY
SUBASH KC/NMC-15TH/2014
Bladder
Sudden onset of suprapubic pain with inability to pass urine suggests
acute retention. There will usually be a past history of difficulty in
starting and a poor stream. A history of dribbling may suggest acute
renal failure associated with upper tract problems from chronic
outflow obstruction. Haematuria, frequency, dysuria may suggest
bladder carcinoma.
Uterus
Missed periods and early morning vomiting will suggest pregnancy.
Menorrhagia and dyspareunia will suggest fibroids. Intermenstrual
bleeding suggests carcinoma.
Urachus
Umbilical discharge may suggest a urachal cyst or abscess.
EXAMINATION
In acute retention there will be a smooth, tender swelling
extending towards (but not above) the umbilicus. It is dull to
percussion and it is impossible to get below it. Digital rectal
examination will usually reveal benign prostatic hypertrophy or
occasionally a hard, irregular prostate associated with carcinoma.
With carcinoma of the bladder, a hard, irregular craggy mass may
be felt arising out of the pelvis.
Uterus
A smooth, regular swelling arising out of the pelvis suggests a
pregnant uterus. Later, as the uterus enlarges, fetal heart sounds
may be heard. Fibroids are usually smooth and firm and may
become very large. Uterine carcinoma is hard and craggy. Bimanual
examination may confirm the diagnosis.
GENERAL INVESTIGATIONS
■■
FBC, ESR
Hb tumour. WCC infection.
Section A