Approach

• Abdominal examination

1. Inspect
   • Hands - clubbing (IBD), pale skin creases (anaemia, chronic bleeds), AV fistula (Transplanted kidney)
   • Eyes - pale conjunctivae (anaemia), sclera (jaundice)
   • Neck - Lymphadenopathy: esp note presence of Virchow's node in left supraclavicular fossa
   • Abdomen - Scars from previous surgery, asymmetry
2. Palpate
   • Size
   • Edge - well defined / poorly defined
   • Surface - smooth / irregular / nodular
   • Relations - arise from pelvis
   • Attachment to skin
   • Attachment to abdominal wall muscles
3. Percuss
4. Ascultate

Completion

1. Further examination depends on diagnosis

Differential diagnoses

1. skin and soft tissues
   • sebaceous cyst
   • lipoma
   • sarcoma
2. bowel
   • carcinoma of caecum
   • crohn's mass
   • TB of terminal ileum
   • Appendicular mass / abscess
3. gynaecological
   • ovarian tumours
   • fibroid uterus
4. male reproductive system
   • undescended testis
   • ectopic testis
5. urological system
   • transplanted kidney
   • ectopic kidney
   • bladder diverticulum
6. blood vessels
   • external iliac or common ilaic artery aneurysm
   • lymphadenopathy

Investigations of RIF mass

1. USS: distinguish bowel, ovarian, uterine, nodes, blood vessels
2. CT  / contrast enhanced CT