Epigastric Mass

Approach

  • Expose patient
  • Begin at the hands
  1. Inspect
    • Signs of anaemia
    • Evidence of jaundice
    • Palpate supraclavicular fossa for lymphadenopathy (especially virchow's node in left supraclavicular fossa)
    • Comment on any abdominal scars
    • May be fullness in epigastrium
  2. Palpate
    • Size
    • Surface
    • Edge
    • Consistency
    • Rleations
  3. Percuss
  4. Ascultate

Completion

  1. Complete rest of abdominal examination

 

 

Differential diagnosis

  1. Skin / soft tissues
    • Sebcecous cysts
    • Sarcoma
    • Lipoma
    • Herniae (epigastric)
  2. GIT
    • Hepatomegaly
    • Carcinoma of stomach
    • Carcinoma of pancreas
    • Pancreatic pseudocyst
  3. Vascular system
    • Abdominal aortic aneurysm
    • Retroperitoneal lymphadenopathy