Causes of Abdominal aortic aneurysm
Causes of Abdominal aortic aneurysm (Diseases Database):
The follow list shows some of the possible medical causes of Abdominal aortic aneurysm
that are listed by the Diseases Database:
Source: Diseases Database
Abdominal aortic aneurysm Causes: Book Excerpts
Medical news summaries relating to Abdominal aortic aneurysm:
The following medical news items are relevant to causes of Abdominal aortic aneurysm:
Related information on causes of Abdominal aortic aneurysm:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Abdominal aortic aneurysm may be found in:
Causes of Abdominal aortic aneurysm: Online Medical Books
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Review excerpts from medical books online, free, without registration,
for more information about the causes of Abdominal aortic aneurysm.
Abdominal Bruit:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Abdominal aortic aneurysm
-
Hepatocellular carcinoma (hepatoma)
-
Cirrhosis
-
Liver hemangioma
-
Arteriovenous malformation
-
Renal artery stenosis
-
Celiac artery stenosis
-
Superior mesenteric artery stenosis
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Tricuspid regurgitation
-
Turbulence of the splenic artery
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Hepatic venous hum
–High-pitched continuous murmur that decreases with forced held expiration
-
Cruveilhier-Baumgarten murmur
–High-pitched venous hum of portal hypertension that becomes louder with forced expiration
-
Abdominal friction rub
–Associated with hepatoma, cholangiocarcinoma, liver metastases, inflammatory processes
-
Takayasu's arteritis
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Carotid Bruits:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Internal carotid artery stenosis
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External carotid artery stenosis
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Normal (nonstenotic), yet tortuous, carotid arteries
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Heart murmur with radiation to the neck (e.g., aortic stenosis)
-
Excessive compression of the stethoscope over the neck vessels, resulting in deformity of vessel wall and turbulence
-
Hyperthyroidism
–Results in hyperdynamic circulation, tachycardia, and hypertension
-
Takayasu's arteritis
–Decreased pulses and bruits may occur over the abdominal aorta, carotid arteries, brachial arteries, and subclavian arteries
-
Fisher's contralateral systolic bruit
–Heard over the carotid bifurcation, eyeball, and/or skull on the “normal side” due to increased flow, as the “silent” side is completely occluded
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Source: In a Page: Signs and Symptoms, 2004
Abdominal Masses:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Constipation/inability to pass stool
–Most commonly due to dehydration and/or low dietary fiber intake
–Hirschsprung's disease (congenital aganglionic megacolon)
–Medications: Narcotics, opiates, or anticholinergic medications
–Ogilvie's syndrome (colonic pseudo-obstruction)
-
Ascites
–May be due to malignancy, nephrotic syndrome, liver disease, or congestive heart failure
Large or small bowel obstruction Soft tissue mass
–Tumor (e.g., ovarian, uterine, bowel, liver)
–Uterine fibroids
–Lipoma: Soft, fleshy, mobile, and contained in the subcutaneous tissue of the abdominal wall
–Hernia: Bowel sounds may be audible over the mass; incarceration causes pain; strangulation leads to bowel death
–Pyloric stenosis: Seen primarily in infants; palpable pyloric olive-shaped mass
–Pregnancy
–Massive lymphadenopathy (e.g.,
lymphoma)
–Organomegaly (e.g., hepatomegaly, splenomegaly)
–Infection: Intra-abdominal or tubo-ovarian abscess
–Abdominal aortic aneurysm: Associated with pulsatile mass and hypotension
- Cyst
–Mesenteric cysts: Fluid collections in the mesentery; typically benign
–Hydatid cyst: Caused by larval form of Echinococcus granulosus; typically found in the liver in patients with history of travel to tropical areas
–Dermoid cyst: May be massive due to delayed presentation
- Palpable gallbladder (Courvoisier's sign): Associated with common bile duct obstruction and a distended gallbladder
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Source: In a Page: Signs and Symptoms, 2004
Abdominal Guarding:
Differential Diagnosis
(In a Page: Signs and Symptoms)
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Appendicitis
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Pancreatitis
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Diverticulitis
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Abdominal wall strain/injury
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Pelvic inflammatory disease
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Ectopic pregnancy
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Bowel obstruction
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Ileus
-
Pneumonia
-
Dyspepsia
-
Nephrolithiasis
-
Peptic ulcer disease
-
Abdominal aortic aneurysm
-
Anxiety
-
Malingering
-
Spontaneous bacterial peritonitis (SBP)
-
Mesenteric ischemia
-
GERD
-
Ovarian cyst
-
Hepatic or splenic contusion/laceration
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Pneumoperitoneum secondary to trauma
-
Urinary tract infection/pyelonephritis
-
Zoster
–Skin lesions may not be visible until another day or two
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Insect toxins (e.g., black widow spider)
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Abscess (e.g., iliopsoas)
-
Incarcerated hernia
-
Abdominal migraine
-
Intussusception
-
Volvulus
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Abdominal Masses:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
-
Wilms tumor
–More common in younger children
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Neuroblastoma
–More common in younger children
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Leukemia/lymphoma
–Involvement of retroperitoneal nodes, liver, or spleen
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Hepatic tumors
–Hepatoblastoma, hepatocellular carcinoma, angiosarcoma, rhabdomyosarcoma of the liver, metastatic disease
-
Germ cell tumors
–Ovarian, teratoma
-
Soft tissue sarcoma
–Rhabdomyosarcoma
-
Rare malignancies in children
–Carcinoid tumors, adrenocortical carcinoma, pancreatoblastoma, malignant rhabdoid tumor
-
Cystic masses
–Ovary, renal, mesenteric
-
Benign tumors
–Adenomas (especially of liver), hamartomas, pheochromocytoma
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Vascular lesions (e.g., hemangioma)
-
Renal etiologies
–Distended, nonemptying bladder, bladder
outlet obstruction
–Congenital mesoblastic nephroma
–Severe hydronephrosis
-
Gynecologic
–Ovarian torsion, endometriosis, pelvic inflammatory disease
-
Gastrointestinal
–Constipation/stool impaction, intestinal obstruction (e.g., Hirschsprung), GI duplication, incarcerated hernia
-
Pancreatic pseudocyst
-
Infectious
–Abscess, hepatitis, virus (EBV, CMV) causing splenomegaly or hepatomegaly
-
Structures normally palpable in small children are liver edge, spleen tip (especially with viral illness), aorta, sigmoid colon, and spine
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Abdominal mass:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
❑ Abdominal aortic aneurysm. Abdominal aortic aneurysm may persist for years, producing only a pulsating periumbilical mass with a systolic bruit over the aorta. However, it may become life-threatening if the aneurysm expands and its walls weaken. In such cases, the patient initially reports constant upper abdominal pain or, less commonly, low back or dull abdominal pain. If the aneurysm ruptures, he’ll report severe abdominal and back pain. After rupture, the aneurysm no longer pulsates.
Associated signs and symptoms of rupture include mottled skin below the waist, absent femoral and pedal pulses, lower blood pressure in the legs than in the arms, mild to moderate tenderness with guarding, and abdominal rigidity. Signs of shock — such as tachycardia and cool, clammy skin — appear with significant blood loss.
❑ Cholecystitis.Deep palpation below the liver border may reveal a smooth, firm, sausage-shaped mass. However, with acute inflammation, the gallbladder is usually too tender to be palpated. Cholecystitis can cause severe right upper quadrant pain that may radiate to the right shoulder, chest, or back; abdominal rigidity and tenderness; fever; pallor; diaphoresis; anorexia; nausea; and vomiting. Recurrent attacks usually occur 1 to 6 hours after meals. Murphy’s sign (inspiratory arrest elicited when the examiner palpates the right upper quadrant as the patient takes a deep breath) is common.
❑ Colon cancer.A right lower quadrant mass may occur with cancer of the right colon, which may also cause occult bleeding with anemia and abdominal aching, pressure, or dull cramps. Associated findings include weakness, fatigue, exertional dyspnea, vertigo, and signs and symptoms of intestinal obstruction, such as obstipation and vomiting.
Occasionally, cancer of the left colon also causes a palpable mass. It usually produces rectal bleeding, intermittent abdominal fullness or cramping, and rectal pressure. The patient may also report fremitus and pelvic discomfort. Later, he develops obstipation, diarrhea, or pencil-shaped, grossly bloody, or mucus-streaked stools. Typically, defecation relieves pain.
❑ Crohn’s disease. With Crohn’s disease, tender, sausage-shaped masses are usually palpable in the right lower quadrant and, at times, in the left lower quadrant. Attacks of colicky right lower quadrant pain and diarrhea are common. Associated signs and symptoms include fever, anorexia, weight loss, hyperactive bowel sounds, nausea, abdominal tenderness with guarding, and perirectal, skin, or vaginal fistulas.
❑ Diverticulitis. Most common in the sigmoid colon, diverticulitis may produce a left lower quadrant mass that’s usually tender, firm, and fixed. It also produces intermittent abdominal pain that’s relieved by defecation or passage of flatus. Other findings may include alternating constipation and diarrhea, nausea, a low-grade fever, and a distended and tympanic abdomen.
❑ Gastric cancer.Advanced gastric cancer may produce an epigastric mass. Early findings include chronic dyspepsia and epigastric discomfort, whereas late findings include weight loss, a feeling of fullness after eating, fatigue and, occasionally, coffee-ground vomitus or melena.
❑ Hepatomegaly. Hepatomegaly produces a firm, blunt, irregular mass in the epigastric region or below the right costal margin. Associated signs and symptoms vary with the causative disorder but commonly include ascites, right upper quadrant pain and tenderness, anorexia, nausea, vomiting, leg edema, jaundice, palmar erythema, spider angiomas, gynecomastia, testicular atrophy and, possibly, splenomegaly.
❑ Hernia. The soft and typically tender bulge is usually an effect of prolonged, increased intra-abdominal pressure on weakened areas of the abdominal wall. An umbilical hernia is typically located around the umbilicus and an inguinal hernia in either the right or left groin. An incisional hernia can occur anywhere along a previous incision. Hernia may be the only sign until strangulation occurs.
❑ Hydronephrosis. Enlarging one or both kidneys, hydronephrosis produces a smooth, boggy mass in one or both flanks. Other findings vary with the degree of hydronephrosis. The patient may have severe colicky renal pain or dull flank pain that radiates to the groin, vulva, or testes. Hematuria, pyuria, dysuria, alternating oliguria and polyuria, nocturia, accelerated hypertension, nausea, and vomiting may also occur.
❑ Ovarian cyst. A large ovarian cyst may produce a smooth, rounded, fluctuant mass, resembling a distended bladder, in the suprapubic region. Large or multiple cysts may also cause mild pelvic discomfort, low back pain, menstrual irregularities, and hirsutism. A twisted or ruptured cyst may cause abdominal tenderness, distention, and rigidity.
❑ Splenomegaly. The lymphomas, leukemias, hemolytic anemias, and inflammatory diseases are among the many disorders that may cause splenomegaly. Typically, the smooth edge of the enlarged spleen is palpable in the left upper quadrant. Associated signs and symptoms vary with the causative disorder but usually include a feeling of abdominal fullness, left upper quadrant abdominal pain and tenderness, splenic friction rub, splenic bruits, and a low-grade fever.
❑ Uterine leiomyomas (fibroids). If large enough, these common, benign uterine tumors produce a round, multinodular mass in the suprapubic region. The patient’s chief complaint is usually menorrhagia; she may also experience a feeling of heaviness in the abdomen, and pressure on surrounding organs may cause back pain, constipation, and urinary frequency or urgency. Edema and varicosities of the lower extremities may develop. Rapid fibroid growth in perimenopausal or postmenopausal women needs further evaluation.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Bruits:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
❑ Abdominal aortic aneurysm. A pulsating periumbilical mass accompanied by a systolic bruit over the aorta characterizes abdominal aortic aneurysm. Associated signs and symptoms include a rigid, tender abdomen; mottled skin; diminished peripheral pulses; and claudication. Sharp, tearing pain in the abdomen, flank, or lower back signals imminent dissection.
❑ Abdominal aortic atherosclerosis. Loud systolic bruits in the epigastric and midabdominal areas are common. They may be accompanied by leg weakness, numbness, paresthesia, or paralysis; leg pain; or decreased or absent femoral, popliteal, or pedal pulses. Abdominal pain is rarely present.
❑ Anemia. Increased cardiac output causes increased blood flow. In patients with severe anemia, short systolic bruits may be heard over both carotid arteries and may be accompanied by headache, fatigue, dizziness, pallor, jaundice, palpitations, mild tachycardia, dyspnea, nausea, anorexia, and glossitis.
❑ Carotid artery stenosis. Systolic bruits can be heard over one or both carotid arteries. Other signs and symptoms may be absent. However, dizziness, vertigo, headache, syncope, aphasia, dysarthria, sudden vision loss, hemiparesis, or hemiparalysis signals a TIA and may herald a stroke.
❑ Carotid cavernous fistula. Continuous bruits heard over the eyeballs and temples are characteristic, as are vision disturbances and protruding, pulsating eyeballs.
❑ Peripheral arteriovenous fistula. A rough, continuous bruit with systolic accentuation may be heard over the fistula; a palpable thrill is also common.
❑ Peripheral vascular disease.Peripheral vascular disease characteristically produces bruits over the femoral artery and other arteries in the legs. It can also cause diminished or absent femoral, popliteal, or pedal pulses; intermittent claudication; numbness, weakness, pain, and cramping in the legs, feet, and hips; and cool, shiny skin and hair loss on the affected extremity. It also predisposes the patient to lower-extremity ulcers that heal with difficulty.
❑ Renal artery stenosis. Systolic bruits are commonly heard over the abdominal midline and flank on the affected side. Hypertension commonly accompanies stenosis. Headache, palpitations, tachycardia, anxiety, dizziness, retinopathy, hematuria, and mental sluggishness may also appear.
❑ Subclavian steal syndrome. With subclavian steal syndrome, systolic bruits may be heard over one or both subclavian arteries as a result of arterial lumen narrowing. They may be accompanied by decreased blood pressure and claudication in the affected arm, hemiparesis, vision disturbances, vertigo, and dysarthria.
❑ Thyrotoxicosis. A systolic bruit is commonly heard over the thyroid gland. Accompanying signs and symptoms appear in all body systems, but the most characteristic ones include thyroid enlargement, fatigue, nervousness, tachycardia, heat intolerance, sweating, tremor, diarrhea, and weight loss despite increased appetite. Exophthalmos may also be present.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Abdominal rigidity [Abdominal muscle spasm, involuntary guarding]:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
❑ Abdominal aortic aneurysm (dissecting). Mild to moderate abdominal rigidity occurs with abdominal aortic aneurysm, a life-threatening disorder. Typically, it’s accompanied by constant upper abdominal pain that may radiate to the lower back. The pain may worsen when the patient lies down and may be relieved when he leans forward or sits up. Before rupture, the aneurysm may produce a pulsating mass in the epigastrium, accompanied by a systolic bruit over the aorta. However, the mass stops pulsating after rupture. Associated signs and symptoms include mottled skin below the waist, absent femoral and pedal pulses, lower blood pressure in the legs than in the arms, and mild to moderate tenderness with guarding. Significant blood loss causes signs of shock, such as tachycardia, tachypnea, and cool, clammy skin.
❑ Insect toxins. Insect stings and bites, especially black widow spider bites, release toxins that can produce generalized, cramping abdominal pain, usually accompanied by rigidity. These toxins may also cause a low-grade fever, nausea, vomiting, tremors, and burning sensations in the hands and feet. Some patients develop increased salivation, hypertension, paresis, and hyperactive reflexes. Children commonly are restless, have an expiratory grunt, and keep their legs flexed.
❑ Mesenteric artery ischemia. A life-threatening disorder, mesenteric artery ischemia is characterized by 2 to 3 days of persistent, low-grade abdominal pain and diarrhea leading to sudden, severe abdominal pain and rigidity. Rigidity occurs in the central or periumbilical region and is accompanied by severe abdominal tenderness, fever, and signs of shock, such as tachycardia and hypotension. Other findings may include vomiting, anorexia, and diarrhea or constipation. Always suspect this disorder in patients older than age 50 who have a history of heart failure, arrhythmia, cardiovascular infarct, or hypotension.
❑ Peritonitis. Depending on the cause of peritonitis, abdominal rigidity may be localized or generalized. For example, if an inflamed appendix causes local peritonitis, rigidity may be localized in the right lower quadrant. If a perforated ulcer causes widespread peritonitis, rigidity may be generalized and, in severe cases, boardlike.
Peritonitis also causes sudden and severe abdominal pain that can be localized or generalized. In addition, it can produce abdominal tenderness and distention, rebound tenderness, guarding, hyperalgesia, hypoactive or absent bowel sounds, nausea, and vomiting. Usually, the patient also displays fever, chills, tachycardia, tachypnea, and hypotension.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Abdominal aneurysm:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Abdominal aortic aneurysms result from arteriosclerosis, hypertension, congenital weakening, cystic medial necrosis, trauma, syphilis, and other infections. In children, this disorder can result from blunt abdominal injury or Marfan syndrome. These aneurysms develop slowly. First, a focal weakness in the muscular layer of the aorta (tunica media), due to degenerative changes, allows the inner layer (tunica intima) and outer layer (tunica adventitia) to stretch outward. Blood pressure within the aorta progressively weakens the vessel walls and enlarges the aneurysm.
This disorder is four times more common in men than in women and is most prevalent in whites ages 40 to 70. Less than 50% of people with a ruptured abdominal aortic aneurysm survive.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Femoral and popliteal aneurysms:
Causes
(Professional Guide to Diseases (Eighth Edition))
Femoral and popliteal aneurysms are usually secondary to atherosclerosis. Rarely, they result from congenital weakness in the arterial wall. They may also result from trauma (blunt or penetrating), bacterial infection, or peripheral vascular reconstructive surgery (which causes “suture line” aneurysms, or false aneurysms, in which a blood clot forms a second lumen).
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Abdominal mass:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Abdominal aortic aneurysm
An abdominal aortic aneurysm may persist for years, producing only a pulsating periumbilical mass with a systolic bruit over the aorta. However, it may become life-threatening if the aneurysm expands and its walls weaken. In such cases, the patient initially reports constant upper abdominal pain or, less often, low back or dull abdominal pain. If the aneurysm ruptures, he’ll report severe abdominal and back pain. And after rupture, the aneurysm no longer pulsates.
Associated signs and symptoms of rupture include mottled skin below the waist, absent femoral and pedal pulses, lower blood pressure in the legs than in the arms, mild to moderate tenderness with guarding, and abdominal rigidity. Signs of shock—such as tachycardia and cool, clammy skin—appear with significant blood loss.
Bladder distention
A smooth, rounded, fluctuant suprapubic mass is characteristic. In extreme distention, the mass may extend to the umbilicus. Severe suprapubic pain and urinary frequency and urgency may also occur.
Cholecystitis
Deep palpation below the liver border may reveal a smooth, firm, sausage-shaped mass. However, in acute inflammation, the gallbladder is usually too tender to be palpated. Cholecystitis can cause severe right-upper-quadrant pain that may radiate to the right shoulder, chest, or back; abdominal rigidity and tenderness; fever; pallor; diaphoresis; anorexia; nausea; and vomiting. Recurrent attacks usually occur 1 to 6 hours after meals. Murphy’s sign (inspiratory arrest elicited when the examiner palpates the right upper quadrant as the patient takes a deep breath) is common.
Cholelithiasis
A stone-filled gallbladder usually produces a painless right-upper-quadrant mass that’s smooth and sausage-shaped. However, passage of a stone through the bile or cystic duct may cause severe right-upper-quadrant pain that radiates to the epigastrium, back, or shoulder blades. Accompanying signs and symptoms include anorexia, nausea, vomiting, chills, diaphoresis, restlessness, and low-grade fever. Jaundice may occur with obstruction of the common bile duct. The patient may also experience intolerance of fatty foods and frequent indigestion.
Colon cancer
A right-lower-quadrant mass may occur in cancer of the right colon, which may also cause occult bleeding with anemia and abdominal aching, pressure, or dull cramps. Associated findings include weakness, fatigue, exertional dyspnea, vertigo, and signs and symptoms of intestinal obstruction, such as obstipation and vomiting.
Occasionally, cancer of the left colon also causes a palpable mass. Usually though, it produces rectal bleeding, intermittent abdominal fullness or cramping, and rectal pressure. The patient may also report fremitus and pelvic discomfort. Later, he develops obstipation, diarrhea, or pencil-shaped, grossly bloody, or mucus-streaked stools. Typically, defecation relieves pain.
Crohn’s disease
In Crohn’s disease, tender, sausage-shaped masses are usually palpable in the right lower quadrant and, at times, in the left lower quadrant. Attacks of colicky right-lower-quadrant pain and diarrhea are common. Associated signs and symptoms include fever, anorexia, weight loss, hyperactive bowel sounds, nausea, abdominal tenderness with guarding, and perirectal, skin, or vaginal fistulas.
Diverticulitis
Most common in the sigmoid colon, diverticulitis may produce a left-lower-quadrant mass that’s usually tender, firm, and fixed. It also produces intermittent abdominal pain that’s relieved by defecation or passage of flatus. Other findings may include alternating constipation and diarrhea, nausea, low-grade fever, and a distended and tympanic abdomen.
Gallbladder cancer
Gallbladder cancer may produce a moderately tender, irregular mass in the right upper quadrant. Accompanying it is chronic, progressively severe epigastric or right-upper-quadrant pain that may radiate to the right shoulder. Associated signs and symptoms include nausea, vomiting, anorexia, weight loss, jaundice, and possibly hepatosplenomegaly.
Gastric cancer
Advanced gastric cancer may produce an epigastric mass. Early findings include chronic dyspepsia and epigastric discomfort, whereas late findings include weight loss, a feeling of fullness after eating, fatigue, and occasionally coffee-ground vomitus or melena.
Hepatic cancer
Hepatic cancer produces a tender, nodular mass in the right upper quadrant or right epigastric area accompanied by severe pain that’s aggravated by jolting. Other effects include weight loss, weakness, anorexia, nausea, fever, dependent edema, and occasionally jaundice and ascites. A large tumor can also cause a bruit or hum.
Hepatomegaly
Hepatomegaly produces a firm, blunt, irregular mass in the epigastric region or below the right costal margin. Associated signs and symptoms vary with the causative disorder but commonly include ascites, right-upper-quadrant pain and tenderness, anorexia, nausea, vomiting, leg edema, jaundice, palmar erythema, spider angiomas, gynecomastia, testicular atrophy, and possibly splenomegaly.
Hydronephrosis
By enlarging one or both kidneys, hydronephrosis produces a smooth, boggy mass in one or both flanks. Other findings vary with the degree of hydronephrosis. The patient may have severe colicky renal pain or dull flank pain that radiates to the groin, vulva, or testes. Hematuria, pyuria, dysuria, alternating oliguria and polyuria, nocturia, accelerated hypertension, nausea, and vomiting may also occur.
Ovarian cyst
A large ovarian cyst may produce a smooth, rounded, fluctuant mass, resembling a distended bladder, in the suprapubic region. Large or multiple cysts may also cause mild pelvic discomfort, low back pain, menstrual irregularities, and hirsutism. A twisted or ruptured cyst may cause abdominal tenderness, distention, and rigidity.
Pancreatic abscess
Occasionally, pancreatic abscess may produce a palpable epigastric mass accompanied by epigastric pain and tenderness. The patient’s temperature usually rises abruptly but may climb steadily. Nausea, vomiting, diarrhea, tachycardia, and hypotension may also occur.
Pancreatic pseudocysts
After pancreatitis, pseudocysts may form on the pancreas, causing a palpable nodular mass in the epigastric area. Other findings include nausea, vomiting, diarrhea, abdominal pain and tenderness, low-grade fever, and tachycardia.
Renal cell carcinoma
Usually occurring in only one kidney, renal cell carcinoma produces a smooth, firm, nontender mass near the affected kidney. Accompanying it are dull, constant abdominal or flank pain and hematuria. Other signs and symptoms include elevated blood pressure, fever, and urine retention. Weight loss, nausea, vomiting, and leg edema occur in late stages.
Splenomegaly
Lymphomas, leukemias, hemolytic anemias, and inflammatory diseases are among the many disorders that may cause splenomegaly. Typically, the smooth edge of the enlarged spleen is palpable in the left upper quadrant. Associated signs and symptoms vary with the causative disorder but often include a feeling of abdominal fullness, left-upper-quadrant abdominal pain and tenderness, splenic friction rub, splenic bruits, and low-grade fever.
Uterine leiomyomas (fibroids)
If large enough, these common, benign uterine tumors produce a round, multinodular mass in the suprapubic region. The patient’s chief complaint is usually menorrhagia; she may also experience a feeling of heaviness in the abdomen, and pressure on surrounding organs may cause back pain, constipation, and urinary frequency or urgency. Edema and varicosities of the lower extremities may develop. Rapid fibroid growth in perimenopausal or postmenopausal women needs further evaluation.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Bruits:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Abdominal aortic aneurysm
A pulsating periumbilical mass accompanied by a systolic bruit over the aorta characterizes an abdominal aortic aneurysm. Associated signs and symptoms include a rigid, tender abdomen; mottled skin; diminished peripheral pulses; and claudication. Sharp, tearing pain in the abdomen, flank, or lower back signals imminent dissection.
Abdominal aortic atherosclerosis
Loud systolic bruits in the epigastric and midabdominal areas are common in this disorder. They may be accompanied by leg pain, weakness, numbness, paresthesia, or paralysis or by decreased or absent femoral, popliteal, or pedal pulses. Abdominal pain is rare.
Anemia
Increased cardiac output in anemia causes increased blood flow. In patients with severe anemia, short systolic bruits may be heard over both carotid arteries and may be accompanied by headache, fatigue, dizziness, pallor, jaundice, palpitations, mild tachycardia, dyspnea, nausea, anorexia, and glossitis.
Carotid artery stenosis
Systolic bruits heard over one or both carotid arteries may be the only sign of this disorder. However, dizziness, vertigo, headache, syncope, aphasia, dysarthria, sudden vision loss, hemiparesis, or hemiparalysis signals TIA and may herald a stroke.
Carotid cavernous fistula
Continuous bruits heard over the eyeballs and temples are characteristic, as are vision disturbances and protruding, pulsating eyeballs.
Peripheral arteriovenous fistula
A rough, continuous bruit with systolic accentuation may be heard over the fistula; a palpable thrill is also common.
Peripheral vascular disease
Peripheral vascular disease characteristically produces bruits over the femoral artery and other arteries in the legs. It can also cause diminished or absent femoral, popliteal, or pedal pulses; intermittent claudication; numbness, weakness, pain, and cramping in the legs, feet, and hips; and cool, shiny skin and hair loss on the affected extremity. It also predisposes the patient to lower extremity ulcers that heal with difficulty.
Renal artery stenosis
Systolic bruits are commonly heard over the abdominal midline and flank on the affected side. Hypertension commonly accompanies stenosis. Headache, palpitations, tachycardia, anxiety, dizziness, retinopathy, hematuria, and mental sluggishness may also appear.
Subclavian steal syndrome
In subclavian steal syndrome, systolic bruits may be heard over one or both subclavian arteries as a result of narrowing of the arterial lumen. They may be accompanied by decreased blood pressure and claudication in the affected arm, hemiparesis, vision disturbances, vertigo, and dysarthria.
Thyrotoxicosis
A systolic bruit is commonly heard over the thyroid gland. Accompanying signs and symptoms appear in all body systems, but the most characteristic ones include thyroid enlargement, fatigue, nervousness, tachycardia, heat intolerance, sweating, tremor, diarrhea, and weight loss despite increased appetite. Exophthalmos may also be present.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Abdominal rigidity [Abdominal muscle spasm, involuntary guarding]:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Abdominal aortic aneurysm (dissecting)
Mild to moderate abdominal rigidity occurs in abdominal aortic aneurysm, a life-threatening disorder. It’s typically accompanied by constant upper abdominal pain that may radiate to the lower back. The pain may worsen when the patient lies down and may be relieved when he leans forward or sits up. Before rupture, the aneurysm may produce a pulsating mass in the epigastrium, accompanied by a systolic bruit over the aorta. However, the mass stops pulsating after rupture. Associated signs and symptoms include mottled skin below the waist, absent femoral and pedal pulses, blood pressure that’s lower in the legs than in the arms, and mild to moderate abdominal tenderness with guarding. Significant blood loss causes signs of shock, such as tachycardia, tachypnea, and cool, clammy skin.
Mesenteric artery ischemia
This life-threatening disorder is characterized by 2 to 3 days of persistent, low-grade abdominal pain and diarrhea leading to sudden, severe abdominal pain and rigidity. Rigidity occurs in the central or periumbilical region and is accompanied by severe abdominal tenderness, fever, and signs of shock, such as tachycardia and hypotension. Other findings may include vomiting, anorexia, diarrhea, and constipation. Always suspect mesenteric artery ischemia in patients older than age 50 who have a history of heart failure, arrhythmias, cardiovascular infarct, or hypotension.
Peritonitis
Depending on the cause of peritonitis, abdominal rigidity may be localized or generalized. For example, if an inflamed appendix causes local peritonitis, rigidity may be localized in the right lower quadrant. If a perforated ulcer causes widespread peritonitis, rigidity may be generalized and, in severe cases, boardlike.
Peritonitis also causes sudden and severe abdominal pain that can be localized or generalized. It can also produce abdominal tenderness and distention, rebound tenderness, guarding, hyperalgesia, hypoactive or absent bowel sounds, nausea, and vomiting. Most patients also experience fever, chills, tachycardia, tachypnea, and hypotension.
Pneumonia
In lower lobe pneumonia, severe upper abdominal pain and tenderness accompany rigidity that diminishes with inspiration. Associated signs and symptoms include blood-tinged or rusty sputum, dyspnea, achiness, headache, fever, sudden onset of chills, crackles, egophony, decreased breath sounds, dullness on percussion, and a dry, hacking cough.
Other causes
Insect toxins
Insect stings and bites, especially black widow spider bites, release toxins that can produce generalized cramping abdominal pain, usually accompanied by rigidity. These toxins may also cause low-grade fever, nausea, vomiting, tremors, and burning sensations in the hands and feet. Some patients develop increased salivation, hypertension, paresis, and hyperactive reflexes. Children commonly are restless, have an expiratory grunt, and keep their legs flexed.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Abdominal/Pelvic Mass:
Differential Overview
(Field Guide to Bedside Diagnosis)
Abdominal Mass
❑ Liver enlargement
❑ Spleen enlargement
❑ Fecal mass
❑ Diverticulitis
❑ Colon cancer
❑ Gallbladder enlargement
❑ Pancreatic pseudocyst
❑ Crohn disease
❑ Abdominal aortic aneurysm
❑ Renal enlargement
Pelvic Mass
❑ Distended bladder
❑ Pregnant uterus
❑ Salpingitis
❑ Ovarian cyst
❑ Uterine fibromyoma
❑ Ovarian cancer
❑ Endometrial cancer
❑ Ectopic pregnancy
❑ Malignant deposit
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Carotid Bruit:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Carotid artery stenosis
❑ Carotid artery ruptured plaque
❑ Transmitted valvular murmur
❑ Carotid tortuosity
❑ Carotid compression
❑ Jugular venous hum
❑ Thyrotoxicosis
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Aneurysm, abdominal:
Causes
(Handbook of Diseases)
About 95% of abdominal aortic aneurysms result from arteriosclerosis; the rest, from cystic medial necrosis, trauma, syphilis, and other infections. These aneurysms develop slowly.
First, a focal weakness in the muscular layer of the aorta (tunica media), due to degenerative changes, allows the inner layer (tunica intima) and outer layer (tunica adventitia) to stretch outward. Blood pressure within the aorta progressively weakens the vessel walls and enlarges the aneurysm.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Aneurysms, femoral and popliteal:
Causes
(Handbook of Diseases)
Femoral and popliteal aneurysms are usually secondary to atherosclerosis. Rarely, they result from congenital weakness in the arterial wall. They may also result from trauma (blunt or penetrating), bacterial infection, or peripheral vascular reconstructive surgery (which causes “suture line” aneurysms, whereby a blood clot forms a second lumen, also called false aneurysms).
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
aneurysm,ventricular:
Causes
(Handbook of Diseases)
When MI destroys a large muscular section of the left ventricle, necrosis reduces the ventricular wall to a thin sheath of fibrous tissue. Under intracardiac pressure, this thin layer stretches and forms a separate noncontractile sac (aneurysm).
Abnormal muscle wall movement
Accompanying ventricular aneurysm, abnormal muscle wall movement includes akinesia (lack of movement), dyskinesia (paradoxical movement), asynergia (decreased and inadequate movement), and asynchrony (uncoordinated movement).
During systolic ejection, the abnormal muscle wall movements associated with the aneurysm cause the remaining normally functioning myocardial fibers to increase the force of contraction in order to maintain stroke volume and cardiac output. At the same time, a portion of the stroke volume is lost to passive distention of the noncontractile sac.
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Source: Handbook of Diseases, 2003
Aneurysm, thoracic aortic:
Causes
(Handbook of Diseases)
Commonly, a thoracic aortic aneurysm results from atherosclerosis, which weakens the aortic wall and gradually distends the lumen. An intimal tear in the ascending aorta initiates a dissecting aneurysm in about 60% of patients.
Aneurysm of the ascending part of the aorta is usually seen in hypertensive men who are younger than age 60. Aneurysm of the descending part of the aorta, usually found just below the origin of the subclavian artery, is most common in elderly hypertensive men. It’s also seen in younger patients with a history of traumatic chest injury, although less often in those with infection. Aneurysm of the transverse part of the aorta is the least common.
Other causes include:
fungal infection (mycotic aneurysms) of the aortic arch and descending segments
congenital disorders, such as coarctation of the aorta
trauma, usually of the descending part of the aorta around the thorax, from an accident that shears the aorta transversely (acceleration-deceleration injuries)
syphilis, usually of the ascending part of the aorta (uncommon because of antibiotics)
hypertension (in dissecting aneurysm).
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Abdominal mass:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Abdominal aortic aneurysm
An abdominal aortic aneurysm may persist for years, producing only a pulsating periumbilical mass with a systolic bruit over the aorta. However, it may become life-threatening if the aneurysm expands and its walls weaken. In such cases, the patient initially reports constant upper abdominal pain or, less often, low back or dull abdominal pain. If the aneurysm ruptures, he’ll report severe abdominal and back pain. After rupture, the aneurysm no longer pulsates.
Associated signs and symptoms of rupture include mottled skin below the waist, absent femoral and pedal pulses, lower blood pressure in the legs than in the arms, mild to moderate tenderness with guarding, and abdominal rigidity. Signs of shock — such as tachycardia and cool, clammy skin — appear with significant blood loss.
Bladder distention
A smooth, rounded, fluctuant suprapubic mass is characteristic of bladder distention. With extreme distention, the mass may extend to the umbilicus. Severe suprapubic pain and urinary frequency and urgency may also occur.
Cholecystitis
With cholecystitis, deep palpation below the liver border may reveal a smooth, firm, sausage-shaped mass. However, with acute inflammation, the gallbladder is usually too tender to be palpated. Cholecystitis can cause severe right-upper-quadrant pain that may radiate to the right shoulder, chest, or back; abdominal rigidity and tenderness; fever; pallor; diaphoresis; anorexia; nausea; and vomiting. Recurrent attacks usually occur 1 to 6 hours after meals. Murphy’s sign (inspiratory arrest elicited when the examiner palpates the right upper quadrant as the patient takes a deep breath) is common.
Cholelithiasis
With cholelithiasis, a stone-filled gallbladder usually produces a painless right-upper-quadrant mass that’s smooth and sausage-shaped. However, passage of a stone through the bile or cystic duct may cause severe right-upper-quadrant pain that radiates to the epigastrium, back, or shoulder blades. Accompanying signs and symptoms include anorexia, nausea, vomiting, chills, diaphoresis, restlessness, and low-grade fever. Jaundice may occur with obstruction of the common bile duct. The patient may also experience intolerance to fatty foods and frequent indigestion.
Colon cancer
A right-lower-quadrant mass may occur with cancer of the right colon, which may also cause occult bleeding with anemia and abdominal aching, pressure, or dull cramps. Associated findings include weakness, fatigue, exertional dyspnea, vertigo, and signs and symptoms of intestinal obstruction, such as obstipation and vomiting.
Occasionally, cancer of the left colon also causes a palpable mass. Usually though, it produces rectal bleeding, intermittent abdominal fullness or cramping, and rectal pressure. The patient may also report fremitus and pelvic discomfort. Later, he develops obstipation, diarrhea, or pencil-shaped, grossly bloody, or mucus-streaked stools. Typically, defecation relieves pain.
Crohn’s disease
With Crohn’s disease, tender, sausage-shaped masses are usually palpable in the right lower quadrant and, at times, in the left lower quadrant. Attacks of colicky right-lower-quadrant pain and diarrhea are common. Associated signs and symptoms include fever, anorexia, weight loss, hyperactive bowel sounds, nausea, abdominal tenderness with guarding, and perirectal, skin, or vaginal fistulas.
Diverticulitis
Most common in the sigmoid colon, diverticulitis may produce a left-lower-
quadrant mass that’s usually tender, firm, and fixed. It also produces intermittent abdominal pain that’s relieved by defecation or passage of flatus. Other findings may include alternating constipation and diarrhea, nausea, low-grade fever, and a distended and tympanic abdomen.
Gallbladder cancer
Gallbladder cancer may produce a moderately tender, irregular mass in the right upper quadrant. Accompanying it is chronic, progressively severe epigastric or right-upper-quadrant pain that may radiate to the right shoulder. Associated signs and symptoms include nausea, vomiting, anorexia, weight loss, jaundice and, at times, hepatosplenomegaly.
Gastric cancer
Advanced gastric cancer may produce an epigastric mass. Early findings include chronic dyspepsia and epigastric discomfort, whereas late findings include weight loss, a feeling of fullness, fatigue and, occasionally, coffee-ground vomitus or melena.
Hepatic cancer
Hepatic cancer produces a tender, nodular mass in the right upper quadrant or right epigastric area accompanied by severe pain that’s aggravated by jolting. Other effects include weight loss, weakness, anorexia, nausea, fever, dependent edema and, occasionally, jaundice and ascites. A large tumor can also cause a bruit or hum.
Hepatomegaly
Hepatomegaly produces a firm, blunt, irregular mass in the epigastric region or below the right costal margin. Associated signs and symptoms vary with the causative disorder but commonly include ascites, right-upper-quadrant pain and tenderness, anorexia, nausea, vomiting, leg edema, jaundice, palmar erythema, spider angiomas, gynecomastia, testicular atrophy and, possibly, splenomegaly.
Hydronephrosis
Enlarging one or both kidneys, hydronephrosis produces a smooth, boggy mass in one or both flanks. Other findings vary with the degree of hydronephrosis. The patient may have severe colicky renal pain or dull flank pain that radiates to the groin, vulva, or testes. Hematuria, pyuria, dysuria, alternating oliguria and polyuria, nocturia, accelerated hypertension, nausea, and vomiting may also occur.
Ovarian cyst
A large ovarian cyst may produce a smooth, rounded, fluctuant mass, resembling a distended bladder, in the suprapubic region. Large or multiple cysts may also cause mild pelvic discomfort, low back pain, menstrual irregularities, and hirsutism. A twisted or ruptured cyst may cause abdominal tenderness, distention, and rigidity.
Pancreatic abscess
Occasionally, pancreatic abscess may produce a palpable epigastric mass accompanied by epigastric pain and tenderness. The patient’s temperature usually rises abruptly but may climb steadily. Nausea, vomiting, diarrhea, tachycardia, and hypotension may also occur.
Renal cell cancer
Usually occurring in only one kidney, renal cell carcinoma produces a smooth, firm, nontender mass near the affected kidney. Accompanying it are dull, constant abdominal or flank pain and hematuria. Other signs and symptoms include elevated blood pressure, fever, and urine retention. Weight loss, nausea, vomiting, and leg edema occur in late stages.
Splenomegaly
The lymphomas, leukemias, hemolytic anemias, and inflammatory diseases are among the many disorders that may cause splenomegaly. Typically, the smooth edge of the enlarged spleen is palpable in the left upper quadrant. Associated signs and symptoms vary with the causative disorder but commonly include a feeling of abdominal fullness, left-upper-quadrant abdominal pain and tenderness, splenic friction rub, splenic bruits, and low-grade fever.
Uterine leiomyomas (fibroids)
If large enough, a uterine leiomyoma (common, benign uterine tumor) can produce a round, multinodular mass in the suprapubic region. The patient’s chief complaint is usually menorrhagia; she may also experience a feeling of heaviness in the abdomen, and pressure on surrounding organs may cause back pain, constipation, and urinary frequency or urgency. Edema and varicosities of the lower extremities may develop. Rapid fibroid growth in perimenopausal or postmenopausal women needs further evaluation.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Bruits:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Abdominal aortic aneurysm
A pulsating periumbilical mass accompanied by a systolic bruit over the aorta characterizes an abdominal aortic aneurysm. Associated signs and symptoms include a rigid, tender abdomen; mottled skin; diminished peripheral pulses; and claudication. Sharp, tearing pain in the abdomen, flank, or lower back signals imminent dissection.
Abdominal aortic atherosclerosis
Loud systolic bruits in the epigastric and midabdominal areas are common in abdominal aortic atherosclerosis. They may be accompanied by leg weakness, numbness, paresthesia, or paralysis; leg pain; or decreased or absent femoral, popliteal, or pedal pulses. Abdominal pain is rarely present.
Carotid artery stenosis
Systolic bruits can be heard over one or both carotid arteries in a patient with carotid artery stenosis. Other signs and symptoms may be absent. However, dizziness, vertigo, headache, syncope, aphasia, dysarthria, sudden vision loss, hemiparesis, or hemiparalysis signals TIA and may herald a stroke.
Peripheral arteriovenous fistula
With a peripheral arteriovenous fistula, a rough, continuous bruit with systolic accentuation may be heard over the fistula; a palpable thrill is also common. Other signs and symptoms depend on the location of the fistula. For example, there may be claudication or absent pulses distal to the fistula. Skin distal to the fistula may be cool.
Peripheral vascular disease
Peripheral vascular disease characteristically produces bruits over the femoral artery and other arteries in the legs. It can also cause diminished or absent femoral, popliteal, or pedal pulses; intermittent claudication; numbness, weakness, pain, and cramping in the legs, feet, and hips; and cool, shiny skin and hair loss on the affected extremity. It also predisposes the patient to lower extremity ulcers that heal with difficulty.
Renal artery stenosis
With renal artery stenosis, systolic bruits are commonly heard over the abdominal midline and flank on the affected side. Hypertension commonly accompanies stenosis. Headache, palpitations, tachycardia, anxiety, dizziness, retinopathy, hematuria, and mental sluggishness may also appear.
Subclavian steal syndrome
With subclavian steal syndrome, systolic bruits may be heard over one or both subclavian arteries as a result of narrowing of the arterial lumen. They may be accompanied by decreased blood pressure and claudication in the affected arm, hemiparesis, vision disturbances, vertigo, and dysarthria.
Thyrotoxicosis
A systolic bruit heard over the thyroid gland commonly occurs with thyrotoxicosis. Accompanying signs and symptoms appear in all body systems, but the most characteristic ones include thyroid enlargement, fatigue, nervousness, tachycardia, heat intolerance, sweating, tremor, diarrhea, and weight loss despite increased appetite. Exophthalmos may also be present.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Abdominal Masses:
Principal Causes of Abdominal Masses
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Rightupper quadrant
- Liver
- Hepatomegaly
- Hepatic cyst
- Primary hepatic neoplasms
- Gallbladder
- Cholecystitis
- Hydrops of the gallbladder
- Biliary tree
- Choledochal cyst
- Intestine
- Pyloric stenosis
- Duodenal hematoma
- Duplication
- Left upper quadrant
- Spleen
- Splenomegaly
- Splenic cyst
- Neoplasm
- Epigastric
- Stomach
- Bezoar
- Duplication
- Pancreas
- Pancreatic cyst
- Pancreatic pseudocyst
- Neoplasm
- Right/left mid-abdomen
- Kidney
- Unilateral
- Hydronephrosis
- Multicystic dysplastic kidney
- Renal vein thrombosis
- Congenital mesoblastic nephroma
- Wilms tumor
- Renal cyst
- Ectopic kidney
- Horseshoe kidney
- Renal or perinephric abscess
- Bilateral
- Hydronephrosis
- Multicystic dysplastic kidney
- Renal vein thrombosis
- Polycystic kidney disease
- Beckwith-Wiedemann syndrome
- Adrenal
- Neonatal adrenal hematoma
- Neuroblastoma
- Periumbilical
- Intestine
- Mesenteric cyst
- Volvulus
- Duplication
- Neoplasm
- Right lower quadrant
- Intestine
- Abscess
- Intussusception
- Lymphoma
- Ovary
- Cyst
- Torsion
- Neoplasm
- Left lower quadrant
- Intestine
- Constipation
- Ovary (see right lower quadrant)
- Hypogastrium
- Bladder
- Distension/obstruction
- Uterus
- Pregnancy
- Hydrometrocolpos
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Abdominal mass:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Abdominal aortic aneurysm.An abdominal aortic aneurysm may exist for years, producing only a pulsating periumbilical mass with a systolic bruit over the aorta. It may become life-threatening if the aneurysm expands and its walls weaken. In such cases, the patient initially reports constant upper abdominal pain or, less commonly, low back or dull abdominal pain. If the aneurysm ruptures, he'll report severe abdominal and back pain. After rupture, the aneurysm no longer pulsates.
Associated signs and symptoms of rupture include mottled skin below the waist, absent femoral and pedal pulses, lower blood pressure in the legs than in the arms, mild to moderate tenderness with guarding, and abdominal rigidity. Signs of shock—such as altered mental status, tachycardia, and cool, clammy skin—appear with significant blood loss.
Cholecystitis.Deep palpation below the liver border may reveal a smooth, firm, sausage-shaped mass. With acute inflammation, the gallbladder is usually too tender to be palpated. Cholecystitis can cause severe right upper quadrant pain that may radiate to the right shoulder, chest, or back; abdominal rigidity and tenderness; fever; pallor; diaphoresis; anorexia; nausea; and vomiting. Recurrent attacks usually occur 1 to 6 hours after meals. Murphy's sign (inspiratory arrest elicited when the examiner palpates the right upper quadrant as the patient takes a deep breath) is common.
Colon cancer.A right lower quadrant mass may occur with cancer of the right colon, which may also cause occult bleeding with anemia and abdominal aching, pressure, or dull cramps. Associated findings include weakness, fatigue, exertional dyspnea, vertigo, and signs and symptoms of intestinal obstruction, such as obstipation and vomiting.
Occasionally, cancer of the left colon also causes a palpable mass. It usually produces rectal bleeding, intermittent abdominal fullness or cramping, and rectal pressure. The patient may also report fremitus and pelvic discomfort. Later, he develops obstipation, diarrhea, or pencil-shaped, grossly bloody, or mucus-streaked stools. Typically, defecation relieves pain.
Crohn's disease.With Crohn's disease, tender, sausage-shaped masses are usually palpable in the right lower quadrant and, at times, in the left lower quadrant. Attacks of colicky right lower quadrant pain and diarrhea are common. Associated signs and symptoms include fever, anorexia, weight loss, hyperactive bowel sounds, nausea, abdominal tenderness with guarding, and perirectal, skin, or vaginal fistulas.
Diverticulitis.Most common in the sigmoid colon, diverticulitis may produce a left lower quadrant mass that's usually tender, firm, and fixed. It also produces intermittent abdominal pain that's relieved by defecation or passage of flatus. Other findings may include alternating constipation and diarrhea, nausea, a low-grade fever, and a distended and tympanic abdomen.
Gastric cancer.Advanced gastric cancer may produce an epigastric mass. Early findings include chronic dyspepsia and epigastric discomfort, whereas late findings include weight loss, a feeling of fullness after eating, fatigue and, occasionally, coffee-ground vomitus or melena.
Hepatomegaly.Hepatomegaly produces a firm, blunt, irregular mass in the epigastric region or below the right costal margin. Associated signs and symptoms vary with the causative disorder but commonly include ascites, right upper quadrant pain and tenderness, anorexia, nausea, vomiting, leg edema, jaundice, palmar erythema, spider angiomas, gynecomastia, testicular atrophy and, possibly, splenomegaly.
Hernia.The soft and typically tender bulge is usually an effect of prolonged, increased intra-abdominal pressure on weakened areas of the abdominal wall. An umbilical hernia is typically located around the umbilicus and an inguinal hernia in either the right or left groin. An incisional hernia can occur anywhere along a previous incision. Hernia may be the only sign until strangulation occurs.
Hydronephrosis.Enlarging one or both kidneys, hydronephrosis produces a smooth, boggy mass in one or both flanks. Other findings vary with the degree of hydronephrosis. The patient may have severe colicky renal pain or dull flank pain that radiates to the groin, vulva, or testes. Hematuria, pyuria, dysuria, alternating oliguria and polyuria, nocturia, accelerated hypertension, nausea, and vomiting may also occur.
Ovarian cyst.A large ovarian cyst may produce a smooth, rounded, fluctuant mass, resembling a distended bladder, in the suprapubic region. Large or multiple cysts may also cause mild pelvic discomfort, low back pain, menstrual irregularities, and hirsutism. A twisted or ruptured cyst may cause abdominal tenderness, distention, and rigidity.
Splenomegaly.With splenomegaly,the smooth edge of the enlarged spleen is palpable in the left upper quadrant. Associated signs and symptoms vary with the causative disorder but usually include a feeling of abdominal fullness, left upper quadrant abdominal pain and tenderness, splenic friction rub, splenic bruits, and a low-grade fever.
Uterine leiomyomas (fibroids).If large enough, these common, benign uterine tumors produce a round, multinodular mass in the suprapubic region. The patient's chief complaint is usually menorrhagia; she may also experience a feeling of heaviness in the abdomen, and pressure on surrounding organs may cause back pain, constipation, and urinary frequency or urgency. Edema and varicosities of the lower extremities may develop. Rapid fibroid growth in perimenopausal or postmenopausal women needs further evaluation.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Bruits:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Abdominal aortic aneurysm.A pulsating periumbilical mass accompanied by a systolic bruit over the aorta characterizes abdominal aortic aneurysm. Associated signs and symptoms include a rigid, tender abdomen; mottled skin; diminished peripheral pulses; and claudication. Sharp, tearing pain in the abdomen, flank, or lower back signals imminent dissection.
Abdominal aortic atherosclerosis.Loud systolic bruits in the epigastric and midabdominal areas are common with abdominal aortic atherosclerosis. They may be accompanied by leg weakness, numbness, paresthesia, or paralysis; leg pain; or decreased or absent femoral, popliteal, or pedal pulses. Abdominal pain is rarely present.
Anemia.In patients with severe anemia, short systolic bruits may be heard over both carotid arteries and may be accompanied by headache, fatigue, dizziness, pallor, jaundice, palpitations, mild tachycardia, dyspnea, nausea, anorexia, and glossitis.
Carotid artery stenosis.Systolic bruits can be heard over one or both carotid arteries with carotid artery stenosis. Other signs and symptoms may be absent. Dizziness, vertigo, headache, syncope, aphasia, dysarthria, sudden vision loss, hemiparesis, or hemiparalysis signals a TIA and may herald a stroke.
Carotid cavernous fistula.A carotid cavernous fistula causes characteristic continuous bruits heard over the eyeballs and temples. Vision disturbances and protruding, pulsating eyeballs are also common.
Peripheral arteriovenous fistula.A rough, continuous bruit with systolic accentuation may be heard over the fistula in a peripheral arteriovenous fistula. A palpable thrill is also common.
Peripheral vascular disease.Peripheral vascular disease characteristically produces bruits over the femoral artery and other arteries in the legs. It can also cause diminished or absent femoral, popliteal, or pedal pulses; intermittent claudication; numbness, weakness, pain, and cramping in the legs, feet, and hips; and cool, shiny skin and hair loss on the affected extremity. It also predisposes the patient to lower-extremity ulcers that heal with difficulty.
Renal artery stenosis.With renal artery stenosis, systolic bruits are commonly heard over the abdominal midline and flank on the affected side. Hypertension commonly accompanies stenosis. Headache, palpitations, tachycardia, anxiety, dizziness, retinopathy, hematuria, and mental sluggishness may also appear.
Subclavian steal syndrome.With subclavian steal syndrome, systolic bruits may be heard over one or both subclavian arteries as a result of arterial lumen narrowing. They may be accompanied by decreased blood pressure and claudication in the affected arm, hemiparesis, vision disturbances, vertigo, and dysarthria.
Thyrotoxicosis.With thyrotoxicosis, a systolic bruit is commonly heard over the thyroid gland. Accompanying signs and symptoms appear in all body systems, but the most characteristic ones include thyroid enlargement, fatigue, nervousness, tachycardia, heat intolerance, sweating, tremor, diarrhea, and weight loss despite increased appetite. Exophthalmos may also be present.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Abdominal rigidity [Abdominal muscle spasm, involuntary guarding]:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Abdominal aortic aneurysm
(dissecting).Mild to moderate abdominal rigidity occurs with a dissecting abdominal aortic aneurysm, a life-threatening disorder. Typically, it's accompanied by constant upper abdominal pain that may radiate to the lower back. The pain may worsen when the patient lies down and may be relieved when he leans forward or sits up. Before rupture, the aneurysm may produce a pulsating mass in the epigastrium, accompanied by a systolic bruit over the aorta. The mass stops pulsating after rupture. Associated signs and symptoms include mottled skin below the waist, absent femoral and pedal pulses, lower blood pressure in the legs than in the arms, and mild to moderate tenderness with guarding. Significant blood loss causes signs of shock, such as tachycardia, tachypnea, and cool, clammy skin.
Insect toxins.Insect stings and bites, especially black widow spider bites, release toxins that can produce generalized, cramping abdominal pain, usually accompanied by rigidity. These toxins may also cause a low-grade fever, nausea, vomiting, tremors, and burning sensations in the hands and feet. Some patients develop increased salivation, hypertension, paresis, and hyperactive reflexes. Children commonly are restless, have an expiratory grunt, and keep their legs flexed.
Mesenteric artery ischemia.A life-threatening disorder, mesenteric artery ischemia is characterized by 2 or 3 days of persistent, low-grade abdominal pain and diarrhea leading to sudden, severe abdominal pain and rigidity. Rigidity occurs in the central or periumbilical region and is accompanied by severe abdominal tenderness, fever, and signs of shock, such as tachycardia and hypotension. Other findings may include vomiting, anorexia, and diarrhea or constipation. Always suspect this disorder in patients older than age 50 who have a history of heart failure, arrhythmia, cardiovascular infarct, or hypotension.
Peritonitis.Depending on the cause of peritonitis, abdominal rigidity may be localized or generalized. For example, if an inflamed appendix causes local peritonitis, rigidity may be localized in the right lower quadrant. If a perforated ulcer causes widespread peritonitis, rigidity may be generalized and, in severe cases, boardlike.
Peritonitis also causes sudden and severe abdominal pain that can be localized or generalized. In addition, it can produce abdominal tenderness and distention, rebound tenderness, guarding, hyperalgesia, hypoactive or absent bowel sounds, nausea, and vomiting. Usually, the patient also displays fever, chills, tachycardia, tachypnea, and hypotension.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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