Definition
An abdominal swelling is an abnormal protuberance that arises from the abdominal cavity or the abdominal wall and may be general or localized, acute or chronic, cystic or solid.
- Generalized abdominal swellings affect the entire abdominal cavity.
- Localized swellings can be located in the various regions of the abdomen.
- Abdominal wall swellings can be differentiated from intra-abdominal swellings by asking the patient to raise his or her head from the couch (intraperitoneal swellings disappear while abdominal wall swellings persist).
- Giant masses, other than ovarian cystadenocarcinoma or lymphomatous lymphadenopathy, are rarely malignant.
Important Diagnostic Features
‘Fat’
Obesity: deposition of fat in the abdominal wall and intra-abdominally (extraperitoneal layer, omentum and mesentery). Commoner in males than females (where hip and thigh obesity is more common). Clinical obesity = body weight 120% greater than that recommended for their height, age and sex (BMI = weight (kg)/height (m)2). A BMI of >25 is overweight, >30 obese.
‘Flatus’
Intestinal obstruction: swallowed air accumulates in the bowel causing distension. This gives a tympanic note on percussion and produces the characteristic air–fluid levels and ‘ladder’ pattern on an abdominal radiograph. Sigmoid or caecal volvulus produces gross distension with characteristic features of distended loops on abdominal X-ray.
‘Fluid’
- Intestinal obstruction: as well as air, fluid accumulates in the obstructed intestine.
- Ascites: fluid accumulates in the peritoneal cavity due to the ‘7 Cs’:
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