Left Iliac Fossa Mass - Lecture notes Year 4 Digestive PDF

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Summary

LIF masses...

Description

Left Iliac Fossa Mass - Differential Diagnosis

Causes: Faeces (impacted)

Relevant Investigations: ● ● ● ● ●

Sigmoid/descending colon tumor

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Medical Hx of constipation, may also be evidenced by stool charts. Diet and food/drink intake questions may add. Abdominal examination may reveal a hard mass in the LIF on deep palpation PR examination may feel hard and impacted faeces XR images of abdomen Sigmoidoscopy may also be used to confirm diagnosis, although this is rarely necessary. History classic of cancer, with weight loss, fresh rectal bleeding, fatigue etc Cancer can cause LBO Abdominal examination will reveal large mass FBC may show anaemic secondary to occult abdominal bleeds CEA (carcinoembryonic antigen) is raised in about 60% of bowel cancer patients. Various imaging techniques

Diverticular disease

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Diverticulosis is normally discovered accidentally when investigating other pathology ● Hx of pain, constipation, bleeding (minor or massive). Sx also of infection. ● Contrast CT is the best for diagnosis. ● FBC may show high white cell counts, raised CRP. With severe infection ESR will also be raised.

Ovarian tumour/cyst

● Sx typical of cancer ● LIF/RIF mass ● If cancer then CA125 (cancer antigen)will be raised, although it is also raised in endometriosis, fibroids and pregnancy ○ CA125 is a protein found in ovarian cancer cells and is associated with ovarian cancer, but a raised CA125 alone is not diagnostic of ovarian cancer.

Psoas abscess

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Crohn’s disease

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Non specific symptoms ○ Fever ○ Flank pain ○ Abdominal pain ○ Limp ○ Nausea ○ Anorexia ● Pain with extension and internal rotation of the hip (psoas sign) is a common examination finding ● FBC - WCC, ESR and CRP will all be raised ● Contrast CT is the preferred imaging modality See crohn's disease page

Transplanted pelvic kidney

Iliac lymphadenopathy

● Inguinal and pelvic lymph nodes becoming inflamed can form masses in the LIF. ● If found then a cause for the swelling should be investigated, check lower limb for skin infections, cuts, cancers etc...