Abdominal swelling (generalised)

Probability diagnosis

Pregnancy

Obesity

Constipation, esp. chronic

Irritable bowel syndrome

Enlarged bladder

Fibroid uterus/ovarian tumour/cyst

Serious disorders not to be missed

Vascular:

• CCF (ascites)

• aortic aneurysm

Infection:

• intrabdominal abscess

• peritoneal tuberculosis

• hydatid cyst

• clostridial intra-abdominal infection

Cancer:

• ovary, stomach, colon, other

• carcinomatosis peritonei

Other:

• ascites (several causes)

• intestinal obstruction (large bowel)

• acute gastric dilatation

Pitfalls (often missed)

Hepatomegaly, splenomegaly

Hydronephrosis

Massive lymphadenopathy/lymphosarcoma

Rarities:

• chronic idiopathic pseudo-obstruction

Is the patient trying to tell me something?

Consider pseudocyesis.

Consider the classic five:

• fat

• flatus

• fluid

• faeces

• fetus

Key history

• Is the swelling intermittent, variable or progressive (the most serious)?

• Associated symptoms, especially gastrointestinal, menstrual (?pregnancy)

• Red flags, especially weight loss, fever, pain, lymph nodes

• History of alcoholism, hepatitis, kidney disease, heart disorder

• Past history of abdominal surgery, cancer

Key examination

• General appearance

• Vital signs

• Abdomen (inspection, palpation, auscultation, percussion)

• Rectal and vaginal examination

• Tests for ascites (if present)

• Dipstick of urine

Key investigations

• FBE and ESR/CRP

• Urinalysis

• U&E and LFTs

• Plain abdominal X-ray, ultrasound (best)

• Pregnancy test in females with amenorrhoea

• Specialised imaging according to findings, e.g. CT scan

Diagnostic tips

• Be alert for pregnancy in women of childbearing age, especially teenagers and perimenopausal women.

• Be alert for constipation, especially in the elderly.

• Weight loss with abdominal swelling suggests malignancy.