Professional Documents
Culture Documents
The list of risk factors mentioned for Gallstones in various sources includes:
• Age - especially over 60
• Obesity
• Dieting
• Gastric bypass surgery - stomach reduction surgery
• Race - High risk for Native Americans
• Native Americans
• Pima Indians
• Mexican-Americans
• Gender - women twice as likely
• Cholesterol-lowering drugs
• Diabetes
• Rapid weight loss
• Fasting
Gallstones Risk Factors: Book Excerpts
• Cholelithiasis - risk factors - Cholelithiasis
Risk factors discussion:
Dieting and Gallstones: NIDDK (Excerpt)
Overweight people are at greater risk of developing gallstones that people of average weight.
However, people who are considering a diet program requiring very low intake of calories each
day should be aware that during rapid or substantial weight loss, a person's risk of developing
gallstones is increased. (Source: excerpt from Dieting and Gallstones: NIDDK)
Dieting and Gallstones: NIDDK (Excerpt)
Why obesity is a risk factor for gallstones is unclear. But researchers believe that in obese
people, the liver produces too much cholesterol. The excess cholesterol leads to supersaturation
in the gallbladder. (Source: excerpt from Dieting and Gallstones: NIDDK)
Dieting and Gallstones: NIDDK (Excerpt)
People who lose a lot of weight rapidly are at greater risk for developing gallstones. Gallstones
are one of the most medically important complications of voluntary weight loss. The relationship
of dieting to gallstones has only recently received attention.
One major study found that women who lost from 9 to 22 pounds (over a 2-year period) were 44
percent more likely to develop gallstones than women who did not lose weight. Women who lost
more than 22 pounds were almost twice as likely to develop gallstones.
Other studies have shown that 10 to 25 percent of obese people develop gallstones while on a
very-low-calorie diet. (Very-low-calorie diets are usually defined as diets containing 800 calories
a day or less. The food is often in liquid form and taken for a prolonged period, typically 12 to 16
weeks.) The gallstones that developed in people on very-low-calorie diets were usually silent and
did not produce any symptoms. However, about a third of the dieters who developed gallstones
did have symptoms, and a proportion of these required gallbladder surgery.
In short, the likelihood of a person developing symptomatic gallstones during or shortly after
rapid weight loss is about 4 to 6 percent. This estimate is based on reviewing just a few clinical
studies, however, and is not conclusive. (Source: excerpt from Dieting and Gallstones: NIDDK)
Dieting and Gallstones: NIDDK (Excerpt)
Researchers believe dieting may cause a shift in the balance of bile salts and cholesterol in the
gallbladder. The cholesterol level is increased and the amount of bile salts is decreased. Going
for long periods without eating (skipping breakfast, for example), a common practice among
dieters, also may decrease gallbladder contractions. If the gallbladder does not contract often
enough to empty out the bile, gallstones may form. (Source: excerpt from Dieting and
Gallstones: NIDDK)
Dieting and Gallstones: NIDDK (Excerpt)
Gallstones are common among obese patients who lose weight rapidly after gastric bypass
surgery. (In gastric bypass surgery, the size of the stomach is reduced, preventing the person
from overeating.)
One study found that more than a third (38 percent) of patients who had gastric bypass surgery
developed gallstones afterward. Gallstones are most likely to occur within the first few months
after surgery. (Source: excerpt from Dieting and Gallstones: NIDDK)
Smoking and Your Digestive System: NIDDK (Excerpt)
Several studies suggest that smoking may increase the risk of developing gallstones and that the
risk may be higher for women. However, research results on this topic are not consistent, and
more study is needed. (Source: excerpt from Smoking and Your Digestive System: NIDDK)
Gallstones: NWHIC (Excerpt)
Risk factors for gallstones include obesity ; a large clinical study showed that being even
moderately overweight increases one's risk for developing gallstones. This is probably true
because obesity tends to cause excess cholesterol in bile, low bile salts, and decreased
gallbladder emptying. Very low calorie, rapid weight-loss diets, and prolonged fasting, seem to
also cause gallstone formation.
No clear relationship has been proven between diet and gallstone formation. However, low-fiber,
high-cholesterol, high protein diets, and diets high in starchy foods have been suggested as
contributing to gallstone formation. (Source: excerpt from Gallstones: NWHIC)
Gallstones: NWHIC (Excerpt)
Those who are most likely to develop gallstones are:
• Women between 20 and 60 years of age. They are twice as likely to develop gallstones
than men.
• Men and women over age 60.
• Pregnant women or women who have used birth control pills or estrogen replacement
therapy.
• Native Americans. They have the highest prevalence of gallstones in the United States. A
majority of Native American men have gallstones by age 60. Among the Pima Indians of
Arizona, 70 percent of women have gallstones by age 30.
• Mexican-American men and women of all ages.
• Men and women who are overweight.
• People who go on "crash" diets or who lose a lot of weight quickly.
(Source: excerpt from Gallstones: NWHIC)
Risks factors for Gallstones: medical news summaries:
The following medical news items are relevant to risk factors for Gallstones:
• All about obesity
• More news »
About risk factors:
Risk factors for Gallstones are factors that do not seem to be a direct cause of the disease, but
seem to be associated in some way. Having a risk factor for Gallstones makes the chances of
getting a condition higher but does not always lead to Gallstones. Also, the absence of any risk
factors or having a protective factor does not necessarily guard you against getting Gallstones.
For general information and a list of risk factors, see the risk center.
Cholelithiasis, cholecystitis, and related disorders: Excerpt
from Handbook of Diseases
Diseases of the gallbladder and biliary tract are common, typically painful conditions that usually
require surgery and may be life-threatening. They’re commonly associated with deposition of
calculi and inflammation. (See Common sites of calculus formation.)
In most cases, gallbladder and bile duct diseases occur during middle age. Between ages 20 and
50, they’re six times more common in women, but the incidence in men and women becomes
equal after age 50. After that, incidence rises with each succeeding decade.
Causes
The origin and frequency of gallbladder and biliary tract disease vary with the particular
disorder.
Cholelithiasis
The presence of stones or calculi (gallstones) in the gallbladder results from changes in bile
components. Gallstones are made of cholesterol, calcium bilirubinate, or a mixture of cholesterol
and bilirubin pigment. They arise during periods of sluggishness in the gallbladder resulting from
pregnancy, use of oral contraceptives, diabetes mellitus, Crohn’s disease, cirrhosis of the liver,
pancreatitis, obesity, and rapid weight loss.
Cholelithiasis is the fifth leading cause of hospitalization among adults and accounts for 90% of
all gallbladder and duct diseases. The prognosis is usually good with treatment unless infection
occurs, in which case the prognosis depends on the infection’s severity and response to
antibiotics.
Cholecystitis
Cholecystitis, an acute or chronic inflammation of the gallbladder, is usually associated with a
gallstone impacted in the cystic duct; the inflammation develops behind the obstruction.
Cholecystitis accounts for 10% to 25% of all patients requiring gallbladder surgery.
The acute form is most common during middle age; the chronic form, among elderly people. The
prognosis is good with treatment.
Biliary cirrhosis
Primary biliary cirrhosis is a chronic, progressive disease of the liver characterized by
autoimmune destruction of the intrahepatic bile ducts and cholestasis. This condition usually
leads to obstructive jaundice and pruritus and involves the portal and periportal spaces of the
liver. It affects women between the ages of 40 and 60 nine times more often than men. The
prognosis is poor without liver transplantation.
Cholangitis
An infection of the bile duct, cholangitis is commonly associated with choledocholithiasis and
may follow percutaneous transhepatic cholangiography. Predisposing factors include bacterial or
metabolic alteration of bile acids. Widespread inflammation may cause fibrosis and stenosis of
the common bile duct. The prognosis for this rare condition is poor without stenting or surgery.
Choledocholithiasis
One out of every 10 patients with gallstones develops choledocholithiasis, or gallstones in the
common bile duct (sometimes called common duct stones). This occurs when stones passed out
of the gallbladder lodge in the hepatic and common bile ducts and obstruct the flow of bile into
the duodenum. The prognosis is good unless infection occurs.
Cholesterolosis
Cholesterol polyps or cholesterol crystal deposits in the gallbladder’s submucosa may result from
bile secretions containing high concentrations of cholesterol and insufficient bile salts. The
polyps may be localized or may speckle the entire gallbladder. Cholesterolosis, the most
common pseudotumor, isn’t related to widespread inflammation of the mucosa or lining of the
gallbladder. The prognosis is good with surgery.
Gallstone ileus
Gallstone ileus results from a gallstone lodging in the terminal ileum. It’s more common in
elderly people. The prognosis is good with surgery.
Postcholecystectomy syndrome
Postcholecystectomy syndrome commonly results from retained or recurrent common bile duct
stones, spasm of the sphincter of Oddi, functional bowel disorder, technical errors, or mistaken
diagnoses. It occurs in 1% to 5% of all patients whose gallbladders have been surgically removed
and may produce right upper quadrant abdominal pain, biliary colic, fatty food intolerance,
dyspepsia, and indigestion. The prognosis is good with selected radiologic procedures,
endoscopic procedures, or surgery.
Complications
Each disorder produces its own set of complications. Cholelithiasis may lead to any of the
disorders associated with gallstone formation: cholangitis, cholecystitis, choledocholithiasis, or
gallstone ileus.
Cholecystitis can progress to gallbladder complications, such as empyema, hydrops or mucocele,
or gangrene. Gangrene may lead to perforation, resulting in peritonitis, fistula formation,
pancreatitis, limy bile, and porcelain gallbladder. Other complications include chronic
cholecystitis and cholangitis.
Choledocholithiasis may lead to cholangitis, obstructive jaundice, pancreatitis, and secondary
biliary cirrhosis. Cholangitis, especially in the suppurative form, may progress to septic shock
and death. Gallstone ileus may cause bowel obstruction, which can lead to intestinal perforation,
peritonitis, septicemia, secondary infection, and septic shock.
Cholelithiasis
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Cholecystitis as a symptom:
Conditions listing Cholecystitis as a symptom may also be potential underlying causes of
Cholecystitis. Our database lists the following as having Cholecystitis as a symptom of that
condition:
• Familial hyperlipoproteinemia
• Hyperlipoproteinemia type 3
• Triosephosphate isomerase 1
• 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
» 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
• Neuroblastoma
–More common in younger children
• Leukemia/lymphoma
–Involvement of retroperitoneal nodes, liver, or spleen
• 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
• 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
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
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
Cholelithiasis, cholecystitis, and related disorders: Causes
(Handbook of Diseases)
The origin and frequency of gallbladder and biliary tract disease vary with the particular
disorder.
Cholelithiasis
The presence of stones or calculi (gallstones) in the gallbladder results from changes in bile
components. Gallstones are made of cholesterol, calcium bilirubinate, or a mixture of cholesterol
and bilirubin pigment. They arise during periods of sluggishness in the gallbladder resulting from
pregnancy, use of oral contraceptives, diabetes mellitus, Crohn’s disease, cirrhosis of the liver,
pancreatitis, obesity, and rapid weight loss.
Cholelithiasis is the fifth leading cause of hospitalization among adults and accounts for 90% of
all gallbladder and duct diseases. The prognosis is usually good with treatment unless infection
occurs, in which case the prognosis depends on the infection’s severity and response to
antibiotics.
Cholecystitis
Cholecystitis, an acute or chronic inflammation of the gallbladder, is usually associated with a
gallstone impacted in the cystic duct; the inflammation develops behind the obstruction.
Cholecystitis accounts for 10% to 25% of all patients requiring gallbladder surgery.
The acute form is most common during middle age; the chronic form, among elderly people. The
prognosis is good with treatment.
Biliary cirrhosis
Primary biliary cirrhosis is a chronic, progressive disease of the liver characterized by
autoimmune destruction of the intrahepatic bile ducts and cholestasis. This condition usually
leads to obstructive jaundice and pruritus and involves the portal and periportal spaces of the
liver. It affects women between the ages of 40 and 60 nine times more often than men. The
prognosis is poor without liver transplantation.
Cholangitis
An infection of the bile duct, cholangitis is commonly associated with choledocholithiasis and
may follow percutaneous transhepatic cholangiography. Predisposing factors include bacterial or
metabolic alteration of bile acids. Widespread inflammation may cause fibrosis and stenosis of
the common bile duct. The prognosis for this rare condition is poor without stenting or surgery.
Choledocholithiasis
One out of every 10 patients with gallstones develops choledocholithiasis, or gallstones in the
common bile duct (sometimes called common duct stones). This occurs when stones passed out
of the gallbladder lodge in the hepatic and common bile ducts and obstruct the flow of bile into
the duodenum. The prognosis is good unless infection occurs.
Cholesterolosis
Cholesterol polyps or cholesterol crystal deposits in the gallbladder’s submucosa may result from
bile secretions containing high concentrations of cholesterol and insufficient bile salts. The
polyps may be localized or may speckle the entire gallbladder. Cholesterolosis, the most
common pseudotumor, isn’t related to widespread inflammation of the mucosa or lining of the
gallbladder. The prognosis is good with surgery.
Gallstone ileus
Gallstone ileus results from a gallstone lodging in the terminal ileum. It’s more common in
elderly people. The prognosis is good with surgery.
Postcholecystectomy syndrome
Postcholecystectomy syndrome commonly results from retained or recurrent common bile duct
stones, spasm of the sphincter of Oddi, functional bowel disorder, technical errors, or mistaken
diagnoses. It occurs in 1% to 5% of all patients whose gallbladders have been surgically removed
and may produce right upper quadrant abdominal pain, biliary colic, fatty food intolerance,
dyspepsia, and indigestion. The prognosis is good with selected radiologic procedures,
endoscopic procedures, or surgery.
Complications
Each disorder produces its own set of complications. Cholelithiasis may lead to any of the
disorders associated with gallstone formation: cholangitis, cholecystitis, choledocholithiasis, or
gallstone ileus.
Cholecystitis can progress to gallbladder complications, such as empyema, hydrops or mucocele,
or gangrene. Gangrene may lead to perforation, resulting in peritonitis, fistula formation,
pancreatitis, limy bile, and porcelain gallbladder. Other complications include chronic
cholecystitis and cholangitis.
Choledocholithiasis may lead to cholangitis, obstructive jaundice, pancreatitis, and secondary
biliary cirrhosis. Cholangitis, especially in the suppurative form, may progress to septic shock
and death. Gallstone ileus may cause bowel obstruction, which can lead to intestinal perforation,
peritonitis, septicemia, secondary infection, and septic shock.
» 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
Abdominal Masses: Principal Causes of Abdominal Masses
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
1. Rightupper quadrant
1. Liver
1. Hepatomegaly
2. Hepatic cyst
3. Primary hepatic neoplasms
2. Gallbladder
1. Cholecystitis
2. Hydrops of the gallbladder
3. Biliary tree
1. Choledochal cyst
4. Intestine
1. Pyloric stenosis
2. Duodenal hematoma
3. Duplication
2. Left upper quadrant
1. Spleen
1. Splenomegaly
2. Splenic cyst
3. Neoplasm
3. Epigastric
1. Stomach
1. Bezoar
2. Duplication
2. Pancreas
1. Pancreatic cyst
2. Pancreatic pseudocyst
3. Neoplasm
4. Right/left mid-abdomen
1. Kidney
1. Unilateral
1. Hydronephrosis
2. Multicystic dysplastic kidney
3. Renal vein thrombosis
4. Congenital mesoblastic nephroma
5. Wilms tumor
6. Renal cyst
7. Ectopic kidney
8. Horseshoe kidney
9. Renal or perinephric abscess
2. Bilateral
1. Hydronephrosis
2. Multicystic dysplastic kidney
3. Renal vein thrombosis
4. Polycystic kidney disease
5. Beckwith-Wiedemann syndrome
2. Adrenal
1. Neonatal adrenal hematoma
2. Neuroblastoma
5. Periumbilical
1. Intestine
1. Mesenteric cyst
2. Volvulus
3. Duplication
4. Neoplasm
6. Right lower quadrant
1. Intestine
1. Abscess
2. Intussusception
3. Lymphoma
2. Ovary
1. Cyst
2. Torsion
3. Neoplasm
7. Left lower quadrant
1. Intestine
1. Constipation
2. Ovary (see right lower quadrant)
8. Hypogastrium
1. Bladder
1. Distension/obstruction
2. Uterus
1. Pregnancy
2. 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
Risks factors for Cholecystitis: medical news summaries:
The following medical news items are relevant to risk factors for Cholecystitis:
• Aortic disease warning
• Use of estrogen by women with hysterectomies may increase the risk of gallbladder
disease
• More news »
About risk factors:
Risk factors for Cholecystitis are factors that do not seem to be a direct cause of the disease, but
seem to be associated in some way. Having a risk factor for Cholecystitis makes the chances of
getting a condition higher but does not always lead to Cholecystitis. Also, the absence of any risk
factors or having a protective factor does not necessarily guard you against getting Cholecystitis.
For general information and a list of risk factors, see the risk center.
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Book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
"I authorize the release of any medical or other information necessary to process
this claim." Do you recognize these words? You should, if...
Your Rights as a Patient
Stress Reduction
Stress takes its toll by making us anxious, depressed and not able to function as
fully as we'd like. What many don't know is that stress can...
Your Health and Your Insurance
"I authorize the release of any medical or other information necessary to process
this claim." Do you recognize these words? You should, if...
Your Rights as a Patient
Whenever you go to a hospital or clinic for a major procedure or diagnostic test,
one of the many forms you are given to sign is an "informed...
Stress Reduction
Stress takes its toll by making us anxious, depressed and not able to function as
fully as we'd like. What many don't know is that stress can...
Your Health and Your Insurance
"I authorize the release of any medical or other information necessary to process
this claim." Do you recognize these words? You should, if...
Your Rights as a Patient
Whenever you go to a hospital or clinic for a major procedure or diagnostic test,
one of the many forms you are given to sign is an "informed...
Stress Reduction
Stress takes its toll by making us anxious, depressed and not able to function as
fully as we'd like. What many don't know is that stress can...
Your Health and Your Insurance