KEY POINTS
• Retroperitoneal mass: no movement with respiration, difficult to
delineate, resonant to percussion.
• Bowel masses: often mobile, may be well defined.
• Pelvic mass: difficult to ‘get below’, bimanually palpable on PR/PV
examination.
Sigmoid colon
• Diverticular mass: tender, ill defined, rubbery hard, non-mobile.
• Paracolic abscess: acutely tender, ill defined, ?fluctuant, systemic
upset.
• Carcinoma: hard, craggy, non-tender unless perforated, immobile,
associated with altered bowel habit/obstructive symptoms.
• Faeces: firm, indentable/‘malleable’, mobile with colon.
• Normal: only in a thin person, non-tender, chord like.
Caecum/ascending colon
• Appendix mass/abscess: acutely tender, ill defined, ?fluctuant,
systemic upset.
• Carcinoma: hard, craggy, non-tender unless perforated, immobile,
associated with anaemia/weight loss and anergia.
Terminal ileum
• Crohn’s mass: tender, ill defined, rubbery hard, non-mobile.
• Tuberculous mass: mildly tender, ill defined, firm, associated
with cutaneous sinuses, ?systemic TB.
Ovary/fallopian tube
• Cyst: may be massive, usually mobile, ?bimanually palpable
on PV examination.
• Neoplasm.
• Ectopic pregnancy: very tender, associated with PV bleeding/
intra-abdominal bleeding and collapse.
• Salpingo-oophoritis: very tender, bimanually palpable, associated
with PV discharge.
Bladder
• Generally: midline swelling, extends up towards umbilicus,
dull to percussion, non-mobile, cannot ‘get below’ it.
• Retention of urine: stony dull to percussion, associated with
desire to pass urine, disappears on voiding/catheterization.
• Transitional cell carcinoma: hard, irregular, fixed, may be
associated with dysuria, haematuria and desire to pass urine on
examination.
Uterus
• Pregnancy: smooth, regular, fetal heart sounds heard/
movements!
• Fibromyoma: usually smooth, may be pedunculated and
mobile, non-tender, associated menorrhagia.
• Uterine carcinoma: firm uterus, may be tender, irregular only
if tumour is extrauterine, associated PV bloody discharge.
Rectum
Carcinoma: firm, irregular, non-tender, relatively immobile,
associated alteration in bowel habit/PR bleeding.
Urachus (rare)
Cyst: small swelling in midline, ?associated umbilical discharge.
Other
Pelvic kidney: smooth, regular, non-tender, non-mobile.
KEY INVESTIGATIONS
• FBC: anaemiabtumours.
• WCC: lymphomas, Crohn’s disease, appendicitis/diverticulitis.
• LFTs: liver lesions.
• Ultrasound: ovarian lesions, appendix/diverticular mass or abscess,
Crohn’s mass, pelvic kidney, ovarian lesions, pregnancy, uterine lesions,
bladder tumours.
• CT scan: retroperitoneal/mesenteric cysts, omental deposits,
appendix/diverticular mass or abscess, Crohn’s mass. Allows guided
drainage of abscesses and biopsy of some tumours.
• Colonoscopy: colonic tumours, diverticular disease.
• Small bowel enema: small intestinal tumours, ileal Crohn’s disease.
• Barium enema: diverticular disease, colonic tumours.
• MSU: infected urinary retention.
• β-HCG: pregnancy.XD369VGTNWWZ
