Large Abdomen

Tonia Ermolaou
21/5/2018
 Large Abdomen
=
Abdominal Distension

Outward expansion beyond the

normal girth of the stomach and
waist.
 Evaluation
•Medical History
•AGE

• Physical Examination
• Position of organs

•Investigations
 Generalized Distension
• 4 F´s
1. Fat
2. Fluid – Ascites
2.1 Urinary : Most common in newborns.
Intrauterine rupture of renal pelvis
2.2 Nephrotic Syndrome – abdominal
pain, red urine, hematuria, edema
2.3 w/ chronic liver disease - Portal
hypertension, G.I. bleeding, jaundice,
bleeding + infections (spontaneous
bacterial peritonitis)
3. Feaces
3.1 Functional Constipation
3.2 Hirschsprung disease –Failure to pass stool
in first 24h, vomiting, enterocolitis ( fever, foul-
smelling diarrhea, megacolon)
Aganglionic segments of bowel
3.3 Anorectal and colonic malformations
physical examination

4. Featus
 Generalized Distension
5. Malabsorption
• Celiac Disease: diarrhea, failure to thrive, ↓
appetite, anemia, ascites by hyponatremia
• Lactose Intolerance: cramping, diarrhea, failure
to thrive, dehydration

6. Obstruction
• Intestinal Atresia (high grade/complete)
 Generalized
7. Toxic Megacolon
• Pain, fever, anemia, ↓ albumin, massively distended
colon.
• Possible complication of Inflammatory Bowel disease

8. Malnutrition
Kwashiorkor: sufficient caloric intake
Insufficient protein intake:
Osmotic disturbancesPitting Edema
Hepatomegaly, decreased bowel
sounds.
 Localized Masses
1. Intussusception
• Ileocolonic – 1, 2 years old; has had URTI. +
vomiting (nonbilious →bilious), pain, passage of
blood and mucus, lethargy.
• Dance sign: right hypochondrium sausage-
shaped mass and emptiness in the RLQ.

2. Wilm´s tumour
• 1st symptom w/pain; fever, hypertension,
hematuria. Unilateral 95%. Recurrency in opposite
side 5%.
 Localized Masses
3. Neuroblastoma
• Most common extracranial solid tumor. Average age
is 20 months old. Pain. Flank, hard, smooth, non-
tender – Adrenal glands 45% of cases.

4. Pyloric Stenosis
• Hypertrophied pylorus “olive”. + Epigastric distension
due to gastric dilation. Peristaltic waves on the LUQ
before vomiting. Featus is still hungry between
feedings
5. Teratoma, ovarian
• In adolescent girls (15-19y) growing mass in the
lower abdomen.
 Localized Masses
6. Splenomegaly
a. Hemolytic anemias: Thalassemias,
Enzymopathies, Sickel Cell + hepatomegaly.
b. Infiltratrive disorders: Acute Leukemias +
lymphadenopathy.
c. Splenic cysts, hemangiomas
d. Disorders of Splenic blood flow: Cavernous
transformation of the portal vein, Hepatic
cirrhosis, Portal and/or splenic vein thrombosis
e. Infections: e.g: Malaria
 Localized Masses
7. Hepatomegaly d. Congestion
a. Inflammation/Infection 1. Congestive heart
1. Infectious hepatitis failure
(viruses, bacteria, 2. Restrictive
fungi, parasites) pericarditis
3. Budd Chiari
2. Autoimmune
b. Storage
e. Obstruction of Biliary
1. Glycogen storage System
diseases 1. Biliary atresia
2. Disorders of lipid 2. Choledochal cysts
storage 3. Gallstones
c. Infiltration
1. Primary hepatic tumors
2. Infiltration of leukemic
or lymphoma cells.
Thank you