This document outlines signs and symptoms of ovarian cancer seen on physical examination. Key signs include an enlarged lower abdomen with a cystic or tense mass felt on palpation. The mass has well-defined upper and lateral borders but a difficult to reach lower pole, suggesting pelvic origin. Percussion over the mass is dull in the center and resonant in the flanks. Bimanual pelvic exam shows the uterus separated from the mass with a groove between them that does not move with the mass.
Inspection consists of visual examination of the abdomen with note made of the shape of the abdomen, skin abnormalities, abdominal masses, and the movement of the abdominal wall with respiration. Abnormalities detected on inspection provide clues to intra-abdominal pathology; these are further investigated with auscultation and palpation.
Inspection consists of visual examination of the abdomen with note made of the shape of the abdomen, skin abnormalities, abdominal masses, and the movement of the abdominal wall with respiration. Abnormalities detected on inspection provide clues to intra-abdominal pathology; these are further investigated with auscultation and palpation.
A brief anatomical, embryological, patho-physiological and surgical description of the Vermiform Appendix.
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Breast mass is a major concern. Aim of this study is to understand the tissue character of any breast mass, if it is solid then to decide about further strategy for regular follow up and or biopsy
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
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Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
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DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
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2. Signs
General condition remains unaffected. However,
in huge mucinous cyst adenoma, the patient may be
cachetic due to protein loss .
Pitting edema of legs may be present when a huge
tumor presses on the great veins.
3. Abdominal Examination :
An ovarian tumor which is enlarged sufficiently so as to
occupy the lower abdomen presents with the following :
Inspection : There is bulging of lower abdomen over which
the abdominal wall moves freely with respiration. The mass
may be placed centrally or in one side. At times the mass fills
the entire abdominal cavity everting the umbilicus with
visible veins under the skin, the flanks remain flat ( flanks are
full with ascites).
4. Palpation
Feel is cystic or tense cystic. Benign solid tumors
such as fibroma, thecoma .Brenner tumor are rare.
Mobility: Freely mobile from side to side but
restricted from above down unless the pedicle
Is long. Too big a tumor or adhesions make its
mobility restricted.
5. Borders: Upper and lateral borders are well-defined
but the lower pole is difficult to reach suggestive of
pelvic origin. However, with long pedicle, the tumor
may be displaced upwards so as to reach the lower
pole.
Surface over the tumor is smooth but often grooved
in lobulated tumor.
6. Percussion
Percussion note is dull in the center and resonant in the flanks (c.f. In ascites—just
the opposite). A fluid thrill may be elicited when the
walls are thin and the content is watery. Coexisting
ascites may be present even in a benign solid tumor
(fibroma) and is called Meigs’ syndrome.
Auscultation: A friction rub may be present over the
tumor (hissing sound over a vascular fibroid, gargling
sound in ascites and FHS over a pregnant uterus).
7. Pelvic Examination
Bimanual examination
The uterus is separated from the mass.
A groove is felt between the uterus and the mass.
Movement of the mass per abdomen fails to move
the cervix.
On elevation of the mass per abdomen, the cervix
remains in stationary position.The lower pole of the cyst can be felt through the
fornix.
Absence of pulsation of the uterine vessels through
the fornices.
