Abdominal masses and distension

Western Differentiation: Abdominal masses and distension 1. Stemming from liver pathology: a) Hepatomegaly: firm smooth mass below right ribs. b) Liver cancer: firm, lumpy mass below right ribs. 2. Stemming from gallbladder pathology: a) Acute cholecystitis: tenderness sometimes with a mass below liver in right upper quadrant. 3. Stemming from kidney pathology: a) Hydronephrosis: smooth, spongy mass in side or back. b) Cyst: tender mass; flank pain. c) Kidney cancer: smooth, firm, non-tender mass near kidney. 4. Stemming from stomach pathology: a) Stomach cancer: mass left upper or central abdomen. b) Appendicitis: vague pain around navel developing into sharp, severe pain in lower right abdomen. 5. Stemming from spleen pathology: a) Spleen enlargement (splenomegaly): abdominal mass in left upper quadrant. 6. Stemming from intestinal pathology: a) Irritable bowel syndrome: abdominal distension with alternating diarrhoea and constipation. b) Faecal impaction: abdominal mass left lower quadrant. c) Colorectal cancer: variable location. d) Crohn’s disease: bowel fibrosis causing multiple tender sausage-shaped masses in abdomen. e) Diverticulitis: mass usually left lower quadrant. 7. Stemming from bladder pathology: a) Bladder distension: firm mass centre lower abdomen. 8. Stemming from ovarian and uterine pathology: a) Ovarian cyst: smooth rounded rubbery mass above the pelvis in lower abdomen. b) Uterine fibroid: abdominal mass with sensation of pressure.

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Chinese Differentiation: Abdominal masses and distension Diagnostic questioning according to: 1. Eight principles/six divisions: internal (spleen qi deficiency, retained pathogen, i.e. damp phlegm, damp heat); external (wind invasion blocks lung/spleen qi, taiyin). 2. Qi, blood and body fluids: qi and blood stasis; water accumulation; food stagnation; retention of phlegm/damp; qi obstruction causing constipation. 3. Location of mass/distension: upper/lower abdomen; umbilicus/groin region; region below heart; hypochondrium. 4. Digestive/gynaecological: according to symptoms. 5. Nature of abdominal mass: fixed, substantial, painful (blood stagnation); comes and goes, changes location, moveable (qi stagnation); soft on palpation, no pain (phlegm). 6. Nature of distension: comes and goes, changes location (qi stagnation); soft on palpation, no pain (phlegm, qi, food stagnation); fluid retention (spleen qi deficiency). 7. Aetiology: emotional strain (repressed anger, frustration, resentment); poor diet (irregular eating, excessive cold/greasy foods); external pathogenic factors (i.e. external cold/external dampness invading). 8. Underlying patterns: blood deficiency; kidney yin and yang deficiency. 9. Zangfu patterns with masses: Qi masses

Blood masses

Stagnation of liver qi Retention of food in stomach Phlegm obstructing middle burner Blood stasis in stomach Liver blood stasis Blood stasis in the uterus Cold in the uterus

10. Zangfu patterns with distension: Spleen/stomach qi, yin or yang deficiency; Retention of damp phlegm or damp heat T 3

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