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renal cell carcinoma.pptx
- 1. Lump in Abdomen (Renal cell carcinoma) HOD: Prof. Dr Dhananjay Sharma Guide: Prof. Dr Deepti B Sharma By : Dr Ashutosh Carpenter NSCB,MCH , Jabalpur
- 2. Patients particulars Name: Mrs x Age/sex:48y/f Occupation: Farmer Address: Katni , MP
- 3. Chief complaints Patient c/o lump in left side of abdomen since 1 month
- 4. HOPI The patient was apparently alright 1 months back when she incidentally noticed a painless lump of approximate 15x10cm in left lumbar region, which has rapidly progressed to its present size. There is no change in size of the lump and has no association with bladder or bowel movements. There was no pain associated with the lump with any changes in position, or movement of trunk or extremities.
- 5. Negative history Patient had no h/o abdominal pain or distension or of alternate constipation or diarrhea with passage of black colour stools. No c/o vomiting or of early satiety/ hematemesis. No c/o hesitancy/urgency/frequency. No c/o colicky pain in the flanks radiating to inner thigh or passage of stone or blood clots or dark colour urine. No c/o evening rise of temperature, or fever with chills /sweating/itching or weight loss. No paroxysm of sudden palpitation with diaphoresis No c/o periodic pain or episodes of pain in abdomen radiating to back. No c/o pain in the back or per vaginal bleed. No c/o cough with hemoptysis.
- 6. Past history No past h/o PTB/BA/HTN/DM/COPD or any other chronic medical or surgical illness. No history of taking any medication for any disorder .
- 7. Personal history The patient is married has 3 children Takes mixed diet Bowel/bladder functions are normal No history of tobacco addiction or other significant addiction. Low socioeconomic status Family history- no h/o similar illness in family
- 8. Menstrual history Patient has menarche at 16 years of age Her menstrual cycle are regular in duration and frequency, and no c/o dysmenorrhoea.
- 9. Physical examination The patient was examined under adequate light with proper privacy in presence of a chaperone and with implied consent in supine and sitting position, and was examined from front and back. Patient is cooperative and is oriented time ,place and person. The patient is average in built Wt -62kg ht -165cm BMI- 23.4 Karnofsky status-90
- 10. . Afebrile-temp-97 F P-80/min taken in right radial artery in supine position, which was regular in rate and rhythm, normovolumic and no radioradial or radiofemoral delay. BP-118/78mmHg taken in supine position in left brachial artery. No signs of pallor/icterus/cyanosis/clubbing/or lymphadenopathy.
- 11. Per abdominal examination Inspection The abdomen is exposed from xiphisternum to mid thigh. The abdomen in neither distended nor scaphoid in shape. Umbilicus is central in position and inverted, and fullness noted in left lumbar region. Renal angle fullness present on left side. There are multiple hyper pigmented patches present on abdomen s/o fungal infection. All the abdominal quadrants move proportionately with respiration. No signs of any scars or dilated veins over the abdomen, with no visible peristalsis or appreciable cough impulse . External genitalia and all hernial orifices are normal.
- 12. Palpation On palpation findings of inspection were confirmed. On superficial palpation temperature of abdomen is normal. Abdomen is soft ,no guarding tenderness or rigidity present. On palpation a well defined lump of 20x10cm is present on left lumbar area, extending into umbilical region, 5 cm lateral to midline which bimanually palpable and non ballotable , hard in consistency, non reniform in shape with irregular margins, which does not moves with respiration. Fingers can be insinuated below the costal margins, and getting over the swelling was possible. The mass becomes less appreciable on straight leg raising test. Shift test negative. There is no organomegaly or any other mass palpable , no cough impulse over the hernial orifices. No inguinal lymphadenopathy or Virchows node palpable. No tenderness present at the renal angles.
- 13. percussion On percussion-tympanic note present all over the abdomen. Colonic resonance present over the mass. Dull note present on renal angle. No shifting dullness present. Shifting test for the lump was negative. Bs + on auscultation/no bruit heard over the mass. Per rectal : normal anal tone with soft fecal matter present. PV-NAD
- 14. Systemic examination CNS-conscious/oriented CVS-s1 s2 present no murmur RS-AEBE
- 15. In summary A 48y/f presented with a painless lump which is rapidly increasing in size, with no significant complain. On examination: On inspection renal angle fullness present on left side. On palpation a well defined lump of 20x10cm is present on left lumbar and umbilical region, which is bimanually palpable and non ballotable, hard in consistency, non reniform in shape with irregular margins, which does not moves with respiration. Colonic resonance present over the mass and dull note present on renal angle.
- 16. My provisional diagnosis is 48y/f with left sided renal mass probably renal cell carcinoma with no clinical signs of metastasis.
- 19. Thank you .