Differential diagnoses: Abdominal swellings

Four presentations of abdominal swellings, including paraumbilical hernia, umbilical hernia, umbilical granuloma and ovarian cysts, and advice on their management.

Paraumbilical hernia

Presentation

  • Defect in abdominal musculature adjacent to umbilicus
  • Acquired, as opposed to umbilical hernia, which may be congenital
  • Usually enlarges with time if untreated and may strangulate
  • May reduce on lying down and recur on standing
  • Usually painless, unless large or strangulated
  • Exacerbating factors include obesity, lifting, straining, ascites, COPD and coughing
  • May be a familial predisposition

Management

  • Treated by surgical repair or mesh insertion under general anaesthesia

Umbilical hernia

Presentation

  • May be congenital or acquired
  • Occurs because of defect at site of umbilicus
  • Acquired umbilical hernia is three times more common in women than in men
  • Risk factors include obesity, lifting, coughing and multiple pregnancies
  • Usually painless swelling

Management

  • Congenital hernias usually resolve by age of two or three years
  • If not, can be treated surgically at five or six years old
  • Large acquired hernias can be treated by direct closure or mesh

Umbilical granuloma

Presentation

  • Occurs in neonatal period after separation of umbilical cord
  • Friable, moist surface, which may discharge clear fluid
  • Secondary infection may occur, producing an odour

Management

  • Usually heal without treatment
  • If treatment is required, topical silver nitrate can be used, under the guidance of a healthcare professional
  • If secondary infection present, may require topical antibiotics

Ovarian cyst

Presentation

  • Rare cause of abdominal swelling, which may look like term pregnancy
  • Usually gradually increases in size over a period of months
  • When very large, as in this case, can affect eating, causing bloating and weight loss
  • May be benign or malignant
  • No variation in size with position
  • Ultrasound scan can aid diagnosis

Management

  • In larger cysts, surgical excision is treatment of choice

Dr Stollery is a GP in Leicestershire

Take a test on this article and claim your certificate on MIMS Learning

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

First COVID-19 jabs to target care home residents and staff under new JCVI advice

First COVID-19 jabs to target care home residents and staff under new JCVI advice

Older adults living in care homes and staff working there will be first to receive...

GPs unable to veto virtual fitness to practise hearings during pandemic

GPs unable to veto virtual fitness to practise hearings during pandemic

GPs facing fitness to practise investigations during the COVID-19 pandemic will be...

Government rejects major NHSPS overhaul - but changes 'could ease GP service charge disputes'

Government rejects major NHSPS overhaul - but changes 'could ease GP service charge disputes'

A government review has rejected calls for a major overhaul of an NHS Property Services...

RCGP urges GPs to collaborate with pharmacies on flu jabs this year

RCGP urges GPs to collaborate with pharmacies on flu jabs this year

The RCGP and the Royal Pharmaceutical Society have called on GP practices and community...

GP appointments rising fast as COVID-19 cases 'near 10,000 a day'

GP appointments rising fast as COVID-19 cases 'near 10,000 a day'

GP appointments have risen rapidly in recent weeks as schools returned, according...

COVID-19 impact on medical schools risks 'serious damage' to future NHS workforce

COVID-19 impact on medical schools risks 'serious damage' to future NHS workforce

Medical training and the future NHS workforce could be seriously damaged by the financial...