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Abdominal Pain 407 Summary The list of disease processes that cause abdominal pain is extensive cheap extra super cialis 100mg overnight delivery erectile dysfunction drugs history. Most of these maladies never require surgery; however purchase 100 mg extra super cialis free shipping erectile dysfunction treatment acupuncture, recognizing when emergent buy extra super cialis 100mg fast delivery erectile dysfunction young cure, urgent order 100mg eriacta with visa, or elective operative intervention is required is a necessary skill for general surgeons and most physicians generic propecia 5 mg with mastercard. Starting with a directed history of the nature of the pain and the associated symptoms purchase discount suhagra line, one can begin to formulate a differential diagnosis. The past medical and surgical history often provides additional clues as well as a picture of the patient’s overall condition. Understanding that the rigid abdomen seen with free air and the involuntary guarding seen with peritoneal irritation are signs of surgi- cal emergencies is the first step. Further refinement of diagnostic skills comes with the number of abdominal exams one performs. The history and physical combined with laboratory and imaging studies usually provide enough information to determine if the patient has a cata- strophic abdominal emergency, an urgent surgical condition, an elec- tive surgical condition, or a nonsurgical condition. To describe the causes of hepatomegaly; to discuss the role of imaging and liver biopsy; to discuss the most frequently encountered benign and malig- nant liver masses and their management. To describe the differential diagnosis of a pancre- atic mass; to discuss the most useful imaging studies and the role of biopsy. To understand the relationship of the pancreatic duct to the common bile duct and how this may affect the diagnosis and treatment of a pancreatic mass; to discuss the management of cysts of the pancreas. To describe the causes of hypersplenism; to discuss the common signs and symptoms of hypersplenism and contrast with splenomegaly; to discuss the role and consequences of splenec- tomy in the treatment of splenic disease. To discuss the most frequently encountered retroperitoneal masses; to contrast the manage- ment of lymphomas and sarcomas. Cases Case 1 A 46-year-old male police officer noticed mild pressure in his abdomen when he bent to tie his shoes. Further question- ing revealed early satiety, and physical examination revealed a large epigastric mass that was firm but not hard. Physical examination revealed a midline epigastric mass along with an enlarged spleen. Case 4 A 48-year-old man presented with increasing abdominal girth and decreased appetite. Case 5 A 45-year-old man presented with intermittent nausea and blood in his stools. Introduction Abdominal masses may be caused by a large variety of pathologic con- ditions. All abdominal masses need to be thoroughly and expeditiously evaluated, sometimes with significant urgency. A detailed history and physical examination, combined with knowledge of normal anatomy, allow the physician to generate a reasonable differential diagnosis.