Kembara Xtra - Symptoms and Signs - Abdominal Pulsation

Kembara Xtra - Symptoms and Signs - Abdominal Pulsation 
​
​A pulsating swelling in the abdomen could be caused by any of the following: • A prominent aorta, either normal or arteriosclerotic • An abdominal aortic aneurysm • Transmission of aortic pulsations through an abdominal mass • A pulsating, enlarged liver • Transmission of aortic pulsations through an abdominal mass

Prominent Aorta 
It is possible for totally normal people who are very thin to feel the pulsations of the normal aorta along a line that extends from the xiphoid to the bifurcation of the aorta at the level of the fourth lumbar vertebra. This line runs from the xiphoid to the bifurcation of the aorta.
This is on a line that joins the iliac crests, approximately 2 centimeters below the umbilicus and a little bit to the left of it. When it comes to the question of arteriosclerosis and hypertension, it may be difficult to determine whether the aorta is simply thickened and tortuous, or whether it is aneurysmal instead of just thickened and tortuous. It is possible to determine the distance between the fingers by positioning the two index fingers in parallel with the aorta and positioning one finger on either side of the artery.
It is possible that a distance of two to three centimeters (cm) between the patient's fingertips is deemed normal; nevertheless, any measurement that is greater than this raises the possibility of aneurysmal dilatation.
Visualization of the aorta with ultrasonography or computed tomography provides reliable measurement of the aorta, hence this technique should be used if there is any uncertainty.


Abdominal Aortic Aneurysm 
There is no question that arteriosclerotic abdominal aneurysms are getting more common, and that the acute emergency that results from the rupture or leakage of one of these aneurysms is also becoming more common. Patients often have an age range of over sixty years old, and the vast majority of them are male. There may be no symptoms at all associated with the aneurysm, or the patient may experience discomfort that originates in the epigastric or central abdominal region and frequently spreads to the lumbar region.
Patients may really be the ones to notice the pulsating lump in their own abdominal region.
If it is large enough, the pulse may really seem as a pulsating mass and can be seen in the upper abdomen, which is located above the umbilicus. An aneurysm can be palpated as a swelling that is located in the middle of the body and protrudes to the left side, away from the neighboring inferior vena cava. If the mass extends below the level of the umbilicus, this raises the possibility that the iliac arteries are involved.
The mass exhibits an expansile pulsation, which is the defining feature of the mass's physical manifestation. It is possible to measure the diameter of the mass by positioning the index fingers on either side of the object being examined. If the diameter is greater than 3 centimeters, aneurysmal dilatation of the aorta is almost probably the clinical diagnosis; if the diameter is greater than 5 centimeters, the clinical diagnosis is virtually certain. 
In most cases, the fingers are moved apart during each pulse rather than being moved up and down. The latter sign indicates that the pulsation is being sent (for more information, see the subsequent section).
In most cases, the aneurysm is resonant to percussion because the loops of intestine that are overlaying it. On the other hand, an exceptionally big aneurysm will displace the bowel laterally, causing it to reach the anterior abdominal wall. This will cause a dull percussion note to be produced. An aneurysm may have bruits along its lower extremity, which can be detected by auscultation. 

This indicates that there is turbulence in the flow of blood at the aorto-iliac junctions, which is produced by relative stenosis.
When either one or both of the internal iliac arteries are implicated in the aneurysmal process, a rectal examination could indicate a pulsatile mass in that area.
An urgent abdominal emergency exists in the event that the aneurysm ruptures or leaks. The patient has significant stomach discomfort, lumbar pain, and noticeable abdominal soreness and guarding in addition to the characteristics of large blood loss, which include being pale, sweating, having clammy skin, having a quick pulse, and having a low blood pressure.
It may be quite difficult to palpate the aneurysm because of the low blood pressure and the concomitant peri-aneurysmal haematoma, in addition to the underlying guarding, and it is easy enough to miss if one does not seek it out carefully.
Because of the accompanying calcification in its wall, an aortic aneurysm is typically delineated on a plain abdominal X-ray (Fig. A.4), which is frequently used to confirm the diagnosis of aortic aneurysm.
It is common for the aneurysm to protrude over to the left side of the abdomen when it is present. To be more precise, an ultrasound or computed tomography of the abdomen can visualize the aneurysm and make it possible to correctly estimate its length and diameter.

The Transmission of Aortic Pulsation Through the Mass of the Abdomen 
It is possible for a large solid mass to transmit aortic pulsation if it is located either within the abdomen or the retroperitoneum and presses against the aorta. A massive carcinoma of the body of the stomach, a carcinoma or cyst of the pancreas, and a large ovarian cyst are three examples that are typical of this condition. In point of fact, it is possible that a cystic mass and significant ascites can be difficult to differentiate from one another when the entire belly is occupied by the cystic mass. Ascites causes dullness in the flanks, which is different from the dullness that a large intra-abdominal mass causes in the center of the abdomen, hence percussion is helpful in this situation. When placed on the mass, the two index fingers will be able to perceive that the pulsation is transferred directly forwards from the aorta and is not expansile, as it would be in an aneurysm.


Pulsatile Liver 
It is quite unlikely that a pulsatile liver that has grown to be abnormally large will be confused for any other sort of pulsatile tumor.
In most cases, mitral stenosis or tricuspid stenosis are to blame for the chronic failure of cardiac compensation that leads to this condition. There is also ascites, cyanosis, and edematous leg swelling linked with this condition. However, not all livers that appear to pulsate actually display expansile pulsation, even if they do appear to be doing so. The movements that are sent straight to the liver by the hypertrophied right heart can sometimes provide the sensation of pulsation.