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{{ physical examination of peptic ulcer disease}}
 
{{physical examination of peptic ulcer disease}}


{{CMG}} {{AE}} {{MKK}}
{{CMG}} {{AE}} {{MKK}}
==Introduction to the Physical Examination Page==
* The page name should be '''"(Disease name) physical examination"''', with only the first letter of the title capitalized.
* '''Goal:'''To describe in detail the various aspects of the physical examination with attention to how the disease you are describing may present.
* Remember this section is to describe what characteristics may be found on physical examination, not how to do a physical exam (unless you are including specialized signs, eg Chvostek's sign, in which case you may give a brief description).
*You may describe a physical exam finding that is commonly present in a disease without adding additional information (e.g. appendicitis physical exam - RLQ abdominal tenderness). In some cases, some unique findings are suggestive of specific aspects / complications of the disease. If present, it is preferable that you mention what these unique findings suggest or when they may be present (e.g. appendicitis physical exam - rebound tenderness may be suggestive of peritonitis).
* As with all microchapter pages linking to the main page, at the top of the edit box put <nowiki>{{CMG}}</nowiki>, your name template, and the microchapter navigation template you created at the beginning.
* Remember to create links within Wikidoc by placing <nowiki>[[square brackets]]</nowiki> around key words which you want to link to other pages. Make sure you makes your links as specific as possible. For example if a sentence contained the phrase anterior spinal artery syndrome, the link should be to [[anterior spinal artery syndrome]] not [[anterior]] or [[artery]] or [[syndrome]].  For more information on how to create links click [[Help|here]].
* Remember to follow the same format and capitalization of letters  as outlined in the template below.
* Below you will see examples of what you may describe as part of the physical examination.


==Overview==
==Overview==
* The overview section should include the disease name in the first sentence.
Peptic ulcer disease patient appears in severe stress due to [[abdominal pain]]. Common physical examination findings of peptic ulcer disease include epigastric tenderness, [[tachycardia]].Perforated peptic ulcer disease patient presents with classic triad of severe epigastric tenderness, [[tachycardia]], and abdominal rigidity. Clinical signs of perforated peptic ulcer occurs in 3 stages: In the initial stage within first 2 hours, the patient presents with [[tachycardia]], [[epigastric pain]] and [[cool extremities]].In next 2 to 12 hours, the patient presents with lower right quadrant tenderness and [[abdominal rigidity]]. In more than 12 hours, the patient presents with [[abdominal distension]], [[hypotension]], and [[pyrexia]] with [[acute circulatory collapse]].<ref>{{cite journal |vauthors=Chung KT, Shelat VG |title=Perforated peptic ulcer - an update |journal=World J Gastrointest Surg |volume=9 |issue=1 |pages=1–12 |year=2017 |pmid=28138363 |pmc=5237817 |doi=10.4240/wjgs.v9.i1.1 |url=}}</ref>
* The goal is to summarize the physical examination page in several sentences. This section can be the same as the physical examination segment on the overview page.
* To see an example of an overview section on a physical examination page, click [[Gastric cancer physical examination|here]].
===Template===
*'''First Sentences:'''
:Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
:OR
:Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
:OR
:The presence of [finding(s)] on physical examination is diagnostic of [disease name].
:OR
:The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
 
*'''Examples:'''
:Example 1: Patients with shigellosis usually appear lethargic. Physical examination of patients with shigellosis is usually remarkable for high-grade [[fever]] and signs of dehydration, such as [[tachycardia]], [[tachypnea]], [[hypotension]], and dry mucus membranes.
:Example 2: Common physical examination findings of cholecystitis include right upper abdominal tenderness and a positive Murphy sign.
:Example 3: The presence of both upper motor neuron and lower motor neuron involvement on physical examination is diagnostic of amyotrophic lateral sclerosis.
:Example 4: The presence of facial tenderness and fever on physical examination is highly suggestive of acute sinusitis.
 
==Preferred Template Statements==
*Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
*Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


==Physical Examination==
==Physical Examination==
===Appearance of the Patient===
===Appearance of the Patient===
*Patient usually appear in severe distress due to severe abdominal pain.
*Patient usually appear in severe distress due to severe [[Abdominal pain|abdominal pain.]]


===Vital Signs===
===Vital Signs===
*Patient has normal vital signs in initial stages of peptic ulcer.  
*Patient has normal vital signs in initial stages of peptic ulcer.  
*In peptic ulcer perforations vital signs may include :{{cite journal |vauthors=Bertleff MJ, Lange JF |title=Perforated peptic ulcer disease: a review of history and treatment |journal=Dig Surg |volume=27 |issue=3 |pages=161–9 |year=2010 |pmid=20571260 |doi=10.1159/000264653 |url=}}
*In peptic ulcer perforations vital signs may include :<ref>{{cite journal |vauthors=Bertleff MJ, Lange JF |title=Perforated peptic ulcer disease: a review of history and treatment |journal=Dig Surg |volume=27 |issue=3 |pages=161–9 |year=2010 |pmid=20571260 |doi=10.1159/000264653 |url=}}</ref>
**Tachycardia with regular pulse
**[[Tachycardia]] with regular pulse
**Weak pulse
**Weak pulse
**low blood pressure with normal pulse pressure
**low [[blood pressure]] with normal pulse pressure
**High-grade fever is present at later stage of peptic ulcer perforation
**High-grade [[fever]] is present at later stage of peptic ulcer perforation


===Skin===  
===Skin===  
*Pallor is present in patients presents with hematemesis and melena.
*Pallor is present in patients presents with [[hematemesis]] and [[melena]].
<gallery widths=150px>
<gallery widths="150">
 
File:Iron deficiency anemia blood film.jpg|Source- Dr Graham Beards (Own work) <ref>CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons</ref>  
Iron deficiency anemia blood film.jpg|By Dr Graham Beards (Own work) <ref>CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons</ref> Anemia.jpg|The hand of a person with severe anemia (on the left) compared to one without (on the right)By James Heilman, MD - Own work<ref> CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=10313974</ref>
File:Anemia.jpg|The hand of a person with severe anemia (on the left) compared to one without (on the right) Source -James Heilman, MD - Own work<ref> CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=10313974</ref>
 
</gallery>
</gallery>


===HEENT===
===HEENT===
* Abnormalities of the head/hair may include ___
* Pallor on the lower [[conjunctiva]] can be seen.
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]  
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accomodation / non-reactive to neither light nor accomodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae / tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
 
===Neck===
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]


===Lungs===
===Lungs===
* Asymmetric chest expansion / Decreased chest expansion
* Normal  B/L vesicular [[breath sounds.]]
*Lungs are hypo/hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds / Distant breath sounds
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]
 
===Heart===
===Heart===
*Chest tenderness upon palpation
*S1 and S2 normal ,no murmur/rubs/gallops.
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope
 
===Abdomen===
===Abdomen===
*[[Abdominal distention]]
*[[Abdominal tenderness]] at the epigastrium 
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*Perforated peptic ulcer presents with<ref>{{cite journal |vauthors=Bertleff MJ, Lange JF |title=Perforated peptic ulcer disease: a review of history and treatment |journal=Dig Surg |volume=27 |issue=3 |pages=161–9 |year=2010 |pmid=20571260 |doi=10.1159/000264653 |url=}} </ref>
*[[Rebound tenderness]] (positive Blumberg sign)
**[[Rebound tenderness]]
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
**Decreased [[bowel sound]]<nowiki/>s
*Guarding may be present
**Lower right quadrant tenderness
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
**Abdominal rigdity
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
**[[Abdominal distension]] <ref>{{cite journal |vauthors=Chung KT, Shelat VG |title=Perforated peptic ulcer - an update |journal=World J Gastrointest Surg |volume=9 |issue=1 |pages=1–12 |year=2017 |pmid=28138363 |pmc=5237817 |doi=10.4240/wjgs.v9.i1.1 |url=}}</ref>
 
===Back===
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally (may also be referred to as Murphy's punch sign, which is different from Murphy's sign that suggests cholecystitis. To avoid confusion, write "costovertebral angle tenderness")
*Buffalo hump
 
===Genitourinary===
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
<sup>Write additional pathognomonic findings, such as discharge that resembles cottage cheese for ''C. albicans'' vulvovaginitis / fish-odor for ''T. vaginalis'' ifnection</sup>
 
===Extremities===
*[[Clubbing]]  
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity
 
===Neuromuscular===
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)


==References==
==References==

Latest revision as of 13:13, 23 October 2017


Template:Physical examination of peptic ulcer disease

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]

Overview

Peptic ulcer disease patient appears in severe stress due to abdominal pain. Common physical examination findings of peptic ulcer disease include epigastric tenderness, tachycardia.Perforated peptic ulcer disease patient presents with classic triad of severe epigastric tenderness, tachycardia, and abdominal rigidity. Clinical signs of perforated peptic ulcer occurs in 3 stages: In the initial stage within first 2 hours, the patient presents with tachycardia, epigastric pain and cool extremities.In next 2 to 12 hours, the patient presents with lower right quadrant tenderness and abdominal rigidity. In more than 12 hours, the patient presents with abdominal distension, hypotension, and pyrexia with acute circulatory collapse.[1]

Physical Examination

Appearance of the Patient

Vital Signs

  • Patient has normal vital signs in initial stages of peptic ulcer.
  • In peptic ulcer perforations vital signs may include :[2]
    • Tachycardia with regular pulse
    • Weak pulse
    • low blood pressure with normal pulse pressure
    • High-grade fever is present at later stage of peptic ulcer perforation

Skin

  • Source- Dr Graham Beards (Own work) [3]

    Source- Dr Graham Beards (Own work) [3]

  • The hand of a person with severe anemia (on the left) compared to one without (on the right) Source -James Heilman, MD - Own work[4]

    The hand of a person with severe anemia (on the left) compared to one without (on the right) Source -James Heilman, MD - Own work[4]

HEENT

Lungs

Heart

  • S1 and S2 normal ,no murmur/rubs/gallops.

Abdomen

References

  • References should be cited for the material that you have put on your page. Type in {{reflist|2}}.This will generate your references in small font, in two columns, with links to the original article and abstract.
  • For information on how to add references into your page, click here.
  1. ↑ Chung KT, Shelat VG (2017). "Perforated peptic ulcer - an update". World J Gastrointest Surg. 9 (1): 1–12. doi:10.4240/wjgs.v9.i1.1. PMC 5237817. PMID 28138363.
  2. ↑ Bertleff MJ, Lange JF (2010). "Perforated peptic ulcer disease: a review of history and treatment". Dig Surg. 27 (3): 161–9. doi:10.1159/000264653. PMID 20571260.
  3. ↑ CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
  4. ↑ CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=10313974
  5. ↑ Bertleff MJ, Lange JF (2010). "Perforated peptic ulcer disease: a review of history and treatment". Dig Surg. 27 (3): 161–9. doi:10.1159/000264653. PMID 20571260.
  6. ↑ Chung KT, Shelat VG (2017). "Perforated peptic ulcer - an update". World J Gastrointest Surg. 9 (1): 1–12. doi:10.4240/wjgs.v9.i1.1. PMC 5237817. PMID 28138363.
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