Irritable bowel syndrome physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Irritable bowel syndrome}} | {{Irritable bowel syndrome}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} {{Cherry}} | ||
==Overview== | ==Overview== | ||
Patients with | Patients with [[Irritable bowel syndrome|irritable bowel syndrome]] usually appear normal on [[Physical examination|physical exam]]. [[Physical examination]] of patients with [[Irritable bowel syndrome|IBS]] may elicit [[Tenderness (medicine)|abdominal tenderness]] in some patients. A [[Rectal examination|digital rectal examination]] must be performed in all patients to rule out [[rectal]] growths, blood in [[Human feces|stool]] and evaluate for dyssynergic [[defecation]] (where paradoxical contraction of the rectal [[sphincter]] occurs on straining, leading to [[constipation]]). Physical findings such as [[fever]], [[abdominal mass]], [[hepatosplenomegaly]], [[lymph node]] enlargement, [[weight loss]], [[Peritoneum|peritoneal]] signs and [[ascites]] are absent in [[Irritable bowel syndrome|IBS]] and help rule out organic causes. | ||
==Physical Examination== | ==Physical Examination== | ||
===Appearance of the | ===Appearance of the patient=== | ||
*Patients with | *Patients with [[Irritable bowel syndrome|irritable bowel syndrome]] usually appear normal/mildly distressed. Physical exam is normal in most patients.<ref name="pmid27492916">{{cite journal |vauthors=Bharucha AE, Chakraborty S, Sletten CD |title=Common Functional Gastroenterological Disorders Associated With Abdominal Pain |journal=Mayo Clin. Proc. |volume=91 |issue=8 |pages=1118–32 |year=2016 |pmid=27492916 |pmc=4985027 |doi=10.1016/j.mayocp.2016.06.003 |url=}}</ref><ref name="pmid21872090">{{cite journal |vauthors=Malone MA |title=Irritable bowel syndrome |journal=Prim. Care |volume=38 |issue=3 |pages=433–47; viii |year=2011 |pmid=21872090 |doi=10.1016/j.pop.2011.05.003 |url=}}</ref><ref name="pmid19151451">{{cite journal |vauthors=Abdullah M |title=Irritable bowel syndrome: current review on pathophysiology and diagnotic aspects |journal=Acta Med Indones |volume=40 |issue=4 |pages=218–25 |year=2008 |pmid=19151451 |doi= |url=}}</ref><ref name="pmid17606954">{{cite journal |vauthors=Wilson JF |title=In the clinic. Irritable bowel syndrome |journal=Ann. Intern. Med. |volume=147 |issue=1 |pages=ITC7–1–ITC7–16 |year=2007 |pmid=17606954 |doi=10.7326/0003-4819-147-1-200707030-01007 |url=}}</ref><ref name="pmid16455728">{{cite journal |vauthors=Agrawal A, Whorwell PJ |title=Irritable bowel syndrome: diagnosis and management |journal=BMJ |volume=332 |issue=7536 |pages=280–3 |year=2006 |pmid=16455728 |pmc=1360402 |doi=10.1136/bmj.332.7536.280 |url=}}</ref> | ||
===Vital | ===Vital signs=== | ||
*Afebrile | *Afebrile | ||
*Regular pulse | *Regular [[pulse]] | ||
*Normal | *Normal [[blood pressure]] | ||
*Normal | *Normal [[respiratory rate]] | ||
*IBS-diarrhea patients with dehydration/hypovolemia as a complication develop: | *IBS-diarrhea patients with [[dehydration]]/[[hypovolemia]] as a complication develop:<ref name="pmid10086438">{{cite journal |vauthors=McGee S, Abernethy WB, Simel DL |title=The rational clinical examination. Is this patient hypovolemic? |journal=JAMA |volume=281 |issue=11 |pages=1022–9 |year=1999 |pmid=10086438 |doi= |url=}}</ref> | ||
**tachycardia | **[[tachycardia]] | ||
**low blood pressure | **low [[blood pressure]] | ||
**postural hypotension | **[[Orthostatic hypotension|postural hypotension]] | ||
===Skin=== | ===Skin=== | ||
* Skin turgor is normal in most patients | * Skin turgor is normal in most patients | ||
* IBS-diarrhea patients with dehydration/hypovolemia as a complication develop: | * [[Irritable bowel syndrome|IBS]]-[[diarrhea]] patients with [[dehydration]]/[[hypovolemia]] as a complication develop:<ref name="pmid10086438">{{cite journal |vauthors=McGee S, Abernethy WB, Simel DL |title=The rational clinical examination. Is this patient hypovolemic? |journal=JAMA |volume=281 |issue=11 |pages=1022–9 |year=1999 |pmid=10086438 |doi= |url=}}</ref> | ||
** decreased skin turgor | ** decreased skin turgor | ||
** dryness of tongue and oral mucosa due to decreased salivary secretions | ** dryness of tongue and oral [[Mucous membrane|mucosa]] due to decreased [[Salivary gland|salivary]] secretions | ||
===Lungs=== | ===Lungs=== | ||
* Normal chest expansion | * Normal chest expansion | ||
*Normal vesicular breath sounds in B/L lung fields | *Normal [[Vesicular breathing|vesicular]] breath sounds in B/L lung fields | ||
*Normal [[tactile fremitus]] | *Normal [[tactile fremitus]] | ||
| Line 42: | Line 36: | ||
===Abdomen=== | ===Abdomen=== | ||
Findings on abdominal examination are as follows:<ref name="pmid19521341">{{cite journal |vauthors=Brandt LJ, Chey WD, Foxx-Orenstein AE, Schiller LR, Schoenfeld PS, Spiegel BM, Talley NJ, Quigley EM |title=An evidence-based position statement on the management of irritable bowel syndrome |journal=Am. J. Gastroenterol. |volume=104 Suppl 1 |issue= |pages=S1–35 |year=2009 |pmid=19521341 |doi=10.1038/ajg.2008.122 |url=}}</ref><ref name="pmid10588169">{{cite journal |vauthors=Schmulson MW, Chang L |title=Diagnostic approach to the patient with irritable bowel syndrome |journal=Am. J. Med. |volume=107 |issue=5A |pages=20S–26S |year=1999 |pmid=10588169 |doi= |url=}}</ref><ref name="pmid4023607">{{cite journal |vauthors=Svendsen JH, Munck LK, Andersen JR |title=Irritable bowel syndrome--prognosis and diagnostic safety. A 5-year follow-up study |journal=Scand. J. Gastroenterol. |volume=20 |issue=4 |pages=415–8 |year=1985 |pmid=4023607 |doi= |url=}}</ref> | |||
* Examination results are usually normal | * Examination results are usually normal | ||
* [[Abdominal distention]] may be present | * [[Abdominal distention]] may be present | ||
*[[Abdominal tenderness]] may be elicited in different quadrants | *[[Abdominal tenderness]] may be elicited in different quadrants | ||
*Absence of abdominal masses, | *Absence of abdominal masses, [[Splenomegaly|hepatospleenomegaly]] | ||
*Normal bowel sounds | *Normal [[Intestine|bowel]] sounds | ||
*To rule out organic causes, rectal exam must be done in patients to evaluate for: | |||
=== Rectal exam === | |||
*IBS patients usually have a normal [[rectal]] exam.To rule out organic causes of [[constipation]] and [[diarrhea]], rectal exam must be done in patients to evaluate for: <ref name="pmid16803612">{{cite journal |vauthors=Whitehead WE, Palsson OS, Feld AD, Levy RL, VON Korff M, Turner MJ, Drossman DA |title=Utility of red flag symptom exclusions in the diagnosis of irritable bowel syndrome |journal=Aliment. Pharmacol. Ther. |volume=24 |issue=1 |pages=137–46 |year=2006 |pmid=16803612 |doi=10.1111/j.1365-2036.2006.02956.x |url=}}</ref><ref name="pmid6724251">{{cite journal |vauthors=Kruis W, Thieme C, Weinzierl M, Schüssler P, Holl J, Paulus W |title=A diagnostic score for the irritable bowel syndrome. Its value in the exclusion of organic disease |journal=Gastroenterology |volume=87 |issue=1 |pages=1–7 |year=1984 |pmid=6724251 |doi= |url=}}</ref><ref name="pmid18397419">{{cite journal |vauthors=Talley NJ |title=How to do and interpret a rectal examination in gastroenterology |journal=Am. J. Gastroenterol. |volume=103 |issue=4 |pages=820–2 |year=2008 |pmid=18397419 |doi=10.1111/j.1572-0241.2008.01832.x |url=}}</ref><ref name="pmid20656061">{{cite journal |vauthors=Tantiphlachiva K, Rao P, Attaluri A, Rao SS |title=Digital rectal examination is a useful tool for identifying patients with dyssynergia |journal=Clin. Gastroenterol. Hepatol. |volume=8 |issue=11 |pages=955–60 |year=2010 |pmid=20656061 |doi=10.1016/j.cgh.2010.06.031 |url=}}</ref><ref name="pmid26032152">{{cite journal |vauthors=Soh JS, Lee HJ, Jung KW, Yoon IJ, Koo HS, Seo SY, Lee S, Bae JH, Lee HS, Park SH, Yang DH, Kim KJ, Ye BD, Byeon JS, Yang SK, Kim JH, Myung SJ |title=The diagnostic value of a digital rectal examination compared with high-resolution anorectal manometry in patients with chronic constipation and fecal incontinence |journal=Am. J. Gastroenterol. |volume=110 |issue=8 |pages=1197–204 |year=2015 |pmid=26032152 |doi=10.1038/ajg.2015.153 |url=}}</ref> | |||
** presence of [[stool]] and its consistency | ** presence of [[stool]] and its consistency | ||
**Rectal tenderness | **[[Rectal]] tenderness | ||
**Strictures | **Strictures | ||
** Masses | ** Masses | ||
**rectal prolapse | **rectal [[prolapse]] | ||
** [[Fistula|Fistulas]] | ** [[Fistula|Fistulas]] | ||
** [[Hemorrhoid|Hemorrhoids]] | ** [[Hemorrhoid|Hemorrhoids]] | ||
** [[Abscess|Abscesses]] | ** [[Abscess|Abscesses]] | ||
** [[Fissure|Fissures]] | ** [[Fissure|Fissures]] | ||
**impaired sphincter function due to a neurologic disorder | **impaired [[sphincter]] function due to a [[Neurology|neurologic]] disorder | ||
**responses of the puborectalis and external anal sphincter muscles while straining to rule out dyssynergic defecation | **responses of the [[puborectalis]] and [[External anal sphincter|external anal sphincter muscles]] while straining to rule out dyssynergic [[defecation]] | ||
==References== | ==References== | ||
Latest revision as of 14:48, 4 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]
Overview
Patients with irritable bowel syndrome usually appear normal on physical exam. Physical examination of patients with IBS may elicit abdominal tenderness in some patients. A digital rectal examination must be performed in all patients to rule out rectal growths, blood in stool and evaluate for dyssynergic defecation (where paradoxical contraction of the rectal sphincter occurs on straining, leading to constipation). Physical findings such as fever, abdominal mass, hepatosplenomegaly, lymph node enlargement, weight loss, peritoneal signs and ascites are absent in IBS and help rule out organic causes.
Physical Examination
Appearance of the patient
- Patients with irritable bowel syndrome usually appear normal/mildly distressed. Physical exam is normal in most patients.[1][2][3][4][5]
Vital signs
- Afebrile
- Regular pulse
- Normal blood pressure
- Normal respiratory rate
- IBS-diarrhea patients with dehydration/hypovolemia as a complication develop:[6]
Skin
- Skin turgor is normal in most patients
- IBS-diarrhea patients with dehydration/hypovolemia as a complication develop:[6]
Lungs
- Normal chest expansion
- Normal vesicular breath sounds in B/L lung fields
- Normal tactile fremitus
Heart
Abdomen
Findings on abdominal examination are as follows:[7][8][9]
- Examination results are usually normal
- Abdominal distention may be present
- Abdominal tenderness may be elicited in different quadrants
- Absence of abdominal masses, hepatospleenomegaly
- Normal bowel sounds
Rectal exam
- IBS patients usually have a normal rectal exam.To rule out organic causes of constipation and diarrhea, rectal exam must be done in patients to evaluate for: [10][11][12][13][14]
- presence of stool and its consistency
- Rectal tenderness
- Strictures
- Masses
- rectal prolapse
- Fistulas
- Hemorrhoids
- Abscesses
- Fissures
- impaired sphincter function due to a neurologic disorder
- responses of the puborectalis and external anal sphincter muscles while straining to rule out dyssynergic defecation
References
- ↑ Bharucha AE, Chakraborty S, Sletten CD (2016). "Common Functional Gastroenterological Disorders Associated With Abdominal Pain". Mayo Clin. Proc. 91 (8): 1118–32. doi:10.1016/j.mayocp.2016.06.003. PMC 4985027. PMID 27492916.
- ↑ Malone MA (2011). "Irritable bowel syndrome". Prim. Care. 38 (3): 433–47, viii. doi:10.1016/j.pop.2011.05.003. PMID 21872090.
- ↑ Abdullah M (2008). "Irritable bowel syndrome: current review on pathophysiology and diagnotic aspects". Acta Med Indones. 40 (4): 218–25. PMID 19151451.
- ↑ Wilson JF (2007). "In the clinic. Irritable bowel syndrome". Ann. Intern. Med. 147 (1): ITC7–1–ITC7–16. doi:10.7326/0003-4819-147-1-200707030-01007. PMID 17606954.
- ↑ Agrawal A, Whorwell PJ (2006). "Irritable bowel syndrome: diagnosis and management". BMJ. 332 (7536): 280–3. doi:10.1136/bmj.332.7536.280. PMC 1360402. PMID 16455728.
- ↑ 6.0 6.1 McGee S, Abernethy WB, Simel DL (1999). "The rational clinical examination. Is this patient hypovolemic?". JAMA. 281 (11): 1022–9. PMID 10086438.
- ↑ Brandt LJ, Chey WD, Foxx-Orenstein AE, Schiller LR, Schoenfeld PS, Spiegel BM, Talley NJ, Quigley EM (2009). "An evidence-based position statement on the management of irritable bowel syndrome". Am. J. Gastroenterol. 104 Suppl 1: S1–35. doi:10.1038/ajg.2008.122. PMID 19521341.
- ↑ Schmulson MW, Chang L (1999). "Diagnostic approach to the patient with irritable bowel syndrome". Am. J. Med. 107 (5A): 20S–26S. PMID 10588169.
- ↑ Svendsen JH, Munck LK, Andersen JR (1985). "Irritable bowel syndrome--prognosis and diagnostic safety. A 5-year follow-up study". Scand. J. Gastroenterol. 20 (4): 415–8. PMID 4023607.
- ↑ Whitehead WE, Palsson OS, Feld AD, Levy RL, VON Korff M, Turner MJ, Drossman DA (2006). "Utility of red flag symptom exclusions in the diagnosis of irritable bowel syndrome". Aliment. Pharmacol. Ther. 24 (1): 137–46. doi:10.1111/j.1365-2036.2006.02956.x. PMID 16803612.
- ↑ Kruis W, Thieme C, Weinzierl M, Schüssler P, Holl J, Paulus W (1984). "A diagnostic score for the irritable bowel syndrome. Its value in the exclusion of organic disease". Gastroenterology. 87 (1): 1–7. PMID 6724251.
- ↑ Talley NJ (2008). "How to do and interpret a rectal examination in gastroenterology". Am. J. Gastroenterol. 103 (4): 820–2. doi:10.1111/j.1572-0241.2008.01832.x. PMID 18397419.
- ↑ Tantiphlachiva K, Rao P, Attaluri A, Rao SS (2010). "Digital rectal examination is a useful tool for identifying patients with dyssynergia". Clin. Gastroenterol. Hepatol. 8 (11): 955–60. doi:10.1016/j.cgh.2010.06.031. PMID 20656061.
- ↑ Soh JS, Lee HJ, Jung KW, Yoon IJ, Koo HS, Seo SY, Lee S, Bae JH, Lee HS, Park SH, Yang DH, Kim KJ, Ye BD, Byeon JS, Yang SK, Kim JH, Myung SJ (2015). "The diagnostic value of a digital rectal examination compared with high-resolution anorectal manometry in patients with chronic constipation and fecal incontinence". Am. J. Gastroenterol. 110 (8): 1197–204. doi:10.1038/ajg.2015.153. PMID 26032152.