Gastrointestinal varices physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
[[Physical examination]] of patients with gastrointestinal varices is usually remarkable for [[ascites]], [[pallor]], [[jaundice]], [[tachycardia]], low [[blood pressure]] in case of [[shock]], [[hepatomegaly]] or shrunken [[liver]] (in case of [[cirrhosis]]), [[spleenomegaly]], [[altered mental status]], [[palmar erythema]], [[cyanosis]] and [[clubbing]]. | |||
==Physical Examination== | ==Physical Examination== | ||
[[Physical examination]] of patients with gastrointestinal varices is usually remarkable for the following findings: | |||
===Appearance of the Patient=== | |||
*Patients with gastrointestinal varices due to [[chronic liver disease]] usually appear weak and disoriented. Patient may have [[pallor]] if there is active [[bleeding]] from varices | |||
===Vital Signs=== | |||
*[[Tachycardia]] | |||
*Low [[blood pressure]] in case of [[shock]] due to severe [[bleeding]] from ruptured varices | |||
*[[Tachycardia]] with bounding pulses | |||
*[[Tachypnea]] in case of [[hepatopulmonary syndrome]] | |||
===Skin=== | |||
*[[Jaundice]] | |||
* [[Pallor]] | |||
===HEENT=== | |||
* [[Pallor]] in [[conjunctiva]] and [[cyanosis]] of the [[tongue]], [[lips]], and peripheries, due to low [[oxygen saturation]] | |||
* [[Telangiectasis]] of the [[lips]] | |||
===Neck=== | |||
*[[Lymphadenopathy]] incase of [[lymphoma]] | |||
===Heart=== | |||
* S1 and S2 positive | |||
*[[Chest]] examination may reveal [[gynecomastia]] in males from failure of [[liver]] to metabolize [[Estrogen-related receptor alpha|estrogen]] (normally occurs in the [[liver]]) | |||
=== Abdomen === | |||
*[[Abdominal distention]] due to ascites | |||
*Dilated [[veins]] in the anterior [[abdominal wall]] | |||
*[[Caput medusae]] ([[tortuous]] [[Paraumbilical veins|paraumbilical]] collateral veins) | |||
*[[Hepatomegaly]] / [[splenomegaly]] | |||
*Paraumbilical [[hernia]] | |||
*[[Liver]] may be shrunken in case of [[cirrhosis]] | |||
===Genitourinary=== | |||
*[[Testicular]] [[atrophy]] in [[males]] | |||
*[[Rectal]] [[hemorrhoids]] | |||
*Tarry stools filling the [[rectal]] vault on [[Rectal examination|rectal exam]] | |||
===Neuromuscular=== | |||
*Patient may be disoriented to time, person or place in case of [[hepatic]] [[decompensation]] | |||
*[[Altered mental status]] | |||
*[[Asterixis]] | |||
===Extremities=== | |||
*[[Clubbing]] | |||
*[[Cyanosis]] | |||
*[[Dupuytrens contracture|Dupuytren contracture]] | |||
*[[Muscle wasting]] | |||
*[[Palmar erythema]] and [[leukonychia]] | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 14:21, 26 January 2018
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Gastrointestinal varices Microchapters |
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Differentiating Gastrointestinal varices from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Gastrointestinal varices physical examination On the Web |
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American Roentgen Ray Society Images of Gastrointestinal varices physical examination |
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Risk calculators and risk factors for Gastrointestinal varices physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Physical examination of patients with gastrointestinal varices is usually remarkable for ascites, pallor, jaundice, tachycardia, low blood pressure in case of shock, hepatomegaly or shrunken liver (in case of cirrhosis), spleenomegaly, altered mental status, palmar erythema, cyanosis and clubbing.
Physical Examination
Physical examination of patients with gastrointestinal varices is usually remarkable for the following findings:
Appearance of the Patient
- Patients with gastrointestinal varices due to chronic liver disease usually appear weak and disoriented. Patient may have pallor if there is active bleeding from varices
Vital Signs
- Tachycardia
- Low blood pressure in case of shock due to severe bleeding from ruptured varices
- Tachycardia with bounding pulses
- Tachypnea in case of hepatopulmonary syndrome
Skin
HEENT
- Pallor in conjunctiva and cyanosis of the tongue, lips, and peripheries, due to low oxygen saturation
- Telangiectasis of the lips
Neck
- Lymphadenopathy incase of lymphoma
Heart
- S1 and S2 positive
- Chest examination may reveal gynecomastia in males from failure of liver to metabolize estrogen (normally occurs in the liver)
Abdomen
- Abdominal distention due to ascites
- Dilated veins in the anterior abdominal wall
- Caput medusae (tortuous paraumbilical collateral veins)
- Hepatomegaly / splenomegaly
- Paraumbilical hernia
- Liver may be shrunken in case of cirrhosis
Genitourinary
- Testicular atrophy in males
- Rectal hemorrhoids
- Tarry stools filling the rectal vault on rectal exam
Neuromuscular
- Patient may be disoriented to time, person or place in case of hepatic decompensation
- Altered mental status
- Asterixis