Polyarteritis nodosa physical examination: Difference between revisions

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{{Polyarteritis nodosa}}
{{Polyarteritis nodosa}}
{{CMG}}; {{AE}} {{CZ}}; [[User:Haritha|Haritha Machavarapu, M.B.B.S.]]
* {{CMG}}; {{AE}} {{SSW}}


==Overview==
== Overview ==
Physical examination plays an important role in diagnosing polyarteritis nodosa. Arteritis can be suspected with the presence of multiple [[Mononeuropathy|mononeuropathies]].Signs of ischemia such as extremity ischemia, hypertension and renovascular disease can help in diagnosing polyarteritis nodosa. Skin examination of patients with polyarteritis nodosa can show [[Livedo reticularis|Livedo]] [[Livedo reticularis|reticularis]], ulceration, digital ischemia, and nodules. Polyarteritis nodosa may present with ophthalmologic symptoms like retinal vasculitis, retinal detachment and cotton-wool spots. Cardiovascular examination of patients with polyarteritis nodosa shows hypertension, tachycardia, pericardial friction rub, arrhythmias and congestive heart failure. Abdominal examination of patients with polyarteritis nodosa shows abdominal tenderness and gastro-intestinal bleeding. Neuromuscular examination of patients with polyarteritis nodosa shows sensory and/or motor neuropathies and mononeuritis multiplex.


==Physical Examination==
== Physical Examination ==
* Physical examination plays an important role in diagnosing PAN.  
* Physical examination plays an important role in diagnosing polyarteritis nodosa.  
* Arteritis can be suspected with the presence of multiple mononeuropathies.  
* Arteritis can be suspected with the presence of multiple [[Mononeuropathy|mononeuropathies]].  
* Signs of ischemia such as extremity ischemia, hypertension and renovascular disease can help in diagnosing PAN.  
* Signs of ischemia such as extremity ischemia, hypertension and renovascular disease can help in diagnosing polyarteritis nodosa.  


=== Skin ===
=== Skin ===
* Skin examination of patients with PAN can show:<ref name="pmid12350194">{{cite journal |vauthors=Stone JH |title=Polyarteritis nodosa |journal=JAMA |volume=288 |issue=13 |pages=1632–9 |date=October 2002 |pmid=12350194 |doi= |url=}}</ref>
* Skin examination of patients with polyarteritis nodosa can show:<ref name="pmid12350194">{{cite journal |vauthors=Stone JH |title=Polyarteritis nodosa |journal=JAMA |volume=288 |issue=13 |pages=1632–9 |date=October 2002 |pmid=12350194 |doi= |url=}}</ref>
** [[Livedo reticularis]]
** [[Livedo reticularis]]
** [[Ulcer|Ulcerations]]  
** [[Ulcer|Ulcerations]]  
Line 21: Line 22:
*** Nodules are a rare finding.  
*** Nodules are a rare finding.  
*** Most commonly seen on lower extremity.   
*** Most commonly seen on lower extremity.   
=== HEENT ===
* Polyarteritis nodosa may present with ophthalmologic symptoms like:
** Retinal vasculitis
** Retinal detachment
** Cotton-wool spots
=== Heart ===
* Cardiovascular examination of patients with polyarteritis nodosa shows:
** Hypertension
** Tachycardia
** Pericardial friction rub
** Arrhythmias
** Congestive heart failure
=== Abdomen ===
* Abdominal examination of patients with polyarteritis nodosa shows:<ref name="pmid11904113">{{cite journal |vauthors=Levine SM, Hellmann DB, Stone JH |title=Gastrointestinal involvement in polyarteritis nodosa (1986-2000): presentation and outcomes in 24 patients |journal=Am. J. Med. |volume=112 |issue=5 |pages=386–91 |date=April 2002 |pmid=11904113 |doi= |url=}}</ref>
** Abdominal tenderness
** Gastro-intestinal bleeding
=== Genitourinary ===
* Genitourinary examination of patients with polyarteritis nodosa reveals testicular tenderness on palpation.
=== Neuromuscular ===
* Neuromuscular examination of patients with polyarteritis nodosa shows:<ref name="pmid1979706">{{cite journal |vauthors=Rosenberg MR, Parshley M, Gibson S, Wernick R |title=Central nervous system polyarteritis nodosa |journal=West. J. Med. |volume=153 |issue=5 |pages=553–6 |date=November 1990 |pmid=1979706 |pmc=1002622 |doi= |url=}}</ref>
** Sensory and/or motor neuropathies
** Mononeuritis multiplex<ref name="pmid11723762">{{cite journal |vauthors=Griffin JW |title=Vasculitic neuropathies |journal=Rheum. Dis. Clin. North Am. |volume=27 |issue=4 |pages=751–60, vi |date=November 2001 |pmid=11723762 |doi= |url=}}</ref>
*** Asymmetrical
*** Nerves that are usually involved include: ulnar, radial,peroneal etc.


==References==
==References==

Latest revision as of 17:26, 21 May 2018

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Overview

Physical examination plays an important role in diagnosing polyarteritis nodosa. Arteritis can be suspected with the presence of multiple mononeuropathies.Signs of ischemia such as extremity ischemia, hypertension and renovascular disease can help in diagnosing polyarteritis nodosa. Skin examination of patients with polyarteritis nodosa can show Livedo reticularis, ulceration, digital ischemia, and nodules. Polyarteritis nodosa may present with ophthalmologic symptoms like retinal vasculitis, retinal detachment and cotton-wool spots. Cardiovascular examination of patients with polyarteritis nodosa shows hypertension, tachycardia, pericardial friction rub, arrhythmias and congestive heart failure. Abdominal examination of patients with polyarteritis nodosa shows abdominal tenderness and gastro-intestinal bleeding. Neuromuscular examination of patients with polyarteritis nodosa shows sensory and/or motor neuropathies and mononeuritis multiplex.

Physical Examination

  • Physical examination plays an important role in diagnosing polyarteritis nodosa.
  • Arteritis can be suspected with the presence of multiple mononeuropathies.
  • Signs of ischemia such as extremity ischemia, hypertension and renovascular disease can help in diagnosing polyarteritis nodosa.

Skin

  • Skin examination of patients with polyarteritis nodosa can show:[1]
    • Livedo reticularis
    • Ulcerations
      • Ulcers can be seen on the lower extremeties
    • Digital ischemia
      • Splinter hemorrages can be seen.
      • Gangrene can also be seen.
    • Nodules
      • Nodules are a rare finding.
      • Most commonly seen on lower extremity.

HEENT

  • Polyarteritis nodosa may present with ophthalmologic symptoms like:
    • Retinal vasculitis
    • Retinal detachment
    • Cotton-wool spots

Heart

  • Cardiovascular examination of patients with polyarteritis nodosa shows:
    • Hypertension
    • Tachycardia
    • Pericardial friction rub
    • Arrhythmias
    • Congestive heart failure

Abdomen

  • Abdominal examination of patients with polyarteritis nodosa shows:[2]
    • Abdominal tenderness
    • Gastro-intestinal bleeding

Genitourinary

  • Genitourinary examination of patients with polyarteritis nodosa reveals testicular tenderness on palpation.

Neuromuscular

  • Neuromuscular examination of patients with polyarteritis nodosa shows:[3]
    • Sensory and/or motor neuropathies
    • Mononeuritis multiplex[4]
      • Asymmetrical
      • Nerves that are usually involved include: ulnar, radial,peroneal etc.

References

  1. ↑ Stone JH (October 2002). "Polyarteritis nodosa". JAMA. 288 (13): 1632–9. PMID 12350194.
  2. ↑ Levine SM, Hellmann DB, Stone JH (April 2002). "Gastrointestinal involvement in polyarteritis nodosa (1986-2000): presentation and outcomes in 24 patients". Am. J. Med. 112 (5): 386–91. PMID 11904113.
  3. ↑ Rosenberg MR, Parshley M, Gibson S, Wernick R (November 1990). "Central nervous system polyarteritis nodosa". West. J. Med. 153 (5): 553–6. PMC 1002622. PMID 1979706.
  4. ↑ Griffin JW (November 2001). "Vasculitic neuropathies". Rheum. Dis. Clin. North Am. 27 (4): 751–60, vi. PMID 11723762.

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