Renal amyloidosis physical examination: Difference between revisions

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==Overview==
==Overview==
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].
Physical examination of patients with [[renal amyloidosis]] is usually remarkable for [[swelling]], [[hepatosplenomegaly]], facial or neck [[purpura]] and [[macroglossia]]. Fatigue and unintentional [[weight loss]], are common in patients with AL [[amyloidosis]]. [[Tachycardia]]/[[bradycardia]] depends on the accompanying [[complication]]. Pulmonary fine [[crackles]], faint pulmonary auscultation, suggestive of [[pleural effusion]], decreased [[tactile fremitus]] and dull percussion.
 
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].


==Physical Examination==
==Physical Examination==
Physical examination of patients with [disease name] is usually normal.
Physical examination of patients with [[renal amyloidosis]] is usually remarkable for [[swelling]], [[hepatosplenomegaly]], [[facial or neck purpura]] and [[macroglossia]]. Fatigue and unintentional weight loss, are common in patients with AL amyloidosis. <ref name="pmid23227278">{{cite journal |vauthors=Baker KR, Rice L |title=The amyloidoses: clinical features, diagnosis and treatment |journal=Methodist Debakey Cardiovasc J |volume=8 |issue=3 |pages=3–7 |date=2012 |pmid=23227278 |pmc=3487569 |doi= |url=}}</ref><ref name="pmid8331978">{{cite journal |vauthors=Menke DM, Kyle RA, Fleming CR, Wolfe JT, Kurtin PJ, Oldenburg WA |title=Symptomatic gastric amyloidosis in patients with primary systemic amyloidosis |journal=Mayo Clin. Proc. |volume=68 |issue=8 |pages=763–7 |date=August 1993 |pmid=8331978 |doi= |url=}}</ref><ref name="pmid7878478">{{cite journal |vauthors=Kyle RA, Gertz MA |title=Primary systemic amyloidosis: clinical and laboratory features in 474 cases |journal=Semin. Hematol. |volume=32 |issue=1 |pages=45–59 |date=January 1995 |pmid=7878478 |doi= |url=}}</ref><ref name="pmid17554122">{{cite journal |vauthors=Eder L, Bitterman H |title=Image in clinical medicine. Amyloid purpura |journal=N. Engl. J. Med. |volume=356 |issue=23 |pages=2406 |date=June 2007 |pmid=17554122 |doi=10.1056/NEJMicm061510 |url=}}</ref>
 
OR
 
Physical examination of patients with [disease name] is usually remarkable for [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].
 
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  


===Appearance of the Patient===
*Patient appears well in the earlier stages of the disease<ref name="pmid23608605">{{cite journal |vauthors=Pinney JH, Whelan CJ, Petrie A, Dungu J, Banypersad SM, Sattianayagam P, Wechalekar A, Gibbs SD, Venner CP, Wassef N, McCarthy CA, Gilbertson JA, Rowczenio D, Hawkins PN, Gillmore JD, Lachmann HJ |title=Senile systemic amyloidosis: clinical features at presentation and outcome |journal=J Am Heart Assoc |volume=2 |issue=2 |pages=e000098 |date=April 2013 |pmid=23608605 |pmc=3647259 |doi=10.1161/JAHA.113.000098 |url=}}</ref>
*Patient appears ill in the late stages of the disease due to multi-organ involvement<ref name="pmid27099136">{{cite journal |vauthors=Nishi S, Ubara Y, Utsunomiya Y, Okada K, Obata Y, Kai H, Kiyomoto H, Goto S, Konta T, Sasatomi Y, Sato Y, Nishino T, Tsuruya K, Furuichi K, Hoshino J, Watanabe Y, Kimura K, Matsuo S |title=Evidence-based clinical practice guidelines for nephrotic syndrome 2014 |journal=Clin. Exp. Nephrol. |volume=20 |issue=3 |pages=342–70 |date=June 2016 |pmid=27099136 |pmc=4891386 |doi=10.1007/s10157-015-1216-x |url=}}</ref>
===Vital Signs===
===Vital Signs===
*[[Fever]] depends on accompanying [[infection]]
*[[Tachycardia]]/[[bradycardia]] depends on the accompanying complication<ref name="pmid23608605">{{cite journal |vauthors=Pinney JH, Whelan CJ, Petrie A, Dungu J, Banypersad SM, Sattianayagam P, Wechalekar A, Gibbs SD, Venner CP, Wassef N, McCarthy CA, Gilbertson JA, Rowczenio D, Hawkins PN, Gillmore JD, Lachmann HJ |title=Senile systemic amyloidosis: clinical features at presentation and outcome |journal=J Am Heart Assoc |volume=2 |issue=2 |pages=e000098 |date=April 2013 |pmid=23608605 |pmc=3647259 |doi=10.1161/JAHA.113.000098 |url=}}</ref>
*[[Tachypnea]]/[[bradypnea]] depends on the accompanying complication<ref name="pmid27099136">{{cite journal |vauthors=Nishi S, Ubara Y, Utsunomiya Y, Okada K, Obata Y, Kai H, Kiyomoto H, Goto S, Konta T, Sasatomi Y, Sato Y, Nishino T, Tsuruya K, Furuichi K, Hoshino J, Watanabe Y, Kimura K, Matsuo S |title=Evidence-based clinical practice guidelines for nephrotic syndrome 2014 |journal=Clin. Exp. Nephrol. |volume=20 |issue=3 |pages=342–70 |date=June 2016 |pmid=27099136 |pmc=4891386 |doi=10.1007/s10157-015-1216-x |url=}}</ref>


*High-grade / low-grade fever
=== Skin ===
*[[Hypothermia]] / hyperthermia may be present
*[[Bruises|Pupura]] <ref name="pmid175541222">{{cite journal |vauthors=Eder L, Bitterman H |title=Image in clinical medicine. Amyloid purpura |journal=N. Engl. J. Med. |volume=356 |issue=23 |pages=2406 |date=June 2007 |pmid=17554122 |doi=10.1056/NEJMicm061510 |url=}}</ref>
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
===Eyes===
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
* [[Periorbital edema]]<ref name="pmid23608605">{{cite journal |vauthors=Pinney JH, Whelan CJ, Petrie A, Dungu J, Banypersad SM, Sattianayagam P, Wechalekar A, Gibbs SD, Venner CP, Wassef N, McCarthy CA, Gilbertson JA, Rowczenio D, Hawkins PN, Gillmore JD, Lachmann HJ |title=Senile systemic amyloidosis: clinical features at presentation and outcome |journal=J Am Heart Assoc |volume=2 |issue=2 |pages=e000098 |date=April 2013 |pmid=23608605 |pmc=3647259 |doi=10.1161/JAHA.113.000098 |url=}}</ref>
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]
 
===Skin===
* Skin examination of patients with [disease name] is usually normal.
OR
*[[Cyanosis]]  
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>
 
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]  
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*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===
* Neck examination of patients with [disease name] is usually normal.
OR
*[[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===
* Pulmonary examination of patients with [disease name] is usually normal.
*Pulmonary fine [[crackles]]
OR
*Faint pulmonary auscultation, suggestive of [[pleural effusion]]
* Asymmetric chest expansion OR decreased chest expansion
*Decreased [[tactile fremitus]]
*Lungs are hyporesonant OR hyperresonant
*Dull percussion<ref name="pmid27099136">{{cite journal |vauthors=Nishi S, Ubara Y, Utsunomiya Y, Okada K, Obata Y, Kai H, Kiyomoto H, Goto S, Konta T, Sasatomi Y, Sato Y, Nishino T, Tsuruya K, Furuichi K, Hoshino J, Watanabe Y, Kimura K, Matsuo S |title=Evidence-based clinical practice guidelines for nephrotic syndrome 2014 |journal=Clin. Exp. Nephrol. |volume=20 |issue=3 |pages=342–70 |date=June 2016 |pmid=27099136 |pmc=4891386 |doi=10.1007/s10157-015-1216-x |url=}}</ref>
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]
 
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
OR
*Chest tenderness upon palpation
*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 examination of patients with [disease name] is usually normal.
* [[Abdominal distension]]
OR
*Shifting dullness, suggestive of [[ascites]]
*[[Abdominal distention]]
*Dull percussion
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
 
===Back===
* Back examination of patients with [disease name] is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
 
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
 
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
OR
*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)


===Extremities===
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
*[[Pitting edema]] in lower extremities bilaterally
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

Latest revision as of 19:01, 8 August 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shaghayegh Habibi, M.D.[2]

Overview

Physical examination of patients with renal amyloidosis is usually remarkable for swelling, hepatosplenomegaly, facial or neck purpura and macroglossia. Fatigue and unintentional weight loss, are common in patients with AL amyloidosis. Tachycardia/bradycardia depends on the accompanying complication. Pulmonary fine crackles, faint pulmonary auscultation, suggestive of pleural effusion, decreased tactile fremitus and dull percussion.

Physical Examination

Physical examination of patients with renal amyloidosis is usually remarkable for swelling, hepatosplenomegaly, facial or neck purpura and macroglossia. Fatigue and unintentional weight loss, are common in patients with AL amyloidosis. [1][2][3][4]

Appearance of the Patient

  • Patient appears well in the earlier stages of the disease[5]
  • Patient appears ill in the late stages of the disease due to multi-organ involvement[6]

Vital Signs

Skin

Eyes

Lungs

Abdomen

Extremities

References

  1. ↑ Baker KR, Rice L (2012). "The amyloidoses: clinical features, diagnosis and treatment". Methodist Debakey Cardiovasc J. 8 (3): 3–7. PMC 3487569. PMID 23227278.
  2. ↑ Menke DM, Kyle RA, Fleming CR, Wolfe JT, Kurtin PJ, Oldenburg WA (August 1993). "Symptomatic gastric amyloidosis in patients with primary systemic amyloidosis". Mayo Clin. Proc. 68 (8): 763–7. PMID 8331978.
  3. ↑ Kyle RA, Gertz MA (January 1995). "Primary systemic amyloidosis: clinical and laboratory features in 474 cases". Semin. Hematol. 32 (1): 45–59. PMID 7878478.
  4. ↑ Eder L, Bitterman H (June 2007). "Image in clinical medicine. Amyloid purpura". N. Engl. J. Med. 356 (23): 2406. doi:10.1056/NEJMicm061510. PMID 17554122.
  5. ↑ 5.0 5.1 5.2 Pinney JH, Whelan CJ, Petrie A, Dungu J, Banypersad SM, Sattianayagam P, Wechalekar A, Gibbs SD, Venner CP, Wassef N, McCarthy CA, Gilbertson JA, Rowczenio D, Hawkins PN, Gillmore JD, Lachmann HJ (April 2013). "Senile systemic amyloidosis: clinical features at presentation and outcome". J Am Heart Assoc. 2 (2): e000098. doi:10.1161/JAHA.113.000098. PMC 3647259. PMID 23608605.
  6. ↑ 6.0 6.1 6.2 Nishi S, Ubara Y, Utsunomiya Y, Okada K, Obata Y, Kai H, Kiyomoto H, Goto S, Konta T, Sasatomi Y, Sato Y, Nishino T, Tsuruya K, Furuichi K, Hoshino J, Watanabe Y, Kimura K, Matsuo S (June 2016). "Evidence-based clinical practice guidelines for nephrotic syndrome 2014". Clin. Exp. Nephrol. 20 (3): 342–70. doi:10.1007/s10157-015-1216-x. PMC 4891386. PMID 27099136.
  7. ↑ Eder L, Bitterman H (June 2007). "Image in clinical medicine. Amyloid purpura". N. Engl. J. Med. 356 (23): 2406. doi:10.1056/NEJMicm061510. PMID 17554122.

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