Gastrointestinal stromal tumor physical examination: Difference between revisions

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{{Gastrointestinal stromal tumor}}
{{Gastrointestinal stromal tumor}}
 
{{CMG}};{{AE}}{{Akshun}}
melena
hematochezia
hematemesis,
abdominal  fullness,
palpable mass.
dysphagia (GISTs in proximal stomach)
gastric outlet obstruction( tumors in pylorus)
hemoperitoneum(intraperitoneal rupture of large tumor).
 
GISTs can occur as part of a syndrome; Carneys triad (gastric GIST, pulmonary chondroma, paraganglioma), or neurofibromatosis type 1 (mostly spindle cell GIST)[27].


==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].
Common [[physical examination]] findings of gastrointestinal stromal tumors (GIST) include [[abdominal distension]] and palpable [[abdominal mass]]. [[Patient|Patients]] with severe and longstanding GIST can present with [[Medical sign|signs]] of [[Abdomen|abdominal]] [[perforation]] and [[peritonitis]] such as [[abdominal tenderness]], rigidity and [[Abdominal guarding|guarding]]. Other findings include those from [[tumor]] [[rupture]] and [[blood]] loss such as [[low blood pressure]], [[tachycardia]], and [[dyspnea]].


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 [[Patient|patients]] with gastrointestinal stromal tumors (GIST) is usually positive for [[abdominal distension]] and palpable [[abdominal mass]]. Other findings include:<ref name="pmid18193130">{{cite journal |vauthors=Szanto P, Barbus A, Al Hajjar N, Zaharia T, Manciula D |title=Gastric stromal tumor: a rare cause of upper gastrointestinal bleeding |journal=J Gastrointestin Liver Dis |volume=16 |issue=4 |pages=441–3 |year=2007 |pmid=18193130 |doi= |url=}}</ref><ref name="pmid21489899">{{cite journal |vauthors=Sandvik OM, Søreide K, Kvaløy JT, Gudlaugsson E, Søreide JA |title=Epidemiology of gastrointestinal stromal tumours: single-institution experience and clinical presentation over three decades |journal=Cancer Epidemiol |volume=35 |issue=6 |pages=515–20 |year=2011 |pmid=21489899 |doi=10.1016/j.canep.2011.03.002 |url=}}</ref><ref name="pmid15743318">{{cite journal |vauthors=Motegi A, Sakurai S, Nakayama H, Sano T, Oyama T, Nakajima T |title=PKC theta, a novel immunohistochemical marker for gastrointestinal stromal tumors (GIST), especially useful for identifying KIT-negative tumors |journal=Pathol. Int. |volume=55 |issue=3 |pages=106–12 |year=2005 |pmid=15743318 |doi=10.1111/j.1440-1827.2005.01806.x |url=}}</ref>
*Physical examination of patients with [disease name] is usually remarkable for:[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].


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*[[Patient|Patients]] with GIST usually appear fatigued.  


===Vital Signs===
===Vital Signs===


*High-grade / low-grade fever
*[[Low-grade fever]]
*[[Hypothermia]] / hyperthermia may be present
*[[Hypothermia]] may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Tachycardia]] with regular pulse  
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Tachypnea]]  
*Tachypnea / bradypnea
*[[Low blood pressure]]
*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===
*[[Cyanosis]]  
*[[Jaundice]] (seen in obstructive [[Duodenum|duodenal]] GIST)
*[[Jaundice]]
* [[Pallor]] (seen with [[Abdomen|abdominal]] [[bleeding]])
* [[Pallor]]
* Bruises
 
<gallery widths=150px>
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
* Abnormalities of the head/hair may include ___
* [[Icterus|Icteric sclera]] (seen in obstructive [[duodenal]] GIST)
* 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===
===Neck===
*[[Jugular venous distension]]
*[[Lymphadenopathy]] (rare)
*[[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===
* Asymmetric chest expansion / Decreased chest expansion
*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===
*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 distention]]  
*[[Abdominal distention]]  
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*Succussion splash ([[gastric outlet obstruction]] with GIST in [[pylorus]])
*[[Rebound tenderness]] (positive Blumberg sign)
*[[Shifting dullness]] ([[intraperitoneal]] [[rupture]] of large GIST with [[hemoperitoneum]])  
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Palpable [[abdominal mass]] (location depends upon the site of GIST)  
*Guarding may be present
*Severe cases may have [[abdominal]] perforation with signs of [[peritonitis]] such as:
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
**[[Abdominal tenderness]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
**Rigidity
 
**[[Abdominal guarding|Guarding]]
===Back===
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
 
===Genitourinary===
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
 
===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)


===Extremities===
===Extremities===
*[[Clubbing]]
*[[Pitting edema]] of the lower [[extremities]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity
 
 


==References==
==References==

Latest revision as of 04:14, 4 March 2019

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

Overview

Common physical examination findings of gastrointestinal stromal tumors (GIST) include abdominal distension and palpable abdominal mass. Patients with severe and longstanding GIST can present with signs of abdominal perforation and peritonitis such as abdominal tenderness, rigidity and guarding. Other findings include those from tumor rupture and blood loss such as low blood pressure, tachycardia, and dyspnea.

Physical Examination

Physical examination of patients with gastrointestinal stromal tumors (GIST) is usually positive for abdominal distension and palpable abdominal mass. Other findings include:[1][2][3]

Appearance of the Patient

  • Patients with GIST usually appear fatigued.

Vital Signs

Skin

HEENT

Neck

Abdomen

Extremities

References

  1. Szanto P, Barbus A, Al Hajjar N, Zaharia T, Manciula D (2007). "Gastric stromal tumor: a rare cause of upper gastrointestinal bleeding". J Gastrointestin Liver Dis. 16 (4): 441–3. PMID 18193130.
  2. Sandvik OM, Søreide K, Kvaløy JT, Gudlaugsson E, Søreide JA (2011). "Epidemiology of gastrointestinal stromal tumours: single-institution experience and clinical presentation over three decades". Cancer Epidemiol. 35 (6): 515–20. doi:10.1016/j.canep.2011.03.002. PMID 21489899.
  3. Motegi A, Sakurai S, Nakayama H, Sano T, Oyama T, Nakajima T (2005). "PKC theta, a novel immunohistochemical marker for gastrointestinal stromal tumors (GIST), especially useful for identifying KIT-negative tumors". Pathol. Int. 55 (3): 106–12. doi:10.1111/j.1440-1827.2005.01806.x. PMID 15743318.


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