Autoimmune pancreatitis physical examination: Difference between revisions

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{{Autoimmune pancreatitis}}
{{Autoimmune pancreatitis}}


{{CMG}}; {{AE}}  
{{CMG}}; {{AE}}{{IQ}}


==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].
Patients with [[acute]] on [[chronic]] autoimmune pancreatitis may assume a characteristic position in an attempt to relieve their [[abdominal pain]]. Patients with [[steatorrhea]] or advanced disease may present with loss of [[subcutaneous fat]], temporal wasting, sunken [[supraclavicular fossa]], and other physical signs of [[malnutrition]].


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 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].
Patients with [[acute]] on [[chronic]] autoimmune pancreatitis may assume a characteristic position in an attempt to relieve their [[abdominal pain]]:
* Lying on the left sid
* Flexing the [[spine]]
* Drawing the [[knees]] up toward the chest
Patients with [[steatorrhea]] or advanced disease may present with:
* Loss of [[subcutaneous fat]]
* Temporal wasting
* Sunken [[supraclavicular fossa]]
* Other physical signs of [[malnutrition]]


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


*High-grade / low-grade fever
*Vital signs usually within normal limits
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*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===
*[[Cyanosis]]
*[[Jaundice]]<ref name="pmid18222442">{{cite journal |vauthors=Ghazale A, Chari ST, Zhang L, Smyrk TC, Takahashi N, Levy MJ, Topazian MD, Clain JE, Pearson RK, Petersen BT, Vege SS, Lindor K, Farnell MB |title=Immunoglobulin G4-associated cholangitis: clinical profile and response to therapy |journal=Gastroenterology |volume=134 |issue=3 |pages=706–15 |year=2008 |pmid=18222442 |doi=10.1053/j.gastro.2007.12.009 |url=}}</ref><ref name="pmid17894845">{{cite journal |vauthors=Church NI, Pereira SP, Deheragoda MG, Sandanayake N, Amin Z, Lees WR, Gillams A, Rodriguez-Justo M, Novelli M, Seward EW, Hatfield AR, Webster GJ |title=Autoimmune pancreatitis: clinical and radiological features and objective response to steroid therapy in a UK series |journal=Am. J. Gastroenterol. |volume=102 |issue=11 |pages=2417–25 |year=2007 |pmid=17894845 |doi=10.1111/j.1572-0241.2007.01531.x |url=}}</ref><ref name="pmid15459324">{{cite journal |vauthors=Sahani DV, Kalva SP, Farrell J, Maher MM, Saini S, Mueller PR, Lauwers GY, Fernandez CD, Warshaw AL, Simeone JF |title=Autoimmune pancreatitis: imaging features |journal=Radiology |volume=233 |issue=2 |pages=345–52 |year=2004 |pmid=15459324 |doi=10.1148/radiol.2332031436 |url=}}</ref><ref name="pmid19345283">{{cite journal |vauthors=Sandanayake NS, Church NI, Chapman MH, Johnson GJ, Dhar DK, Amin Z, Deheragoda MG, Novelli M, Winstanley A, Rodriguez-Justo M, Hatfield AR, Pereira SP, Webster GJ |title=Presentation and management of post-treatment relapse in autoimmune pancreatitis/immunoglobulin G4-associated cholangitis |journal=Clin. Gastroenterol. Hepatol. |volume=7 |issue=10 |pages=1089–96 |year=2009 |pmid=19345283 |doi=10.1016/j.cgh.2009.03.021 |url=}}</ref>
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths=150px>
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>
 
===HEENT===
* 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 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]]
*[[Jugular venous distension]] absent
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Carotid bruits]] absent
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Lymphadenopathy]] not present
*[[Thyromegaly]] / thyroid nodules
*No [[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]
*[[Hepatojugular reflux]] absent


===Lungs===
===Lungs===
* Asymmetric chest expansion / Decreased chest expansion
*Vesicular breath sounds
*Lungs are hypo/hyperresonant
*[[Wheezing]] absent
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*[[Egophony]] absent
*Rhonchi
*[[Bronchophony]] absent
*Vesicular breath sounds / Distant breath sounds
*Normal [[tactile fremitus]]
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]


===Heart===
===Heart===
*Chest tenderness upon palpation
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]] normal and soft
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]] normal
*[[Heave]] / [[thrill]]
*No murmurs
*[[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 tenderness]] may be noticed in the epigastrium or left upper quadrant  
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant  
*A palpable abdominal mass in the epigastrium or left upper 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===
*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===
*[[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 14:22, 19 January 2018

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

Overview

Patients with acute on chronic autoimmune pancreatitis may assume a characteristic position in an attempt to relieve their abdominal pain. Patients with steatorrhea or advanced disease may present with loss of subcutaneous fat, temporal wasting, sunken supraclavicular fossa, and other physical signs of malnutrition.

Physical Examination

Appearance of the Patient

Patients with acute on chronic autoimmune pancreatitis may assume a characteristic position in an attempt to relieve their abdominal pain:

  • Lying on the left sid
  • Flexing the spine
  • Drawing the knees up toward the chest

Patients with steatorrhea or advanced disease may present with:

Vital Signs

  • Vital signs usually within normal limits

Skin

Neck

Lungs

Heart

  • S1 normal and soft
  • S2 normal
  • No murmurs

Abdomen

  • Abdominal tenderness may be noticed in the epigastrium or left upper quadrant
  • A palpable abdominal mass in the epigastrium or left upper quadrant

References

  1. ↑ Ghazale A, Chari ST, Zhang L, Smyrk TC, Takahashi N, Levy MJ, Topazian MD, Clain JE, Pearson RK, Petersen BT, Vege SS, Lindor K, Farnell MB (2008). "Immunoglobulin G4-associated cholangitis: clinical profile and response to therapy". Gastroenterology. 134 (3): 706–15. doi:10.1053/j.gastro.2007.12.009. PMID 18222442.
  2. ↑ Church NI, Pereira SP, Deheragoda MG, Sandanayake N, Amin Z, Lees WR, Gillams A, Rodriguez-Justo M, Novelli M, Seward EW, Hatfield AR, Webster GJ (2007). "Autoimmune pancreatitis: clinical and radiological features and objective response to steroid therapy in a UK series". Am. J. Gastroenterol. 102 (11): 2417–25. doi:10.1111/j.1572-0241.2007.01531.x. PMID 17894845.
  3. ↑ Sahani DV, Kalva SP, Farrell J, Maher MM, Saini S, Mueller PR, Lauwers GY, Fernandez CD, Warshaw AL, Simeone JF (2004). "Autoimmune pancreatitis: imaging features". Radiology. 233 (2): 345–52. doi:10.1148/radiol.2332031436. PMID 15459324.
  4. ↑ Sandanayake NS, Church NI, Chapman MH, Johnson GJ, Dhar DK, Amin Z, Deheragoda MG, Novelli M, Winstanley A, Rodriguez-Justo M, Hatfield AR, Pereira SP, Webster GJ (2009). "Presentation and management of post-treatment relapse in autoimmune pancreatitis/immunoglobulin G4-associated cholangitis". Clin. Gastroenterol. Hepatol. 7 (10): 1089–96. doi:10.1016/j.cgh.2009.03.021. PMID 19345283.

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