Short bowel syndrome physical examination: Difference between revisions

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{{Short bowel syndrome}}
{{Short bowel syndrome}}


{{CMG}}; {{AE}} {{SSH}]
{{CMG}}; {{AE}} {{SSH}}


==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 short bowel syndrome usually appear weak and tired. [[Physical examination]] of patients with short bowel syndrome is usually remarkable for signs of [[malabsorption]], [[dehydration]] and [[Tenderness (medicine)|abdominal tenderness]].  
 
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 short bowel syndrome is usually remarkable for [[weakness]], [[dehydration]] and [[abdominal tenderness]] and [[Abdominal distention|distention]].<ref name="RodriguesSeetharam2011">{{cite journal|last1=Rodrigues|first1=Gabriel|last2=Seetharam|first2=Prasad|title=Short bowel syndrome: A review of management options|journal=Saudi Journal of Gastroenterology|volume=17|issue=4|year=2011|pages=229|issn=1319-3767|doi=10.4103/1319-3767.82573}}</ref><ref name="Wall2013">{{cite journal|last1=Wall|first1=Elizabeth A.|title=An Overview of Short Bowel Syndrome Management: Adherence, Adaptation, and Practical Recommendations|journal=Journal of the Academy of Nutrition and Dietetics|volume=113|issue=9|year=2013|pages=1200–1208|issn=22122672|doi=10.1016/j.jand.2013.05.001}}</ref><ref name="EçaBarbosa2016">{{cite journal|last1=Eça|first1=Rosário|last2=Barbosa|first2=Elisabete|title=Short bowel syndrome: treatment options|journal=Journal of Coloproctology|volume=36|issue=4|year=2016|pages=262–272|issn=22379363|doi=10.1016/j.jcol.2016.07.002}}</ref><ref name="pmid17198059">{{cite journal |vauthors=Misiakos EP, Macheras A, Kapetanakis T, Liakakos T |title=Short bowel syndrome: current medical and surgical trends |journal=J. Clin. Gastroenterol. |volume=41 |issue=1 |pages=5–18 |year=2007 |pmid=17198059 |doi=10.1097/01.mcg.0000212617.74337.e9 |url=}}</ref><ref name="pmid16207689">{{cite journal |vauthors=Matarese LE, O'Keefe SJ, Kandil HM, Bond G, Costa G, Abu-Elmagd K |title=Short bowel syndrome: clinical guidelines for nutrition management |journal=Nutr Clin Pract |volume=20 |issue=5 |pages=493–502 |year=2005 |pmid=16207689 |doi=10.1177/0115426505020005493 |url=}}</ref><ref name="pmid15233682">{{cite journal |vauthors=DiBaise JK, Young RJ, Vanderhoof JA |title=Intestinal rehabilitation and the short bowel syndrome: part 1 |journal=Am. J. Gastroenterol. |volume=99 |issue=7 |pages=1386–95 |year=2004 |pmid=15233682 |doi=10.1111/j.1572-0241.2004.30345.x |url=}}</ref><ref name="pmid24247092">{{cite journal |vauthors=Kelly DG, Tappenden KA, Winkler MF |title=Short bowel syndrome: highlights of patient management, quality of life, and survival |journal=JPEN J Parenter Enteral Nutr |volume=38 |issue=4 |pages=427–37 |year=2014 |pmid=24247092 |doi=10.1177/0148607113512678 |url=}}</ref>


*Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
===Appearance of the patient===
*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===
*Patients with short bowel syndrome usually appear weak and tired.  
*Patients with short bowel syndrome usually appear weak and tired.  


===Vital Signs===
===Vital signs===
*High-grade / low-grade [[fever]]
*Low-grade [[fever]]
*[[Hypothermia]] may be present
*[[Hypothermia]] may be present
*[[Tachycardia]] with regular pulse
*[[Tachycardia]] with regular pulse
*[[Weak pulse]]
*Weak [[pulse]]
*Low blood pressure with normal pulse pressure
*[[Hypotension|Low blood pressure]] with normal [[pulse pressure]]


===Skin===
===Skin===
* [[Pallor]]
* [[Pallor]]
* Dry skin
* [[Xeroderma|Dry skin]]


===HEENT===
===HEENT===
* Abnormalities of the head/hair may include ___
* [[Temporal]] wasting
* Evidence of trauma
* [[Corneal erosion]]
* 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===
*[[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===
* 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
*Hyperactive [[bowel sound]]
*[[Rebound tenderness]] (positive Blumberg sign)
*[[Abdominal tenderness]]  
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive [[Blumberg sign]])
*Guarding may be present
*[[Abdominal guarding|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===
===Neuromuscular===
*Patient is usually oriented to persons, place, and time
*Patient is usually oriented to person, place, and time
* Altered mental status
* [[Confusion]]
* Glasgow coma scale is ___ / 15
* [[Hyporeflexia]]
* Clonus may be present
* [[Peripheral neuropathy]]
* Hyperreflexia / hyporeflexia / areflexia
*Bilateral extremity [[Muscle weakness|weakness]]
* 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]]  
*[[Peripheral edema]]
*[[Cyanosis]]  
*[[Muscle atrophy|Muscular atrophy]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
​


{{WH}}
[[Category:Medicine]]
{{WS}}
[[Category:Gastroenterology]]
[[Category:Surgery]]
[[Category:Up-To-Date]]

Latest revision as of 00:10, 30 July 2020

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

Overview

Patients with short bowel syndrome usually appear weak and tired. Physical examination of patients with short bowel syndrome is usually remarkable for signs of malabsorption, dehydration and abdominal tenderness.

Physical Examination

Physical examination of patients with short bowel syndrome is usually remarkable for weakness, dehydration and abdominal tenderness and distention.[1][2][3][4][5][6][7]

Appearance of the patient

  • Patients with short bowel syndrome usually appear weak and tired.

Vital signs

Skin

HEENT

Abdomen

Neuromuscular

Extremities

References

  1. ↑ Rodrigues, Gabriel; Seetharam, Prasad (2011). "Short bowel syndrome: A review of management options". Saudi Journal of Gastroenterology. 17 (4): 229. doi:10.4103/1319-3767.82573. ISSN 1319-3767.
  2. ↑ Wall, Elizabeth A. (2013). "An Overview of Short Bowel Syndrome Management: Adherence, Adaptation, and Practical Recommendations". Journal of the Academy of Nutrition and Dietetics. 113 (9): 1200–1208. doi:10.1016/j.jand.2013.05.001. ISSN 2212-2672.
  3. ↑ Eça, Rosário; Barbosa, Elisabete (2016). "Short bowel syndrome: treatment options". Journal of Coloproctology. 36 (4): 262–272. doi:10.1016/j.jcol.2016.07.002. ISSN 2237-9363.
  4. ↑ Misiakos EP, Macheras A, Kapetanakis T, Liakakos T (2007). "Short bowel syndrome: current medical and surgical trends". J. Clin. Gastroenterol. 41 (1): 5–18. doi:10.1097/01.mcg.0000212617.74337.e9. PMID 17198059.
  5. ↑ Matarese LE, O'Keefe SJ, Kandil HM, Bond G, Costa G, Abu-Elmagd K (2005). "Short bowel syndrome: clinical guidelines for nutrition management". Nutr Clin Pract. 20 (5): 493–502. doi:10.1177/0115426505020005493. PMID 16207689.
  6. ↑ DiBaise JK, Young RJ, Vanderhoof JA (2004). "Intestinal rehabilitation and the short bowel syndrome: part 1". Am. J. Gastroenterol. 99 (7): 1386–95. doi:10.1111/j.1572-0241.2004.30345.x. PMID 15233682.
  7. ↑ Kelly DG, Tappenden KA, Winkler MF (2014). "Short bowel syndrome: highlights of patient management, quality of life, and survival". JPEN J Parenter Enteral Nutr. 38 (4): 427–37. doi:10.1177/0148607113512678. PMID 24247092.

​

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