Anal fissure physical examination: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
m (Bot: Removing from Primary care)
 
(26 intermediate revisions by 2 users not shown)
Line 3: Line 3:
{{CMG}}; {{AE}}{{ADS}}
{{CMG}}; {{AE}}{{ADS}}
==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 anal fissure usually appear in pain. Physical examination of patients with anal fissure is usually remarkable for painful skin laceration, skin tags in the chronic anal fissure. A tear is usually seen in the posterior part of anal canal (90)% and in anterior or middle part (10%). Patient usually resists use of anoscope due to the pain. Acute anal fissures appear as fresh laceration while chronic have raised margins.
 
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].


==Physical Examination==
==Physical Examination==
*Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
*Physical examination of patients with anal fissure is usually remarkable for painful skin laceration, skin tags in the chronic anal fissure.
*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 anal fissure usually appear in pain.


===Vital Signs===
===Vital Signs===
 
*[[Tachycardia]] with regular pulse (in pain).
*High-grade / low-grade fever
*[[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===
* Skin examination of patients with [disease name] is usually normal.
*Skin examination of patients with anal fissure:
OR
**Perianal skin can be inflamed.
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises


===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
* HEENT examination of patients with anal fissure 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 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===
* Neck examination of patients with [disease name] is usually normal.
* Neck examination of patients with anal fissure 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 examination of patients with anal fissure is usually normal.
OR
* 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===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
* Cardiovascular examination of patients with anal fissure 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 examination of patients with anal fissure is usually normal.
 


===Back===
===Back===
* Back examination of patients with [disease name] is usually normal.
* Back examination of patients with anal fissure is usually normal.
OR
===Genitourinary===
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===  
* Genitourinary examination of patients with anal fissure is usually normal.
===Local/anal examination===
{| align="right"
{| align="right"
|[[File:Anal fissure 2.jpg|thumb|250px|By Bernardo Gui - Own work, Public Domain<ref> https://commons.wikimedia.org/w/index.php?curid=8885756</ref>]]
|[[File:Anal fissure 2.jpg|thumb|250px|By Bernardo Gui - Own work, Public Domain<ref>https://commons.wikimedia.org/w/index.php?curid=8885756</ref>]]
|[[File:Anal fissure.jpg|thumb|250px|By Jonathanlund - Own work, Public Domain<ref> https://commons.wikimedia.org/w/index.php?curid=5148617</ref>]]
|[[File:Anal fissure.jpg|thumb|250px|By Jonathanlund - Own work, Public Domain<ref>https://commons.wikimedia.org/w/index.php?curid=5148617</ref>]]
|}
|}
* Genitourinary examination of patients with [disease name] is usually normal.
*The examination should be done when the patient is lying in the lateral position. The digital rectal examination is contraindicated in many patients considering the amount of pain.<ref name="pmid15812586">{{cite journal |vauthors=Jones OM, Ramalingam T, Lindsey I, Cunningham C, George BD, Mortensen NJ |title=Digital rectal examination of sphincter pressures in chronic anal fissure is unreliable |journal=Dis. Colon Rectum |volume=48 |issue=2 |pages=349–52 |year=2005 |pmid=15812586 |doi=10.1007/s10350-004-0753-2 |url=}}</ref>
OR
*[[Anoscopy]]/[[proctoscopy]] can be done with topical anesthesia with [[lidocaine]] gel to examine, and rule out internal [[hemorrhoids]].<ref name="pmid29132530">{{cite journal |vauthors=Davies D, Bailey J |title=Diagnosis and Management of Anorectal Disorders in the Primary Care Setting |journal=Prim. Care |volume=44 |issue=4 |pages=709–720 |year=2017 |pmid=29132530 |doi=10.1016/j.pop.2017.07.012 |url=}}</ref><ref name="pmid27041801">{{cite journal |vauthors=Schlichtemeier S, Engel A |title=Anal fissure |journal=Aust Prescr |volume=39 |issue=1 |pages=14–7 |year=2016 |pmid=27041801 |pmc=4816871 |doi=10.18773/austprescr.2016.007 |url=}}</ref>
*A pelvic/adnexal mass may be palpated
====Inspection====
*Inflamed mucosa
*On inspection, there is a breach in the skin. A laceration can be seen usually in the posterior midline in 90% of patients while in the remaining 10% of patients in the anterior midline.
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
*Acute anal fissures appear as fresh laceration while chronic have raised margins.<ref name="pmid27041801" />
*Chronic anal fissures may have a skin tag also.


===Local/anal examination===
====Palpation====
*Anal fissures are usually exquisitely [[Tenderness (medicine)|tender]] and the patient is scared to touch them or let physician examine.
*Palpation shows tear in the anoderm with exposed internal sphincter (with retraction of the [[buttocks]]).<ref>{{cite book | last = Bope | first = Edward | title = Conn's current therapy 2018 | publisher = Elsevier | location = Philadelphia | year = 2018 | isbn = 978-0323527699 }}</ref>


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


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
​
​
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}


[[Category:Needs content]]
[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Primary care]]
[[Category:Up-To-Date]]
 
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

Latest revision as of 20:24, 29 July 2020

Anal fissure Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Anal Fissure from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Abdominal X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Anal fissure physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Anal fissure physical examination

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Anal fissure physical examination

CDC on Anal fissure physical examination

Anal fissure physical examination in the news

Blogs on Anal fissure physical examination

Directions to Hospitals Treating Anal fissure

Risk calculators and risk factors for Anal fissure physical examination

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

Overview

Patients with anal fissure usually appear in pain. Physical examination of patients with anal fissure is usually remarkable for painful skin laceration, skin tags in the chronic anal fissure. A tear is usually seen in the posterior part of anal canal (90)% and in anterior or middle part (10%). Patient usually resists use of anoscope due to the pain. Acute anal fissures appear as fresh laceration while chronic have raised margins.

Physical Examination

  • Physical examination of patients with anal fissure is usually remarkable for painful skin laceration, skin tags in the chronic anal fissure.

Appearance of the patient

  • Patients with anal fissure usually appear in pain.

Vital Signs

Skin

  • Skin examination of patients with anal fissure:
    • Perianal skin can be inflamed.

HEENT

  • HEENT examination of patients with anal fissure is usually normal.

Neck

  • Neck examination of patients with anal fissure is usually normal.

Lungs

  • Pulmonary examination of patients with anal fissure is usually normal.

Heart

  • Cardiovascular examination of patients with anal fissure is usually normal.

Abdomen

  • Abdominal examination of patients with anal fissure is usually normal.

Back

  • Back examination of patients with anal fissure is usually normal.

Genitourinary

  • Genitourinary examination of patients with anal fissure is usually normal.

Local/anal examination

By Bernardo Gui - Own work, Public Domain[1]
By Jonathanlund - Own work, Public Domain[2]
  • The examination should be done when the patient is lying in the lateral position. The digital rectal examination is contraindicated in many patients considering the amount of pain.[3]
  • Anoscopy/proctoscopy can be done with topical anesthesia with lidocaine gel to examine, and rule out internal hemorrhoids.[4][5]

Inspection

  • On inspection, there is a breach in the skin. A laceration can be seen usually in the posterior midline in 90% of patients while in the remaining 10% of patients in the anterior midline.
  • Acute anal fissures appear as fresh laceration while chronic have raised margins.[5]
  • Chronic anal fissures may have a skin tag also.

Palpation

  • Anal fissures are usually exquisitely tender and the patient is scared to touch them or let physician examine.
  • Palpation shows tear in the anoderm with exposed internal sphincter (with retraction of the buttocks).[6]

Neuromuscular

  • Neuromuscular examination of patients with anal fissure is usually normal.

Extremities

  • Extremities examination of patients with anal fissure is usually normal.

References

  1. ↑ https://commons.wikimedia.org/w/index.php?curid=8885756
  2. ↑ https://commons.wikimedia.org/w/index.php?curid=5148617
  3. ↑ Jones OM, Ramalingam T, Lindsey I, Cunningham C, George BD, Mortensen NJ (2005). "Digital rectal examination of sphincter pressures in chronic anal fissure is unreliable". Dis. Colon Rectum. 48 (2): 349–52. doi:10.1007/s10350-004-0753-2. PMID 15812586.
  4. ↑ Davies D, Bailey J (2017). "Diagnosis and Management of Anorectal Disorders in the Primary Care Setting". Prim. Care. 44 (4): 709–720. doi:10.1016/j.pop.2017.07.012. PMID 29132530.
  5. ↑ 5.0 5.1 Schlichtemeier S, Engel A (2016). "Anal fissure". Aust Prescr. 39 (1): 14–7. doi:10.18773/austprescr.2016.007. PMC 4816871. PMID 27041801.
  6. ↑ Bope, Edward (2018). Conn's current therapy 2018. Philadelphia: Elsevier. ISBN 978-0323527699.

​ ​

Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Anal_fissure_physical_examination&oldid=1634655"