Gastrointestinal perforation physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{CMG}}; {{AE}} {{MAD}} | {{CMG}}; {{AE}} {{MAD}} | ||
{{Gastrointestinal perforation}} | {{Gastrointestinal perforation}} | ||
==Overview== | ==Overview== | ||
Patients may appear tired, weak, [[diaphoretic]] and [[anxious]] especially if sepsis developed. [[Tachycardia]] and rapid weak [[pulse]] may develop if [[sepsis]] developed. In esophageal perforation, asymmetric [[chest]] expansion/ decreased [[chest]] expansion may develop. [[Abdominal distention]], [[Abdominal tenderness|tenderness]], [[Abdominal guarding|guarding]] or mass may develop in [[intestinal perforation]]. Infants with spontaneous [[Gastrointestinal perforation|intestinal perforation]] present with an acute onset of [[abdominal distension]] and [[hypotension]]. [[Abdominal distension|Abdominal distention]] usually occurs without the abdominal wall [[erythema]], [[crepitus]], and [[induration]] commonly seen in patients with [[Necrotizing enterocolitis|necrotitzing enterocolitis]]. | |||
==Gastrointestinal perforation physical examination== | ==Gastrointestinal perforation physical examination== | ||
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=== Vital Signs === | === Vital Signs === | ||
* [[Tachycardia]] | * [[Tachycardia]] | ||
* Rapid weak [[pulse]] | * Rapid weak [[pulse]]<ref name="pmid29355160" /> | ||
* [[Hypotension]] occurs due to fluid contraction | * [[Hypotension]] occurs due to fluid contraction | ||
=== Skin === | === Skin === | ||
* [[Jaundice]] secondary to deranged [[liver]] function if sepsis developed. | * [[Jaundice]] secondary to deranged [[liver]] function if sepsis developed.<ref name="pmid29355160">{{cite journal| author=Bankole AO, Osinowo AO, Adesanya AA| title=Predictive factors of management outcome in adult patients with mechanical intestinal obstruction. | journal=Niger Postgrad Med J | year= 2017 | volume= 24 | issue= 4 | pages= 217-223 | pmid=29355160 | doi=10.4103/npmj.npmj_143_17 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29355160 }}</ref> | ||
=== Head === | === Head === | ||
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=== Lungs === | === Lungs === | ||
* Asymmetric [[chest]] expansion/ decreased [[chest]] expansion in esophageal perforation patients | * Asymmetric [[chest]] expansion/ decreased [[chest]] expansion in esophageal perforation patients<ref name="pmid29108538">{{cite journal| author=Neesgaard B, Sejling AS, Ostenfeld-Møller LA| title=[Upper abdominal pain caused by oesophageal perforation]. | journal=Ugeskr Laeger | year= 2017 | volume= 179 | issue= 45 | pages= | pmid=29108538 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29108538 }}</ref> | ||
=== Heart === | === Heart === | ||
* Chest [[tenderness]] in esophageal perforation patients | * Chest [[tenderness]] in esophageal perforation patients<ref name="pmid29108538" /> | ||
=== Abdomen === | === Abdomen === | ||
* [[Abdominal distention]] | * [[Abdominal distention]]<ref name="pmid29364805">{{cite journal| author=Devaraj NK| title=Letter to the Editor: Colonic Perforation. | journal=Acta Med Port | year= 2017 | volume= 30 | issue= 12 | pages= 891 | pmid=29364805 | doi=10.20344/amp.9556 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29364805 }}</ref> | ||
* [[Abdominal tenderness]] | * [[Abdominal tenderness]]<ref name="pmid28439845">{{cite journal| author=Rami Reddy SR, Cappell MS| title=A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction. | journal=Curr Gastroenterol Rep | year= 2017 | volume= 19 | issue= 6 | pages= 28 | pmid=28439845 | doi=10.1007/s11894-017-0566-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28439845 }}</ref> | ||
* A palpable [[abdominal mass]] in the lower [[abdominal]] quadrant especially with perforated [[colon]] | * A palpable [[abdominal mass]] in the lower [[abdominal]] quadrant especially with perforated [[colon]] | ||
* [[Abdominal guarding|Guarding]] may be present | * [[Abdominal guarding|Guarding]] may be present<ref name="pmid29364805" /> | ||
* [[Cutaneous]] [[fistula]] may be present | * [[Cutaneous]] [[fistula]] may be present<ref name="pmid28439845" /> | ||
=== Presentation in neonatal perforation: === | |||
* Infants with spontaneous [[Gastrointestinal perforation|intestinal perforation]] (SIP) present with an acute onset of [[abdominal distension]] and [[hypotension]].<ref name="pmid3397802">{{cite journal| author=Aschner JL, Deluga KS, Metlay LA, Emmens RW, Hendricks-Munoz KD| title=Spontaneous focal gastrointestinal perforation in very low birth weight infants. | journal=J Pediatr | year= 1988 | volume= 113 | issue= 2 | pages= 364-7 | pmid=3397802 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3397802 }}</ref> | |||
* [[Abdominal distension|Abdominal distention]] usually occurs without the abdominal wall [[erythema]], [[crepitus]], and [[induration]] commonly seen in patients with [[Necrotizing enterocolitis|necrotitzing enterocolitis]]. | |||
* A black-bluish discoloration of the abdominal wall is often seen in SIP, and is not typical of [[Necrotizing enterocolitis|necrotitzing enterocolitis]].<ref name="pmid16034475">{{cite journal| author=Adesanya OA, O'Shea TM, Turner CS, Amoroso RM, Morgan TM, Aschner JL| title=Intestinal perforation in very low birth weight infants: growth and neurodevelopment at 1 year of age. | journal=J Perinatol | year= 2005 | volume= 25 | issue= 9 | pages= 583-9 | pmid=16034475 | doi=10.1038/sj.jp.7211360 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16034475 }}</ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | |||
Latest revision as of 04:34, 4 February 2018
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
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Overview
Patients may appear tired, weak, diaphoretic and anxious especially if sepsis developed. Tachycardia and rapid weak pulse may develop if sepsis developed. In esophageal perforation, asymmetric chest expansion/ decreased chest expansion may develop. Abdominal distention, tenderness, guarding or mass may develop in intestinal perforation. Infants with spontaneous intestinal perforation present with an acute onset of abdominal distension and hypotension. Abdominal distention usually occurs without the abdominal wall erythema, crepitus, and induration commonly seen in patients with necrotitzing enterocolitis.
Gastrointestinal perforation physical examination
Appearance of the Patient
- Patients may appear tired, weak, diaphoretic and anxious especially if sepsis developed.
- Immunocompromised patients may appear quite well at first.
Vital Signs
- Tachycardia
- Rapid weak pulse[1]
- Hypotension occurs due to fluid contraction
Skin
Head
- Scleral icterus in case of liver failure
Lungs
Heart
- Chest tenderness in esophageal perforation patients[2]
Abdomen
- Abdominal distention[3]
- Abdominal tenderness[4]
- A palpable abdominal mass in the lower abdominal quadrant especially with perforated colon
- Guarding may be present[3]
- Cutaneous fistula may be present[4]
Presentation in neonatal perforation:
- Infants with spontaneous intestinal perforation (SIP) present with an acute onset of abdominal distension and hypotension.[5]
- Abdominal distention usually occurs without the abdominal wall erythema, crepitus, and induration commonly seen in patients with necrotitzing enterocolitis.
- A black-bluish discoloration of the abdominal wall is often seen in SIP, and is not typical of necrotitzing enterocolitis.[6]
References
- ↑ 1.0 1.1 Bankole AO, Osinowo AO, Adesanya AA (2017). "Predictive factors of management outcome in adult patients with mechanical intestinal obstruction". Niger Postgrad Med J. 24 (4): 217–223. doi:10.4103/npmj.npmj_143_17. PMID 29355160.
- ↑ 2.0 2.1 Neesgaard B, Sejling AS, Ostenfeld-Møller LA (2017). "[Upper abdominal pain caused by oesophageal perforation]". Ugeskr Laeger. 179 (45). PMID 29108538.
- ↑ 3.0 3.1 Devaraj NK (2017). "Letter to the Editor: Colonic Perforation". Acta Med Port. 30 (12): 891. doi:10.20344/amp.9556. PMID 29364805.
- ↑ 4.0 4.1 Rami Reddy SR, Cappell MS (2017). "A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction". Curr Gastroenterol Rep. 19 (6): 28. doi:10.1007/s11894-017-0566-9. PMID 28439845.
- ↑ Aschner JL, Deluga KS, Metlay LA, Emmens RW, Hendricks-Munoz KD (1988). "Spontaneous focal gastrointestinal perforation in very low birth weight infants". J Pediatr. 113 (2): 364–7. PMID 3397802.
- ↑ Adesanya OA, O'Shea TM, Turner CS, Amoroso RM, Morgan TM, Aschner JL (2005). "Intestinal perforation in very low birth weight infants: growth and neurodevelopment at 1 year of age". J Perinatol. 25 (9): 583–9. doi:10.1038/sj.jp.7211360. PMID 16034475.