Linitis plastica physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Linitis plastica}} | {{Linitis plastica}} | ||
{{CMG}};{{AE}}{{HM}} | {{CMG}}; {{AE}}{{HM}} | ||
==Overview== | ==Overview== | ||
Patients with linitis plastica in the early stages may appear to be normal. When metastasis | Patients with linitis plastica in the early stages may appear to be normal. When [[metastasis]] occurs, the patient usually appears fatigued and [[Cachexia|cachexic]]. Physical examination of patients with linitis plastica and [[metastasis]] may be remarkable for [[lymphadenopathy]], [[weight loss]], and signs of [[ascites]]. | ||
==Physical Examination== | ==Physical Examination== | ||
Physical examination of patients with metastatic linitis plastica is usually remarkable for: | Physical examination of patients with [[Metastasis|metastatic]] linitis plastica is usually remarkable for: [[lymphadenopathy]], [[ascites]], and [[organomegaly]].<ref name="pmid8239772">{{cite journal |vauthors=Wanebo HJ, Kennedy BJ, Chmiel J, Steele G, Winchester D, Osteen R |title=Cancer of the stomach. A patient care study by the American College of Surgeons |journal=Ann. Surg. |volume=218 |issue=5 |pages=583–92 |year=1993 |pmid=8239772 |pmc=1243028 |doi= |url=}}</ref><ref name="pmid7776992">{{cite journal |vauthors=Fuchs CS, Mayer RJ |title=Gastric carcinoma |journal=N. Engl. J. Med. |volume=333 |issue=1 |pages=32–41 |year=1995 |pmid=7776992 |doi=10.1056/NEJM199507063330107 |url=}}</ref><ref name="pmid7776992">{{cite journal |vauthors=Fuchs CS, Mayer RJ |title=Gastric carcinoma |journal=N. Engl. J. Med. |volume=333 |issue=1 |pages=32–41 |year=1995 |pmid=7776992 |doi=10.1056/NEJM199507063330107 |url=}}</ref><ref name="pmid7776992">{{cite journal |vauthors=Fuchs CS, Mayer RJ |title=Gastric carcinoma |journal=N. Engl. J. Med. |volume=333 |issue=1 |pages=32–41 |year=1995 |pmid=7776992 |doi=10.1056/NEJM199507063330107 |url=}}</ref> | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
Patients with linitis plastica in the early stages may appear to be normal. When metastasis occurs, the patient usually appears fatigued and cachexic. | Patients with linitis plastica in the early stages may appear to be normal. When metastasis occurs, the patient usually appears fatigued and [[Cachexia|cachexic]]. | ||
===Vital Signs=== | ===Vital Signs=== | ||
Low-grade fever | * Low-grade [[fever]] | ||
===Skin=== | ===Skin=== | ||
*[[Jaundice]] is present with liver metastasis. | *[[Jaundice]] is present with liver metastasis. | ||
*Diffuse seborrheic keratoses (sign of Leser-Trélat) | *Diffuse [[seborrheic keratoses]] (sign of Leser-Trélat) | ||
*Acanthosis nigricans | *[[Acanthosis nigricans]] | ||
[[Image:lt.jpg|thumb|center|500px|Diffuse seborrheic keratoses (sign of Leser-Trélat) is shown. By James Heilman, MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=24076793]] | [[Image:lt.jpg|thumb|center|500px|Diffuse seborrheic keratoses (sign of Leser-Trélat) is shown. By James Heilman, MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=24076793]] | ||
===HEENT=== | ===HEENT=== | ||
Icteric sclera with liver metastasis | * [[Icterus (medicine)|Icteric sclera]] with liver [[metastasis]] | ||
===Neck=== | ===Neck=== | ||
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===Genitourinary=== | ===Genitourinary=== | ||
*A pelvic/adnexal mass may be palpated: | *A pelvic/adnexal mass may be palpated: | ||
**Krukenberg's tumor (peritoneal spread results in an enlarged ovary) | **[[Krukenberg tumor|Krukenberg's tumor]] ([[Peritoneum|peritoneal]] spread results in an enlarged ovary) | ||
**Blumer's shelf (mass in the cul-de-sac on per rectal exam) | **Blumer's shelf (mass in the cul-de-sac on per rectal exam) | ||
| Line 53: | Line 51: | ||
*Pitting/non-pitting [[edema]] of the upper/lower extremities | *Pitting/non-pitting [[edema]] of the upper/lower extremities | ||
*Irish node (left axillary node) | *Irish node (left axillary node) | ||
==References== | ==References== | ||
Latest revision as of 13:48, 18 January 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
Patients with linitis plastica in the early stages may appear to be normal. When metastasis occurs, the patient usually appears fatigued and cachexic. Physical examination of patients with linitis plastica and metastasis may be remarkable for lymphadenopathy, weight loss, and signs of ascites.
Physical Examination
Physical examination of patients with metastatic linitis plastica is usually remarkable for: lymphadenopathy, ascites, and organomegaly.[1][2][2][2]
Appearance of the Patient
Patients with linitis plastica in the early stages may appear to be normal. When metastasis occurs, the patient usually appears fatigued and cachexic.
Vital Signs
- Low-grade fever
Skin
- Jaundice is present with liver metastasis.
- Diffuse seborrheic keratoses (sign of Leser-Trélat)
- Acanthosis nigricans
HEENT
- Icteric sclera with liver metastasis
Neck
- Lymphadenopathy may be noted in several regions, in the neck region there may be:
- Virchow's node (left supraclavicular lymph node)
Lungs
- Massive ascites leads to:
- Decreased chest expansion
- Fine crackles upon auscultation of the lung bases bilaterally
Abdomen
- Abdominal distention
- Abdominal tenderness in the left upper quadrant and flanks.
- Sister Mary Joseph nodule (palpable nodule bulging into the umbilicus)
Signs of ascites:
- Hepatomegaly / splenomegaly / hepatosplenomegaly
- Flank fullness
- Shifting dullness (difference in percussion note in the flanks that shifts when the patient is turned on the side)
- If the ascites is massive, a fluid thrill or fluid wave may be present.
Genitourinary
- A pelvic/adnexal mass may be palpated:
- Krukenberg's tumor (peritoneal spread results in an enlarged ovary)
- Blumer's shelf (mass in the cul-de-sac on per rectal exam)
Extremities
- Pitting/non-pitting edema of the upper/lower extremities
- Irish node (left axillary node)
References
- ↑ Wanebo HJ, Kennedy BJ, Chmiel J, Steele G, Winchester D, Osteen R (1993). "Cancer of the stomach. A patient care study by the American College of Surgeons". Ann. Surg. 218 (5): 583–92. PMC 1243028. PMID 8239772.
- ↑ 2.0 2.1 2.2 Fuchs CS, Mayer RJ (1995). "Gastric carcinoma". N. Engl. J. Med. 333 (1): 32–41. doi:10.1056/NEJM199507063330107. PMID 7776992.