Mesenteric ischemia physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Physical examination of patients with [[Mesenteric ischemia|mesenteric]] ischemia can be normal in early stages or there may be mild [[Abdominal distension|abdominal]] | Physical examination of patients with [[Mesenteric ischemia|mesenteric]] ischemia can be normal in early stages or there may be mild [[Abdominal distension|abdominal]] [[distension]] in the absence of [[peritonitis]] which presents as [[rebound tenderness]] and [[Abdominal guarding|guarding]]. As the [[ischemia]] progresses to involve all the layers of the intestine (transmural [[infarction]]), abdomen becomes [[Abdominal distension|distended]], [[Peritoneum|peritoneal]] signs develop and [[bowel sounds]] become absent. A feculent odor of the breath may also be noticed. Signs of [[dehydration]] and [[shock]] may also appear if not treated in time. | ||
== Physical examination == | |||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*Patients presenting with acute occlusive mesenteric ischemia are in acute distress while patients with chronic mesenteric ischemia may look malnourished due to sitophobia (fear of eating). | *Patients presenting with acute occlusive mesenteric ischemia are in acute [[distress]] while patients with chronic mesenteric ischemia may look malnourished due to [[sitophobia]] (fear of eating). | ||
===Vital Signs=== | ===Vital Signs=== | ||
*[[Tachycardia]] with irregular pulse in case | The following findings are present if the patient presents in a state of [[shock]] or hemodyanamic instability:<ref name="CarverVora2016">{{cite journal|last1=Carver|first1=Thomas W.|last2=Vora|first2=Ravi S.|last3=Taneja|first3=Amit|title=Mesenteric Ischemia|journal=Critical Care Clinics|volume=32|issue=2|year=2016|pages=155–171|issn=07490704|doi=10.1016/j.ccc.2015.11.001}}</ref> | ||
*Tachypnea | *[[Tachycardia]] with irregular pulse in case o[[Atrial fibrillation|f atrial fibrillation]]. | ||
*[[Tachypnea]] | |||
===Skin=== | ===Skin=== | ||
* [[Pallor]] | * [[Pallor]] is present in patients presenting with shock. | ||
===Neck=== | ===Neck=== | ||
*[[Jugular venous distension]] in case of congestive heart failure | *[[Jugular venous distension]] in case of congestive heart failure. | ||
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell | *[[Carotid bruits]] may be auscultated unilaterally / bilaterally using the bell of the stethoscope in patients having [[atherosclerosis]]. | ||
===Heart=== | ===Heart=== | ||
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]] and [[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]] is loud if the patient presents in [[shock]]. | |||
*[[Heart sounds#Third heart sound S3|S3]] is present in case of [[Congestive heart failure|congestive]] heart failure. | |||
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]] | |||
*[[Heart sounds#Third heart sound S3|S3]] | |||
===Abdomen=== | ===Abdomen=== | ||
Abdominal examination shows the following findings in later stages of ischemia when transmural infarction has occured:<ref name="CudnikDarbha2013">{{cite journal|last1=Cudnik|first1=Michael T.|last2=Darbha|first2=Subrahmanyam|last3=Jones|first3=Janice|last4=Macedo|first4=Julian|last5=Stockton|first5=Sherrill W.|last6=Hiestand|first6=Brian C.|last7=Jones|first7=Alan E.|title=The Diagnosis of Acute Mesenteric Ischemia: A Systematic Review and Meta-analysis|journal=Academic Emergency Medicine|volume=20|issue=11|year=2013|pages=1087–1100|issn=10696563|doi=10.1111/acem.12254}}</ref> | |||
*[[Abdominal distention]] | *[[Abdominal distention]] | ||
*[[Abdominal tenderness]] | *Generalized [[Abdominal tenderness]] | ||
*[[Rebound tenderness]] | *[[Rebound tenderness]] | ||
*[[Abdominal guarding|Guarding]] may be present | |||
*[[ | |||
===Extremities=== | ===Extremities=== | ||
*[[Cyanosis]] | *[[Cyanosis]] can be present in later stage of [[shock]]. | ||
==References== | ==References== | ||
Latest revision as of 20:08, 19 January 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Feham Tariq, MD [2]
Overview
Physical examination of patients with mesenteric ischemia can be normal in early stages or there may be mild abdominal distension in the absence of peritonitis which presents as rebound tenderness and guarding. As the ischemia progresses to involve all the layers of the intestine (transmural infarction), abdomen becomes distended, peritoneal signs develop and bowel sounds become absent. A feculent odor of the breath may also be noticed. Signs of dehydration and shock may also appear if not treated in time.
Physical examination
Appearance of the Patient
- Patients presenting with acute occlusive mesenteric ischemia are in acute distress while patients with chronic mesenteric ischemia may look malnourished due to sitophobia (fear of eating).
Vital Signs
The following findings are present if the patient presents in a state of shock or hemodyanamic instability:[1]
- Tachycardia with irregular pulse in case of atrial fibrillation.
- Tachypnea
Skin
- Pallor is present in patients presenting with shock.
Neck
- Jugular venous distension in case of congestive heart failure.
- Carotid bruits may be auscultated unilaterally / bilaterally using the bell of the stethoscope in patients having atherosclerosis.
Heart
- S1 and S2 is loud if the patient presents in shock.
- S3 is present in case of congestive heart failure.
Abdomen
Abdominal examination shows the following findings in later stages of ischemia when transmural infarction has occured:[2]
- Abdominal distention
- Generalized Abdominal tenderness
- Rebound tenderness
- Guarding may be present
Extremities
References
- ↑ Carver, Thomas W.; Vora, Ravi S.; Taneja, Amit (2016). "Mesenteric Ischemia". Critical Care Clinics. 32 (2): 155–171. doi:10.1016/j.ccc.2015.11.001. ISSN 0749-0704.
- ↑ Cudnik, Michael T.; Darbha, Subrahmanyam; Jones, Janice; Macedo, Julian; Stockton, Sherrill W.; Hiestand, Brian C.; Jones, Alan E. (2013). "The Diagnosis of Acute Mesenteric Ischemia: A Systematic Review and Meta-analysis". Academic Emergency Medicine. 20 (11): 1087–1100. doi:10.1111/acem.12254. ISSN 1069-6563.