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| __NOTOC__ | | __NOTOC__ |
| {{Anal fistula}} | | {{Anal fistula}} |
| {{CMG}} {{AE}} {{MKK}} | | {{CMG}}, {{AE}}{{MKK}} |
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| ==Overview==
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| ==Physical examination==
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| ''Diagnosis'' is by examination, either in an [[outpatient]] setting or under [[anaesthesia]] (referred to as EUA - Examination Under Anaesthesia). The examination can be an [[anoscopy]].
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| Possible findings:
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| ==Overview== | | ==Overview== |
| Patients with anal fistula usually appear in distress due to rectal pain. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3]. | | Patients with anal fistula usually appear in [[distress]] due to throbbing [[rectal pain]]. Patient presents with anal fistula is having normal vital signs but if [[anal fistula]] gets [[infected]], it will lead to the formation of an [[abscess]]. Patient with an [[abscess]] presents with unstable vitals like high-grade [[fever]], [[Tachycardia]], [[Tachypnea]], low [[Blood pressure|blood pressure]]. On rectal examination, there is redness, tenderness and discharge is seen. |
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| OR
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| Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
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| OR
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| The presence of [finding(s)] on physical examination is diagnostic of [disease name].
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| OR
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| The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
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| ==Physical Examination==
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| * Physical examination of patients with [disease name] is usually normal.
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| OR
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| *Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
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| *The presence of [finding(s)] on physical examination is diagnostic of [disease name].
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| *The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
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| ===Appearance of the Patient=== | | ===Appearance of the Patient=== |
| *Patients with anal fistula usually appear in distress due to throbbing rectal pain. | | *Patients with anal fistula usually appear in [[distress]] due to throbbing [[rectal pain]]. |
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| ===Vital Signs=== | | ===Vital Signs=== |
| | Patient presents with anal fistula is having normal vital signs but if [[anal fistula]] gets [[infected]], it will lead to the formation of an [[abscess]]. Patient with an [[abscess]] presents with unstable vitals: |
| | *High-grade [[fever]] |
| | *[[Tachycardia]] with regular [[pulse]] |
| | *[[Tachypnea]] |
| | *Low [[Blood pressure|blood pressure]]<nowiki/>e with normal [[pulse pressure]] |
| | ==Rectal Exam== |
| | *Patient with [[anal fistula]] usually have throbbing [[rectal pain]]. The examination is usually done under [[sedation]].<ref name="urlwww.fascrs.org">{{cite web |url=https://www.fascrs.org/sites/default/files/downloads/publication/clinical_practice_guideline_for_the_management_of_anorectal_abscess_fistula-in-ano_and_rectovaginal_fistula.pdf |title=www.fascrs.org |format= |work= |accessdate=}}</ref><ref name="pmid27824697">{{cite journal |vauthors=Vogel JD, Johnson EK, Morris AM, Paquette IM, Saclarides TJ, Feingold DL, Steele SR |title=Clinical Practice Guideline for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula |journal=Dis. Colon Rectum |volume=59 |issue=12 |pages=1117–1133 |year=2016 |pmid=27824697 |doi=10.1097/DCR.0000000000000733 |url=}}</ref> |
| | *On [[Inspection (medicine)|inspection]] perianal skin is [[red]] and excoriated. |
| | *On [[palpation]], there is [[tenderness]] and fluctuation due to [[abscess]]. |
| | **The external opening can be palpated if it is just beneath the [[skin]]. |
| | **The external opening is felt like a [[cord]] and [[discharge]] is seen. |
| | *Bidigital [[rectal]] examination is usually done under the local [[anesthesia]] due to severe [[pain]]. |
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| *High-grade / low-grade fever
| | ==Lymph Node Examnination== |
| *[[Hypothermia]] / hyperthermia may be present
| | On palpation, [[Inguinal lymph node|inguinal lymph nodes]] are usually enlarged. |
| *[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
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| *[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
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| *Tachypnea / bradypnea
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| *Kussmal respirations may be present in _____ (advanced disease state)
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| *Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
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| *High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]
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| ===Skin===
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| * Skin examination of patients with [disease name] is usually normal.
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| OR
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| *[[Cyanosis]]
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| *[[Jaundice]]
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| * [[Pallor]]
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| * Bruises
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| <gallery widths="150px">
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| UploadedImage-01.jpg | Description {{dermref}}
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| UploadedImage-02.jpg | Description {{dermref}}
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| </gallery>
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| ===HEENT===
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| * HEENT examination of patients with [disease name] is usually normal.
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| OR
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| * Abnormalities of the head/hair may include ___
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| * Evidence of trauma
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| * Icteric sclera
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| * [[Nystagmus]]
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| * Extra-ocular movements may be abnormal
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| *Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
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| *Ophthalmoscopic exam may be abnormal with findings of ___
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| * Hearing acuity may be reduced
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| *[[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".)
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| *[[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".)
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| * [[Exudate]] from the ear canal
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| * Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
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| *Inflamed nares / congested nares
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| * [[Purulent]] exudate from the nares
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| * Facial tenderness
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| * Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
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| ===Neck===
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| * Neck examination of patients with [disease name] is usually normal.
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| OR
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| *[[Jugular venous distension]]
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| *[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
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| *[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
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| *[[Thyromegaly]] / thyroid nodules
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| *[[Hepatojugular reflux]]
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| ===Lungs===
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| * Pulmonary examination of patients with [disease name] is usually normal.
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| OR
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| * Asymmetric chest expansion / Decreased chest expansion
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| *Lungs are hypo/hyperresonant
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| *Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
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| *Rhonchi
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| *Vesicular breath sounds / Distant breath sounds
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| *Expiratory/inspiratory wheezing with normal / delayed expiratory phase
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| *[[Wheezing]] may be present
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| *[[Egophony]] present/absent
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| *[[Bronchophony]] present/absent
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| *Normal/reduced [[tactile fremitus]]
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| ===Heart===
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| * Cardiovascular examination of patients with [disease name] is usually normal.
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| OR
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| *Chest tenderness upon palpation
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| *PMI within 2 cm of the sternum (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
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| *[[Heave]] / [[thrill]]
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| *[[Friction rub]]
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| *[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
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| *[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
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| *[[Heart sounds#Third heart sound S3|S3]]
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| *[[Heart sounds#Fourth heart sound S4|S4]]
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| *[[Heart sounds#Summation Gallop|Gallops]]
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| *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
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| ===Abdomen===
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| Abdominal examination of patients with [disease name] is usually normal.
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| OR
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| *[[Abdominal distention]]
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| *[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
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| *[[Rebound tenderness]] (positive Blumberg sign)
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| *A palpable abdominal mass in the right/left upper/lower abdominal quadrant
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| *Guarding may be present
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| *[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
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| *Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
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| ===Back===
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| * Back examination of patients with [disease name] is usually normal.
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| OR
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| *Point tenderness over __ vertebrae (e.g. L3-L4)
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| *Sacral edema
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| *Costovertebral angle tenderness bilaterally/unilaterally
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| *Buffalo hump
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| ===Genitourinary===
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| * Genitourinary examination of patients with [disease name] is usually normal.
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| OR
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| *A pelvic/adnexal mass may be palpated
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| *Inflamed mucosa
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| *Clear/(color), foul-smelling/odorless penile/vaginal discharge
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| ===Neuromuscular===
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| * Neuromuscular examination of patients with [disease name] is usually normal.
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| OR
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| *Patient is usually oriented to persons, place, and time
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| * Altered mental status
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| * Glasgow coma scale is ___ / 15
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| * Clonus may be present
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| * Hyperreflexia / hyporeflexia / areflexia
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| * Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
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| * Muscle rigidity
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| * Proximal/distal muscle weakness unilaterally/bilaterally
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| * ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
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| *Unilateral/bilateral upper/lower extremity weakness
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| *Unilateral/bilateral sensory loss in the upper/lower extremity
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| *Positive straight leg raise test
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| *Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
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| *Positive/negative Trendelenburg sign
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| *Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
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| *Normal finger-to-nose test / Dysmetria
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| *Absent/present dysdiadochokinesia (palm tapping test)
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| ===Extremities===
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| * Extremities examination of patients with [disease name] is usually normal.
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| OR
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| *[[Clubbing]]
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| *[[Cyanosis]]
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| *Pitting/non-pitting [[edema]] of the upper/lower extremities
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| *Muscle atrophy
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| *Fasciculations in the upper/lower extremity
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| *The opening of the fistula onto the skin may be seen
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| *The area may be painful on examination
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| *There may be redness
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| *An area of [[induration]] may be felt - thickening due to chronic infection
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| *A discharge may be seen
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| *It may be possible to explore the fistula using a fistula probe (a narrow instrument) and in this way it may be possible to find both openings of the fistula
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| ==References== | | ==References== |