Sialolithiasis physical examination: Difference between revisions

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{{Sialolithiasis}}


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==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 sialolithiasis usually appear normal. Physical examination of patients with [[sialolithiasis]] is usually remarkable for [[tenderness]] of the involved gland, palpable hard [[lump]] and [[pus]] discharging from the duct in cases of acute bacterial [[sialadenitis]].
 
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].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


==Physical Examination==
==Physical Examination==
* Physical examination of patients with [disease name] is usually normal.
Physical examination of patients with sialolithiasis is usually remarkable for: [[tenderness]] of the involved gland, [[palpable]] hard [[lump]] and pus discharging from the duct in cases of acute bacterial [[sialadenitis]].
OR
*Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
*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 sialolithiasis usually appear normal.
{| align="right"
|[[image:Swelling of the submandibular gland.jpeg|thumb|300px|Swelling of the submandibular gland, By James Heilman, MD- via wikimediaCommons<ref><"//commons.wikimedia.org/wiki/User:Jmh649" class="mw-redirect" title="User:Jmh649">, <"https://creativecommons.org/licenses/by-sa/3.0" title="Creative Commons Attribution-Share Alike 3.0">CC BY-SA 3.0, <"https://commons.wikimedia.org/w/index.php?curid=24076831"></ref>]]
|- |
|[[image:Salivary stone in submandibular salivary duct.jpg|thumb|300px|Salivary stone in submandibular salivary duct, By James Heilman, MD- via wikimediaCommons<ref><"//commons.wikimedia.org/wiki/User:Jmh649" class="mw-redirect" title="User:Jmh649"><"https://creativecommons.org/licenses/by-sa/3.0" title="Creative Commons Attribution-Share Alike 3.0">CC BY-SA 3.0, <"https://commons.wikimedia.org/w/index.php?curid=24076829"></ref>]]
|}


===Vital Signs===
===Vital Signs===
 
* Vital signs are usually normal but low grade fever may be seen in sialadenititis as a complication of sialolithiasis.<ref name="pmid3318353">{{cite journal |vauthors=McKenna JP, Bostock DJ, McMenamin PG |title=Sialolithiasis |journal=Am Fam Physician |volume=36 |issue=5 |pages=119–25 |year=1987 |pmid=3318353 |doi= |url=}}</ref>
*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 sialolithiasis is usually normal.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises


<gallery widths="150px">
===HEENT===
 
Normal [[salivary gland]] is spongy.
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
In sialolithiasis:<ref name=":0">{{cite book | last = Hupp | first = James | title = Contemporary oral and maxillofacial surgery | publisher = Mosby Elsevier | location = St. Louis, Mo | year = 2008 | isbn = 9780323049030 }}</ref><ref>{{cite book | last = Neville | first = Brad | title = Oral & maxillofacial pathology | publisher = W.B. Saunders | location = Philadelphia | year = 2002 | isbn = 0721690033 }}</ref>
* HEENT examination of patients with [disease name] is usually normal.
* [[Tenderness]] of the involved gland.
OR
* [[Palpable]] hard lump near the end of the involved duct or under the tongue in submandibular duct stone.
* Abnormalities of the head/hair may include ___
** Stones, sometimes may be felt smooth or irregular.
* Evidence of trauma
* In total obstruction, no saliva is coming from the duct.
* Icteric sclera
* [[Erythema]] of the floor of the mouth in sialadenitis as a complication of sialolithiasis.
* [[Nystagmus]]  
* [[Pus]] discharging from the duct in cases of infection of salivary gland ( acute bacterial sialadenitis).
* Extra-ocular movements may be abnormal
* Stone in the minor salivary glands can be felt as a small [[Nodule (medicine)|nodule]].
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
* Stones are typically rock hard and small; they may be smooth or irregular. They are most commonly felt within the ductal system.
*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.
* Cervical [[lymphadenopathy]] in the cases of infection
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 sialolithiasis 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 sialolithiasis 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 sialolithiasis is usually normal.
 
OR
*[[Abdominal distention]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


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


===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
* Genitourinary examination of patients with sialolithiasis is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
* Neuromuscular examination of patients with sialolithiasis  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===
* Extremities examination of patients with [disease name] is usually normal.
* Extremities examination of patients with sialolithiasis is usually normal.
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}}
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[[Category:Medicine]]
[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date]]
[[Category:Primary care]]

Latest revision as of 00:10, 30 July 2020

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

Overview

Patients with sialolithiasis usually appear normal. Physical examination of patients with sialolithiasis is usually remarkable for tenderness of the involved gland, palpable hard lump and pus discharging from the duct in cases of acute bacterial sialadenitis.

Physical Examination

Physical examination of patients with sialolithiasis is usually remarkable for: tenderness of the involved gland, palpable hard lump and pus discharging from the duct in cases of acute bacterial sialadenitis.

Appearance of the Patient

  • Patients with sialolithiasis usually appear normal.
Swelling of the submandibular gland, By James Heilman, MD- via wikimediaCommons[1]
Salivary stone in submandibular salivary duct, By James Heilman, MD- via wikimediaCommons[2]

Vital Signs

  • Vital signs are usually normal but low grade fever may be seen in sialadenititis as a complication of sialolithiasis.[3]

Skin

  • Skin examination of patients with sialolithiasis is usually normal.

HEENT

Normal salivary gland is spongy.

In sialolithiasis:[4][5]

  • Tenderness of the involved gland.
  • Palpable hard lump near the end of the involved duct or under the tongue in submandibular duct stone.
    • Stones, sometimes may be felt smooth or irregular.
  • In total obstruction, no saliva is coming from the duct.
  • Erythema of the floor of the mouth in sialadenitis as a complication of sialolithiasis.
  • Pus discharging from the duct in cases of infection of salivary gland ( acute bacterial sialadenitis).
  • Stone in the minor salivary glands can be felt as a small nodule.
  • Stones are typically rock hard and small; they may be smooth or irregular. They are most commonly felt within the ductal system.

Neck

Lungs

  • Pulmonary examination of patients with sialolithiasis is usually normal.

Heart

  • Cardiovascular examination of patients with sialolithiasis is usually normal.

Abdomen

Abdominal examination of patients with sialolithiasis is usually normal.

Back

  • Back examination of patients with sialolithiasis is usually normal.

Genitourinary

  • Genitourinary examination of patients with sialolithiasis is usually normal.

Neuromuscular

  • Neuromuscular examination of patients with sialolithiasis is usually normal.

Extremities

  • Extremities examination of patients with sialolithiasis is usually normal.

References

  1. ↑ <"//commons.wikimedia.org/wiki/User:Jmh649" class="mw-redirect" title="User:Jmh649">, <"https://creativecommons.org/licenses/by-sa/3.0" title="Creative Commons Attribution-Share Alike 3.0">CC BY-SA 3.0, <"https://commons.wikimedia.org/w/index.php?curid=24076831">
  2. ↑ <"//commons.wikimedia.org/wiki/User:Jmh649" class="mw-redirect" title="User:Jmh649"><"https://creativecommons.org/licenses/by-sa/3.0" title="Creative Commons Attribution-Share Alike 3.0">CC BY-SA 3.0, <"https://commons.wikimedia.org/w/index.php?curid=24076829">
  3. ↑ McKenna JP, Bostock DJ, McMenamin PG (1987). "Sialolithiasis". Am Fam Physician. 36 (5): 119–25. PMID 3318353.
  4. ↑ Hupp, James (2008). Contemporary oral and maxillofacial surgery. St. Louis, Mo: Mosby Elsevier. ISBN 9780323049030.
  5. ↑ Neville, Brad (2002). Oral & maxillofacial pathology. Philadelphia: W.B. Saunders. ISBN 0721690033.

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