Boerhaave syndrome physical examination: Difference between revisions
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{{CMG}} {{AE}} {{DM}}, {{Ajay}}, {{FT}} | {{CMG}} {{AE}} {{DM}}, {{Ajay}}, {{FT}} | ||
==Overview== | ==Overview== | ||
The | The patients sometimes present in moderate distress with [[epigastric]] pain and bleeding. Patients may experience [[tachycardia]], weak pulse, [[hypotension]], [[diaphoresis]] and [[fever]]. | ||
==Physical examination== | ==Physical examination== | ||
* Physical examination is usually not helpful, particularly early in the course.<ref name="pmid1994204">{{cite journal |vauthors=McGovern M, Egerton MJ |title=Spontaneous perforation of the cervical oesophagus |journal=Med. J. Aust. |volume=154 |issue=4 |pages=277–8 |year=1991 |pmid=1994204 |doi= |url=}}</ref><ref name="pmid5112482">{{cite journal |vauthors=Wilson RF, Sarver EJ, Arbulu A, Sukhnandan R |title=Spontaneous perforation of the esophagus |journal=Ann. Thorac. Surg. |volume=12 |issue=3 |pages=291–6 |year=1971 |pmid=5112482 |doi= |url=}}</ref><ref name="ER09">{{cite journal |author=Woo KM, Schneider JI |title=High-risk chief complaints I: chest pain--the big three |journal=Emerg. Med. Clin. North Am. |volume=27 |issue=4 |pages=685–712, x |year=2009 |month=November |pmid=19932401 |doi=10.1016/j.emc.2009.07.007 |url=}}</ref><ref name="pmid2730190">{{cite journal |vauthors=Pate JW, Walker WA, Cole FH, Owen EW, Johnson WH |title=Spontaneous rupture of the esophagus: a 30-year experience |journal=Ann. Thorac. Surg. |volume=47 |issue=5 |pages=689–92 |year=1989 |pmid=2730190 |doi= |url=}}</ref><ref name="pmid9079278">{{cite journal |vauthors=Brauer RB, Liebermann-Meffert D, Stein HJ, Bartels H, Siewert JR |title=Boerhaave's syndrome: analysis of the literature and report of 18 new cases |journal=Dis. Esophagus |volume=10 |issue=1 |pages=64–8 |year=1997 |pmid=9079278 |doi= |url=}}</ref> | * Physical examination is usually not helpful, particularly early in the course.<ref name="pmid1994204">{{cite journal |vauthors=McGovern M, Egerton MJ |title=Spontaneous perforation of the cervical oesophagus |journal=Med. J. Aust. |volume=154 |issue=4 |pages=277–8 |year=1991 |pmid=1994204 |doi= |url=}}</ref><ref name="pmid5112482">{{cite journal |vauthors=Wilson RF, Sarver EJ, Arbulu A, Sukhnandan R |title=Spontaneous perforation of the esophagus |journal=Ann. Thorac. Surg. |volume=12 |issue=3 |pages=291–6 |year=1971 |pmid=5112482 |doi= |url=}}</ref><ref name="ER09">{{cite journal |author=Woo KM, Schneider JI |title=High-risk chief complaints I: chest pain--the big three |journal=Emerg. Med. Clin. North Am. |volume=27 |issue=4 |pages=685–712, x |year=2009 |month=November |pmid=19932401 |doi=10.1016/j.emc.2009.07.007 |url=}}</ref><ref name="pmid2730190">{{cite journal |vauthors=Pate JW, Walker WA, Cole FH, Owen EW, Johnson WH |title=Spontaneous rupture of the esophagus: a 30-year experience |journal=Ann. Thorac. Surg. |volume=47 |issue=5 |pages=689–92 |year=1989 |pmid=2730190 |doi= |url=}}</ref><ref name="pmid9079278">{{cite journal |vauthors=Brauer RB, Liebermann-Meffert D, Stein HJ, Bartels H, Siewert JR |title=Boerhaave's syndrome: analysis of the literature and report of 18 new cases |journal=Dis. Esophagus |volume=10 |issue=1 |pages=64–8 |year=1997 |pmid=9079278 |doi= |url=}}</ref> | ||
* [[Subcutaneous emphysema]] ([[Crepitations|crepitation]]) is an important diagnostic finding but is not very sensitive, being present in only 9 of 34 patients (27 percent) in one series . | * [[Subcutaneous emphysema]] ([[Crepitations|crepitation]]) is an important diagnostic finding but is not very sensitive, being present in only 9 of 34 patients (27 percent) in one series. | ||
* A [[pleural effusion]] may be occur and be associated with an [[Enterococcal Infection|Enterococcal]] bacterial [[pericardial effusion]]. | * A [[pleural effusion]] may be occur and be associated with an [[Enterococcal Infection|Enterococcal]] bacterial [[pericardial effusion]]. | ||
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=== '''Vital Signs''' === | === '''Vital Signs''' === | ||
* [[Tachycardia]] | * [[Tachycardia]] | ||
* Weak pulse | * Weak [[pulse]] | ||
* Hypotension | * [[Hypotension]] | ||
* [[Diaphoresis]] | * [[Diaphoresis]] | ||
* Fever | * [[Fever]] | ||
=== '''Skin''' === | === '''Skin''' === | ||
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=== Neck === | === Neck === | ||
* | * Low [[Jugular venous pressure]] | ||
=== Lungs === | === Lungs === | ||
* [[Subcutaneous emphysema| | * [[Subcutaneous emphysema|Subcutaneous emphysema]] | ||
* [[Pneumomediastinum]] may cause a crackling sound on chest auscultation, known as the '''[[Hamman's sign|Hamman's crunch]]'''. | * [[Pneumomediastinum]] may cause a crackling sound on chest auscultation, known as the '''[[Hamman's sign|Hamman's crunch]]'''. | ||
| Line 37: | Line 37: | ||
=== Abdomen === | === Abdomen === | ||
* | * Abdominal rigidity | ||
=== Back === | === Back === | ||
Latest revision as of 20:48, 26 February 2018
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Boerhaave syndrome physical examination On the Web |
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Risk calculators and risk factors for Boerhaave syndrome physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamed Diab, MD [2], Ajay Gade MD[3]], Feham Tariq, MD [4]
Overview
The patients sometimes present in moderate distress with epigastric pain and bleeding. Patients may experience tachycardia, weak pulse, hypotension, diaphoresis and fever.
Physical examination
- Physical examination is usually not helpful, particularly early in the course.[1][2][3][4][5]
- Subcutaneous emphysema (crepitation) is an important diagnostic finding but is not very sensitive, being present in only 9 of 34 patients (27 percent) in one series.
- A pleural effusion may be occur and be associated with an Enterococcal bacterial pericardial effusion.
Appearance of the Patient
The patient might be in moderate distress with epigastric pain and bleeding.
Vital Signs
Skin
HEENT
- Normal
Neck
Lungs
- Subcutaneous emphysema
- Pneumomediastinum may cause a crackling sound on chest auscultation, known as the Hamman's crunch.
Heart
Abdomen
- Abdominal rigidity
Back
- Normal
Extremities
- Normal
Genitourinary
- Normal
Neuromuscular
- Normal
References
- ↑ McGovern M, Egerton MJ (1991). "Spontaneous perforation of the cervical oesophagus". Med. J. Aust. 154 (4): 277–8. PMID 1994204.
- ↑ Wilson RF, Sarver EJ, Arbulu A, Sukhnandan R (1971). "Spontaneous perforation of the esophagus". Ann. Thorac. Surg. 12 (3): 291–6. PMID 5112482.
- ↑ Woo KM, Schneider JI (2009). "High-risk chief complaints I: chest pain--the big three". Emerg. Med. Clin. North Am. 27 (4): 685–712, x. doi:10.1016/j.emc.2009.07.007. PMID 19932401. Unknown parameter
|month=ignored (help) - ↑ Pate JW, Walker WA, Cole FH, Owen EW, Johnson WH (1989). "Spontaneous rupture of the esophagus: a 30-year experience". Ann. Thorac. Surg. 47 (5): 689–92. PMID 2730190.
- ↑ Brauer RB, Liebermann-Meffert D, Stein HJ, Bartels H, Siewert JR (1997). "Boerhaave's syndrome: analysis of the literature and report of 18 new cases". Dis. Esophagus. 10 (1): 64–8. PMID 9079278.