Acute diarrhea physical examination: Difference between revisions

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{{Acute diarrhea}}
{{Acute diarrhea}}


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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 acute diarrhea usually appear [[Ill feeling|ill]], [[Dehydration|dehydrated]] or [[Fatigue|lethargic]]. Common [[physical examination]] findings of acute diarrhea include [[hypotension]] and other signs of [[Hypovolemia|volume depletion]] (depressed [[consciousness]], sunken [[anterior fontanelle]], dry [[mucous membranes]], sunken eyes, poor skin turgor and [[Capillary refill time|delayed capillary refill]]), [[abdominal tenderness]] and [[distension]], increased [[Peristalsis|peristaltic]] activity ([[Borborygmus|borborygmi]]).
 
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 acute diarrhea shows signs of [[dehydration]] ([[dry mouth]] and [[tongue]], sunken eyes, sunken [[anterior fontanelle]], poor skin turgor, [[hypotension]], [[Altered mental state|altered consciousness]], absent tears), [[Tenderness (medicine)|abdominal tenderness]] and [[distension]], increased [[Peristalsis|peristaltic]] activity, [[perineal]] [[erythema]] and signs of [[malnutrition]].
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===
*Patients with acute diarrhea may appear [[Ill feeling|ill]], [[dehydrated]], or [[lethargic]] depending upon the seveority of diarrhea.


===Vital Signs===
===Appearance of the patient===
*Patients with acute diarrhea may appear [[Ill feeling|ill]], [[dehydrated]], or [[lethargic]] depending upon the severity of diarrhea. 


===Vital signs===
* [[Hypotension]]
* [[Hypotension]]
* [[Fever]]
* [[Fever]]
* [[Orthostasis]]
* [[Orthostasis]]
*[[Tachycardia]] or [[bradycardia]]
*[[Tachypnea]]
'''Assessment of dehydration:'''<ref name="pmid28613793">{{cite journal |vauthors=Vega RM, Bhimji SS |title= |journal= |volume= |issue= |pages= |year= |pmid=28613793 |doi= |url=}}</ref><ref name="pmid28846339">{{cite journal |vauthors=Nemeth V, Pfleghaar N |title= |journal= |volume= |issue= |pages= |year= |pmid=28846339 |doi= |url=}}</ref>
*[[Dehydration]] is the major cause of [[morbidity]] and [[Mortality rate|mortality]] in diarrhea.
*Every patient with diarrhea should be assessed for [[Medical sign|signs]], [[symptoms]], and severity.
*Common findings of [[Hypovolemia|volume depletion]] on physical examination include [[lethargy]], depressed consciousness, diminshed skin turgor, sunken [[anterior fontanelle]], dry [[mucous membranes]], sunken eyes, lack of tears, and delayed [[capillary refill]] are obvious and important signs of [[dehydration]].
{| class="wikitable"
! style="background:#4479BA; color: #FFFFFF" |
! style="background:#4479BA; color: #FFFFFF" |Mild dehydration (<5%)
! style="background:#4479BA; color: #FFFFFF" |Moderate dehydration (5-10%)
! style="background:#4479BA; color: #FFFFFF" |Severe dehydration
|-
| style="background:#DCDCDC; + " |Eyes
|Normal
|Sunken
|Very sunken
|-
| style="background:#DCDCDC; + " |Tears
|Present
|Absent
|Absent
|-
| style="background:#DCDCDC; + " |Thirst
|Normal
|Thirsty
|Poor
|-
| style="background:#DCDCDC; + " |Mouth
|Moist
|Dry
|Very dry
|-
| style="background:#DCDCDC; + " |Urine output
|Normal
|Decreased
|Oliguric
|-
| style="background:#DCDCDC; + " |Fontanelle
|Normal
|Sunken
|Sunken
|-
| style="background:#DCDCDC; + " |Respirations
|Normal
|[[Tachypnea]]
|[[Tachypnea]]
|-
| style="background:#DCDCDC; + " |Mental status
|Normal
|Irritable
|Altered
|-
| style="background:#DCDCDC; + " |Blood pressure
|Normal
|[[Hypotension]]
|[[Hypotension]]
|}


===Skin===
===Skin===
* Skin examination of patients with [disease name] is usually normal.
* [[Skin]] examination of patients with diarrhea can be done by pinch test.
OR
* If the [[skin]] on the [[thigh]], [[Calf muscle|calf]], or [[forearm]] is pinched, it will immediately return to its normal flat state when the pinch is released in normal patients.
*[[Cyanosis]]
**Mild dehydration (0-5%): Pinch retracts immediately
*[[Jaundice]]
**Moderate dehydration (5-10%): Pinch retracts slowly
* [[Pallor]]
**Severe dehydration (>10%): Pinch remain folded
* Bruises
*Delayed [[capillary refill]]
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>
 
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]  
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*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 examination of patients with [disease name] is usually normal.
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===
* Pulmonary examination of patients with Acute diarrhea is usually normal.
 
 
===Heart===
===Heart===
*Hypotension
*[[Hypotension]]
*Tachycardia/ Bradycardia
*[[Tachycardia]]/ [[Bradycardia]]
 
*Decreased [[jugular venous pressure]]
 
===Abdomen===
===Abdomen===
*[[Abdominal distention]]  
*[[Abdominal distention]]  
*Diffuse [[Abdominal tenderness]]   
*Diffuse [[abdominal tenderness]]   
*Borborygmi
*[[Borborygmus|Borborygmi]]
*Rebound abdominal tenderness
*Rigidity and [[Rebound tenderness|rebound abdominal tenderness]]
*[[Hepatospleenomegaly]] is associated with certain infections.
*[[Organomegaly|Hepatospleenomegaly]] is associated with certain [[Infection|infections]] ([[Mycobacterium avium intracellulare|Mycobacterium Avium complex]], [[Salmonellosis]])
**
'''Perineal erythema'''
 
*In children mostly, frequent passage of [[Human feces|stools]] cause [[perineal]] skin breakdown.
===Genitourinary===
*[[Malabsorption|Carbohydrate malabsorption]] secondary to diarrhea may be responsible for more acidic [[stools]], that results in [[erythema]].
*Perineal erythema
*[[Bile acid malabsorption]] leads to [[Dermatitis|diaper dermatitis]] that is severe, appears as burnt perianal [[skin]].
**In children mostly, frequent passage of stools cause perineal skin breakdown.
'''Failure to thrive and malnutrition'''
**Secondary carbohydrate malabsorption can cause acidic stools.
*Reductions in [[muscle]] and [[fat]] mass or peripheral [[edema]] may be present in presence of underlying [[carbohydrate]], [[fat]], and/or [[protein]] [[malabsorption]].
**Secondary bile acid malabsorption can result in  diaper dermatitis that is severe, often characterized as a "burn."
*[[Giardia lamblia|Giardia]] can cause intermittent diarrhea and fat malabsorption.
 
===Lungs===
*Examination is usually normal.
*[[Tachypnea]] caused by [[metabolic acidosis]] as a result of severe [[Hypovolemia|volume depletion]].
===HEENT===
*Sunken [[anterior fontanelle]]
*Oral mucosal lesions and [[Stomatitis|angular stomatitis]] in [[tropical sprue]]
*Dry [[Mucous membrane|mucous membranes]] and [[tongue]]
===Neuromuscular===
===Neuromuscular===
*[[Muscle weakness]] and [[Seizure|convulsions]] because of moderate to severe [[Electrolyte disturbance|electrolyte imbalance]]


* Altered mental status
* Convulsions
*  sunken anterior fontanel




==References==
{{Reflist|2}}


===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
{{Reflist|2}}


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[[Category: (name of the system)]]
<references />
 
[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Up-To-Date]]

Latest revision as of 20:16, 29 July 2020

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

Overview

Patients with acute diarrhea usually appear ill, dehydrated or lethargic. Common physical examination findings of acute diarrhea include hypotension and other signs of volume depletion (depressed consciousness, sunken anterior fontanelle, dry mucous membranes, sunken eyes, poor skin turgor and delayed capillary refill), abdominal tenderness and distension, increased peristaltic activity (borborygmi).

Physical Examination

Physical examination of patients with acute diarrhea shows signs of dehydration (dry mouth and tongue, sunken eyes, sunken anterior fontanelle, poor skin turgor, hypotension, altered consciousness, absent tears), abdominal tenderness and distension, increased peristaltic activity, perineal erythema and signs of malnutrition.

Appearance of the patient

  • Patients with acute diarrhea may appear ill, dehydrated, or lethargic depending upon the severity of diarrhea.

Vital signs

Assessment of dehydration:[1][2]

Mild dehydration (<5%) Moderate dehydration (5-10%) Severe dehydration
Eyes Normal Sunken Very sunken
Tears Present Absent Absent
Thirst Normal Thirsty Poor
Mouth Moist Dry Very dry
Urine output Normal Decreased Oliguric
Fontanelle Normal Sunken Sunken
Respirations Normal Tachypnea Tachypnea
Mental status Normal Irritable Altered
Blood pressure Normal Hypotension Hypotension

Skin

  • Skin examination of patients with diarrhea can be done by pinch test.
  • If the skin on the thigh, calf, or forearm is pinched, it will immediately return to its normal flat state when the pinch is released in normal patients.
    • Mild dehydration (0-5%): Pinch retracts immediately
    • Moderate dehydration (5-10%): Pinch retracts slowly
    • Severe dehydration (>10%): Pinch remain folded
  • Delayed capillary refill

Heart

Abdomen

Perineal erythema

Failure to thrive and malnutrition

Lungs

HEENT

Neuromuscular


References

  1. ↑ Vega RM, Bhimji SS. PMID 28613793. Missing or empty |title= (help)
  2. ↑ Nemeth V, Pfleghaar N. PMID 28846339. Missing or empty |title= (help)


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