Pancreatic fistula physical examination: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
 
(16 intermediate revisions by the same user not shown)
Line 4: Line 4:


==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 [[Pancreatic fistula|pancreatic fistulas]] usually appear normal and in some they appear [[malnourished]]. Physical examination of patients with [[Pancreatic fistula|pancreatic fistulas]] is usually remarkable for [[infection]], [[dyspnea]], [[pleuritic chest pain]] and [[ascites]].
 
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 internal [[Pancreatic fistula|pancreatic fistulas]] is usually normal or [[asymptomatic]], on the other hand patients with external [[Pancreatic fistula|pancreatic fistulas]] can present with drainage of fluid.


OR
===Appearance of the Patient===


Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
*Most of the patients with [[Pancreatic fistula|pancreatic fistulas]] usually appear normal, but some might show the following the features:
**[[Dehydration]]
**[[Weight loss]] from [[malnourishment]]


OR
===Vital Signs===


The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*Patients with [[Pancreatic fistula|pancreatic fistulas]] may present with [[fever]] when there is an [[infection]].<ref name="pmid194346582">{{cite journal| author=Pratt WB, Callery MP, Vollmer CM| title=The latent presentation of pancreatic fistulas. | journal=Br J Surg | year= 2009 | volume= 96 | issue= 6 | pages= 641-9 | pmid=19434658 | doi=10.1002/bjs.6614 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19434658  }}</ref>
*[[Tachycardia]] with regular pulse may present in some patients.


OR
===Skin===


The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
*Skin examination of patients with [[Pancreatic fistula|pancreatic fistulas]] is usually normal.


===Appearance of the Patient===
===HEENT===
*Patients with [disease name] usually appear [general appearance].


===Vital Signs===
*HEENT examination of patients with [[Pancreatic fistula|pancreatic fistulas]] is usually normal.


*High-grade / low-grade fever
===Neck===
*[[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===
*Neck examination of patients with [[Pancreatic fistula|pancreatic fistulas]] is usually normal.
* Skin examination of patients with [disease name] is usually normal.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises


<gallery widths="150px">
===Lungs===


UploadedImage-01.jpg | Description {{dermref}}
*[[Pulmonary]] examination of patients with [[Pancreatic fistula|pancreatic fistulas]] may shows the following due to large [[Pleural effusion|pleural effusions]]:<ref name="pmid10096323">{{cite journal| author=Fulcher AS, Capps GW, Turner MA| title=Thoracopancreatic fistula: clinical and imaging findings. | journal=J Comput Assist Tomogr | year= 1999 | volume= 23 | issue= 2 | pages= 181-7 | pmid=10096323 | doi=10.1097/00004728-199903000-00004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10096323  }}</ref>
UploadedImage-02.jpg | Description {{dermref}}
**[[Dyspnea]]
**[[Cough]]
**[[Wheeze|Wheezing]]
**[[Pleuritic chest pain]]
**Reduced breath sounds
**Dullness to [[percussion]]


</gallery>
===Heart===


===HEENT===
*Cardiovascular examination of patients with [[Pancreatic fistula|pancreatic fistulas]] is usually normal.
* 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===
===Abdomen===
* 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===
*Abdominal examination of patients with [[Pancreatic fistula|pancreatic fistulas]] is usually shows the following:
* Pulmonary examination of patients with [disease name] is usually normal.
OR
* Asymmetric chest expansion OR decreased chest expansion
*Lungs are hyporesonant OR hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]


===Heart===
*[[Abdominal distension]] due to fluid accumulation which can lead to [[ascites]].
* Cardiovascular examination of patients with [disease name] is usually normal.
*The [[ascites]] have the following physical examination findings:<ref name="pmid24650171">{{cite journal| author=Larsen M, Kozarek R| title=Management of pancreatic ductal leaks and fistulae. | journal=J Gastroenterol Hepatol | year= 2014 | volume= 29 | issue= 7 | pages= 1360-70 | pmid=24650171 | doi=10.1111/jgh.12574 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24650171  }}</ref><ref name="pmid19434658">{{cite journal| author=Pratt WB, Callery MP, Vollmer CM| title=The latent presentation of pancreatic fistulas. | journal=Br J Surg | year= 2009 | volume= 96 | issue= 6 | pages= 641-9 | pmid=19434658 | doi=10.1002/bjs.6614 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19434658  }}</ref>
OR
**Fluid wave
*Chest tenderness upon palpation
**[[Shifting dullness]]
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
**Dullness to [[percussion]] at the flanks
*[[Heave]] / [[thrill]]
**Weight loss
*[[Friction rub]]
**[[Anorexia]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
**Weakness and severe malnutrition
*[[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 stethoscope


===Abdomen===
*Vague abdominal pain
* Abdominal examination of patients with [disease name] is usually normal.
*Altered bowel habits which include:
OR
**[[Hematemesis]]
*[[Abdominal distension]]
**[[Melena]] or [[hematochezia]]
*[[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.
 
OR
*Back examination of patients with [[Pancreatic fistula|pancreatic fistulas]] is usually normal.
*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.
 
OR
*[[Genitourinary]] examination of patients with [[Pancreatic fistula|pancreatic fistulas]] is usually normal.
*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.
 
OR
*[[Neuromuscular]] examination of patients with [[Pancreatic fistula|pancreatic fistulas]] is usually normal.
*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.
 
OR
*Extremities examination of patients with [[Pancreatic fistula|pancreatic fistulas]] is usually normal.
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

Latest revision as of 15:10, 6 April 2021

Pancreatic fistula Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Pancreatic fistula from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Chest X Ray

CT

MRI

ERCP

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Pancreatic fistula physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Pancreatic fistula physical examination

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Pancreatic fistula physical examination

CDC on Pancreatic fistula physical examination

Pancreatic fistula physical examination in the news

Blogs on Pancreatic fistula physical examination

Directions to Hospitals Treating Pancreatic fistula

Risk calculators and risk factors for Pancreatic fistula physical examination

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

Overview

Patients with pancreatic fistulas usually appear normal and in some they appear malnourished. Physical examination of patients with pancreatic fistulas is usually remarkable for infection, dyspnea, pleuritic chest pain and ascites.

Physical Examination

Physical examination of patients with internal pancreatic fistulas is usually normal or asymptomatic, on the other hand patients with external pancreatic fistulas can present with drainage of fluid.

Appearance of the Patient

Vital Signs

Skin

HEENT

Neck

Lungs

Heart

Abdomen

Back

Genitourinary

Neuromuscular

Extremities

References

  1. ↑ Pratt WB, Callery MP, Vollmer CM (2009). "The latent presentation of pancreatic fistulas". Br J Surg. 96 (6): 641–9. doi:10.1002/bjs.6614. PMID 19434658.
  2. ↑ Fulcher AS, Capps GW, Turner MA (1999). "Thoracopancreatic fistula: clinical and imaging findings". J Comput Assist Tomogr. 23 (2): 181–7. doi:10.1097/00004728-199903000-00004. PMID 10096323.
  3. ↑ Larsen M, Kozarek R (2014). "Management of pancreatic ductal leaks and fistulae". J Gastroenterol Hepatol. 29 (7): 1360–70. doi:10.1111/jgh.12574. PMID 24650171.
  4. ↑ Pratt WB, Callery MP, Vollmer CM (2009). "The latent presentation of pancreatic fistulas". Br J Surg. 96 (6): 641–9. doi:10.1002/bjs.6614. PMID 19434658.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Pancreatic_fistula_physical_examination&oldid=1696265"