Pancreatic fistula physical examination: Difference between revisions

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==Overview==
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]].
 
==Physical Examination==
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.
 
===Appearance of the Patient===
 
*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]]
 
===Vital Signs===
 
*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.
 
===Skin===
 
*Skin examination of patients with [[Pancreatic fistula|pancreatic fistulas]] is usually normal.
 
===HEENT===
 
*HEENT examination of patients with [[Pancreatic fistula|pancreatic fistulas]] is usually normal.
 
===Neck===
 
*Neck examination of patients with [[Pancreatic fistula|pancreatic fistulas]] is usually normal.
 
===Lungs===
 
*[[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>
**[[Dyspnea]]
**[[Cough]]
**[[Wheeze|Wheezing]]
**[[Pleuritic chest pain]]
**Reduced breath sounds
**Dullness to [[percussion]]
 
===Heart===
 
*Cardiovascular examination of patients with [[Pancreatic fistula|pancreatic fistulas]] is usually normal.
 
===Abdomen===
 
*Abdominal examination of patients with [[Pancreatic fistula|pancreatic fistulas]] is usually shows the following:
 
*[[Abdominal distension]] due to fluid accumulation which can lead to [[ascites]].
*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>
**Fluid wave
**[[Shifting dullness]]
**Dullness to [[percussion]] at the flanks
**Weight loss
**[[Anorexia]]
**Weakness and severe malnutrition
 
*Vague abdominal pain
*Altered bowel habits which include:
**[[Hematemesis]]
**[[Melena]] or [[hematochezia]]
 
===Back===
 
*Back examination of patients with [[Pancreatic fistula|pancreatic fistulas]] is usually normal.
 
===Genitourinary===
 
*[[Genitourinary]] examination of patients with [[Pancreatic fistula|pancreatic fistulas]] is usually normal.
 
===Neuromuscular===
 
*[[Neuromuscular]] examination of patients with [[Pancreatic fistula|pancreatic fistulas]] is usually normal.
 
===Extremities===
 
*Extremities examination of patients with [[Pancreatic fistula|pancreatic fistulas]] is usually normal.


==References==
==References==
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[[Category: (name of the system)]]

Latest revision as of 15:10, 6 April 2021

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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.

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