Celiac disease physical examination: Difference between revisions

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==Overview==
==Overview==
Patients with celiac disease usually appear [[Fatigue|tired]]. Common physical examination findings of celiac disease include [[hepatosplenomegaly]], [[abdominal tenderness]] with distention and [[Dermatitis herpetiformis|scaly rash]] on extensor surfaces.
Patients with celiac disease usually appear [[Fatigue|tired]]. Common [[physical examination]] findings of celiac disease include [[hepatosplenomegaly]], [[abdominal tenderness]] with distention and [[Dermatitis herpetiformis|scaly rash]] on extensor surfaces.


==Physical Examination==
==Physical Examination==
===Appearance===
===Appearance===
The patient may appear [[pale]] and [[Fatigue|fatigued]].<ref>{{cite journal | author = Crabbé P, Heremans J | title = Selective IgA deficiency with steatorrhea. A new syndrome | journal = Am J Med | volume = 42 | issue = 2 | pages = 319-26 | year = 1967 | id = PMID 4959869}}</ref><ref>{{cite journal | author = Collin P, Mäki M, Keyriläinen O, Hällström O, Reunala T, Pasternack A | title = Selective IgA deficiency and coeliac disease | journal = Scand J Gastroenterol | volume = 27 | issue = 5 | pages = 367-71 | year = 1992|id = PMID 1529270}}</ref><ref name="Marks">{{cite journal | author = Marks J, Shuster S, Watson A | title = Small-bowel changes in dermatitis herpetiformis | journal = Lancet | volume = 2 | issue = 7476 | pages = 1280–2 | year = 1966 | id = PMID 4163419}}</ref><ref>{{cite journal | author = Pengiran Tengah D, Wills A, Holmes G | title = Neurological complications of coeliac disease | journal = Postgrad Med J | volume = 78 | issue = 921 | pages = 393-8 | year = 2002 | url = http://pmj.bmjjournals.com/cgi/content/full/78/921/393 | id = PMID 12151653}}</ref><ref name="Ferguson">{{cite journal | author = Ferguson A, Hutton M, Maxwell J, Murray D | title = Adult coeliac disease in hyposplenic patients | journal = Lancet | volume = 1 | issue = 7639 | pages = 163-4 | year = 1970 | id = PMID 4189238}}</ref><ref name="Holmes">{{cite journal |author=Holmes G |title=Coeliac disease and Type 1 diabetes mellitus - the case for screening |journal=Diabet Med |volume=18 |issue=3 |pages=169-77 |year=2001 |pmid=11318836}}</ref><ref>{{cite journal | author = Collin P, Kaukinen K, Välimäki M, Salmi J | title = Endocrinological disorders and celiac disease | journal = Endocr Rev | volume = 23 | issue = 4 | pages = 464-83 | year = 2002 | url = http://edrv.endojournals.org/cgi/content/full/23/4/464 | id = PMID 12202461}}</ref><!--
The patient may appear [[pale]] and [[Fatigue|fatigued]].<ref>{{cite journal | author = Crabbé P, Heremans J | title = Selective IgA deficiency with steatorrhea. A new syndrome | journal = Am J Med | volume = 42 | issue = 2 | pages = 319-26 | year = 1967 | id = PMID 4959869}}</ref><ref>{{cite journal | author = Collin P, Mäki M, Keyriläinen O, Hällström O, Reunala T, Pasternack A | title = Selective IgA deficiency and coeliac disease | journal = Scand J Gastroenterol | volume = 27 | issue = 5 | pages = 367-71 | year = 1992|id = PMID 1529270}}</ref><ref name="Marks">{{cite journal | author = Marks J, Shuster S, Watson A | title = Small-bowel changes in dermatitis herpetiformis | journal = Lancet | volume = 2 | issue = 7476 | pages = 1280–2 | year = 1966 | id = PMID 4163419}}</ref><ref>{{cite journal | author = Pengiran Tengah D, Wills A, Holmes G | title = Neurological complications of coeliac disease | journal = Postgrad Med J | volume = 78 | issue = 921 | pages = 393-8 | year = 2002 | url = http://pmj.bmjjournals.com/cgi/content/full/78/921/393 | id = PMID 12151653}}</ref><ref name="Ferguson">{{cite journal | author = Ferguson A, Hutton M, Maxwell J, Murray D | title = Adult coeliac disease in hyposplenic patients | journal = Lancet | volume = 1 | issue = 7639 | pages = 163-4 | year = 1970 | id = PMID 4189238}}</ref><ref name="Holmes">{{cite journal |author=Holmes G |title=Coeliac disease and Type 1 diabetes mellitus - the case for screening |journal=Diabet Med |volume=18 |issue=3 |pages=169-77 |year=2001 |pmid=11318836}}</ref><ref>{{cite journal | author = Collin P, Kaukinen K, Välimäki M, Salmi J | title = Endocrinological disorders and celiac disease | journal = Endocr Rev | volume = 23 | issue = 4 | pages = 464-83 | year = 2002 | url = http://edrv.endojournals.org/cgi/content/full/23/4/464 | id = PMID 12202461}}</ref><ref>{{cite journal | author = Kingham J, Parker D | title = The association between primary biliary cirrhosis and coeliac disease: a study of relative prevalences | journal = Gut | volume = 42 | issue = 1 | pages = 120-2 | year = 1998|id = PMID 9518232}}</ref><ref>{{cite journal | author = Matteoni C, Goldblum J, Wang N, Brzezinski A, Achkar E, Soffer E | title = Celiac disease is highly prevalent in lymphocytic colitis | journal = J Clin Gastroenterol | volume = 32 | issue = 3 | pages = 225-7 | year = 2001 | id = PMID 11246349}}</ref>
--><ref>{{cite journal | author = Kingham J, Parker D | title = The association between primary biliary cirrhosis and coeliac disease: a study of relative prevalences | journal = Gut | volume = 42 | issue = 1 | pages = 120-2 | year = 1998|id = PMID 9518232}}</ref><!--
--><ref>{{cite journal | author = Matteoni C, Goldblum J, Wang N, Brzezinski A, Achkar E, Soffer E | title = Celiac disease is highly prevalent in lymphocytic colitis | journal = J Clin Gastroenterol | volume = 32 | issue = 3 | pages = 225-7 | year = 2001 | id = PMID 11246349}}</ref>


===Skin/Mucous Membrane===
===Skin/Mucous Membrane===
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===HEENT===
===HEENT===
* [[Aphthous ulcers]]
* [[Aphthous ulcers]]
* [[Cheliosis]]
* Chelosis
* [[Stomatitis]]
* [[Stomatitis]]
* [[Epistaxis]]
* [[Epistaxis]]


===Heart===
===Heart===
*Normal heart sounds
*Normal [[heart sounds]]
===Lungs===
===Lungs===
*Normal bilateral vesicular breathe sounds
*Normal bilateral [[Vesicular Breathing|vesicular]] breath sounds


===Abdomen===
===Abdomen===
*[[steatorrhoea|Pale]], voluminous and malodorous [[diarrhoea]].  
*[[steatorrhoea|Pale]], voluminous and malodorous [[diarrhoea]].  
*Hepatosplenomegaly
*[[Hepatosplenomegaly]]
*[[Abdominal pain]] and cramping  
*[[Abdominal pain]] and cramping  
*Abdominal distention<ref>{{cite journal | author = Ferguson R, Basu M, Asquith P, Cooke W | title = Jejunal mucosal abnormalities in patients with recurrent aphthous ulceration | journal = Br Med J | volume = 1 | issue = 6000 | pages = 11–13 | year = 1976|id = PMID 1247715}}</ref> .
*Abdominal distention<ref>{{cite journal | author = Ferguson R, Basu M, Asquith P, Cooke W | title = Jejunal mucosal abnormalities in patients with recurrent aphthous ulceration | journal = Br Med J | volume = 1 | issue = 6000 | pages = 11–13 | year = 1976|id = PMID 1247715}}</ref>  
*Increased bowel sounds<ref name="Spiegel">{{cite journal | author = Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS | title = Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis | journal = Gastroenterology | volume = 126 | issue = 7 | pages = 1721–32 | id = PMID 15188167}}</ref><ref name="AGA">{{cite journal | author = | title = American Gastroenterological Association medical position statement: Celiac Sprue | journal = Gastroenterology | volume = 120 | issue = 6 | pages = 1522–5 | year = 2001 | id = PMID 11313323 | url = http://www.gastrojournal.org/article/PIIS0016508501701618/fulltext}}</ref>
*Increased [[bowel]] sounds<ref name="Spiegel">{{cite journal | author = Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS | title = Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis | journal = Gastroenterology | volume = 126 | issue = 7 | pages = 1721–32 | id = PMID 15188167}}</ref><ref name="AGA">{{cite journal | author = | title = American Gastroenterological Association medical position statement: Celiac Sprue | journal = Gastroenterology | volume = 120 | issue = 6 | pages = 1522–5 | year = 2001 | id = PMID 11313323 | url = http://www.gastrojournal.org/article/PIIS0016508501701618/fulltext}}</ref>


===Musculoskeletal===
===Musculoskeletal===
* Non-specific bone and/or joint pain
* Non-specific [[bone]] and/or [[joint]] pain
* [[Fractures]] - [[Osteopenia]]
* [[Fractures]] - [[Osteopenia]]
* [[Tetany]]
* [[Tetany]]
* Decreased range of motion
* Decreased [[range of motion]]


===Neurological===
===Neurological===
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===Systemic===
===Systemic===
* [[Failure to thrive]]
* [[Failure to thrive]]
*Stunted growth   
*[[Stunted growth]]  
* [[fatigue (physical)|Fatigue]]<ref name="Tursi">{{cite journal | author = Tursi A, Brandimarte G, Giorgetti G | title = High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal | journal = Am J Gastroenterol | volume = 98 | issue = 4 | pages = 839-43 | year = 2003 | id = PMID 12738465}}</ref>
* [[fatigue (physical)|Fatigue]]<ref name="Tursi">{{cite journal | author = Tursi A, Brandimarte G, Giorgetti G | title = High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal | journal = Am J Gastroenterol | volume = 98 | issue = 4 | pages = 839-43 | year = 2003 | id = PMID 12738465}}</ref>


Revision as of 21:22, 13 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Patients with celiac disease usually appear tired. Common physical examination findings of celiac disease include hepatosplenomegaly, abdominal tenderness with distention and scaly rash on extensor surfaces.

Physical Examination

Appearance

The patient may appear pale and fatigued.[1][2][3][4][5][6][7][8][9]

Skin/Mucous Membrane

HEENT

Heart

Lungs

Abdomen

Musculoskeletal

Neurological

Systemic

Extermities

References

  1. ↑ Crabbé P, Heremans J (1967). "Selective IgA deficiency with steatorrhea. A new syndrome". Am J Med. 42 (2): 319–26. PMID 4959869.
  2. ↑ Collin P, Mäki M, Keyriläinen O, Hällström O, Reunala T, Pasternack A (1992). "Selective IgA deficiency and coeliac disease". Scand J Gastroenterol. 27 (5): 367–71. PMID 1529270.
  3. ↑ Marks J, Shuster S, Watson A (1966). "Small-bowel changes in dermatitis herpetiformis". Lancet. 2 (7476): 1280–2. PMID 4163419.
  4. ↑ Pengiran Tengah D, Wills A, Holmes G (2002). "Neurological complications of coeliac disease". Postgrad Med J. 78 (921): 393–8. PMID 12151653.
  5. ↑ Ferguson A, Hutton M, Maxwell J, Murray D (1970). "Adult coeliac disease in hyposplenic patients". Lancet. 1 (7639): 163–4. PMID 4189238.
  6. ↑ Holmes G (2001). "Coeliac disease and Type 1 diabetes mellitus - the case for screening". Diabet Med. 18 (3): 169–77. PMID 11318836.
  7. ↑ Collin P, Kaukinen K, Välimäki M, Salmi J (2002). "Endocrinological disorders and celiac disease". Endocr Rev. 23 (4): 464–83. PMID 12202461.
  8. ↑ Kingham J, Parker D (1998). "The association between primary biliary cirrhosis and coeliac disease: a study of relative prevalences". Gut. 42 (1): 120–2. PMID 9518232.
  9. ↑ Matteoni C, Goldblum J, Wang N, Brzezinski A, Achkar E, Soffer E (2001). "Celiac disease is highly prevalent in lymphocytic colitis". J Clin Gastroenterol. 32 (3): 225–7. PMID 11246349.
  10. ↑ Ferguson R, Basu M, Asquith P, Cooke W (1976). "Jejunal mucosal abnormalities in patients with recurrent aphthous ulceration". Br Med J. 1 (6000): 11–13. PMID 1247715.
  11. ↑ Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS. "Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis". Gastroenterology. 126 (7): 1721–32. PMID 15188167.
  12. ↑ "American Gastroenterological Association medical position statement: Celiac Sprue". Gastroenterology. 120 (6): 1522–5. 2001. PMID 11313323.
  13. ↑ Tursi A, Brandimarte G, Giorgetti G (2003). "High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal". Am J Gastroenterol. 98 (4): 839–43. PMID 12738465.
  14. ↑ 14.00 14.01 14.02 14.03 14.04 14.05 14.06 14.07 14.08 14.09 14.10 14.11 14.12 14.13 14.14 14.15 14.16 14.17 14.18 14.19 14.20 14.21 14.22 14.23 14.24 14.25 14.26 14.27 14.28 14.29 14.30 14.31 14.32 14.33 14.34 14.35 14.36 14.37 14.38 14.39 14.40 14.41 14.42 14.43 14.44 14.45 14.46 14.47 14.48 14.49 14.50 14.51 "Dermatology Atlas".

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