Irritable bowel syndrome physical examination: Difference between revisions

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Revision as of 20:48, 6 November 2017

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

Overview

Patients with IBS usually appear normal. Physical examination of patients with IBS may elicit tenderness in the abdomen. A digital rectal examination must be performed in all patients to rule out rectal growths, blood in stool and evaluate for dyssynergic defecation (where paradoxical contraction of the rectal sphincter occurs on bearing down and abnormal perineal descent). Physical findings such as fever, abdominal mass, hepatosplenomegaly, lymph node enlargement, weight loss, peritoneal signs and ascites are absent and help rule out organic causes.

Appearance of the Patient

Patients with IBS usually appear normal/mildly distressed.

Vital Signs

Patients are usually afebrile.
Hypothermia / hyperthermia ma 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

Description (Adapted from Dermatology Atlas)

Description (Adapted from Dermatology Atlas)
Description (Adapted from Dermatology Atlas)

HEENT

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 accomodation / non-reactive to neither light nor accomodation
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

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

Asymmetric chest expansion / Decreased chest expansion
Lungs are hypo/hyperresonant
Fine/coarse crackles upon auscultation of the lung bases/apices unilaterally/bilaterally
Rhonchi
Vesicular breath sounds / Distant breath sounds
Expiratory/inspiratory wheezing with normal / delayed expiratory phase
Wheezing may be present
Egophony present/absent
Bronchophony present/absent
Normal/reduced tactile fremitus

Heart

Chest tenderness upon palpation
PMI within 2 cm of the sternum (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
Heave / thrill
Friction rub
S1
S2
S3
S4
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 otoscope

Abdomen

Abdominal distention
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

Point tenderness over __ vertebrae (e.g. L3-L4)
Sacral edema
Costovertebral angle tenderness bilaterally/unilaterally
Buffalo hump

Genitourinary

A pelvic/adnexal mass may be palpated
Inflamed mucosa
Clear/(color), foul-smelling/odorless penile/vaginal discharge

Neuromuscular

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

Clubbing
Cyanosis
Pitting/non-pitting edema of the upper/lower extremities
Muscle atrophy
Fasciculations in the upper/lower extremity

References

Template:WH Template:WS

@@ Line 4: / Line 4: @@
 ==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 IBS usually appear normal. Physical examination of patients with IBS may elicit tenderness in the abdomen.  A digital rectal examination must be performed in all patients to rule out rectal growths, blood in stool and evaluate for dyssynergic defecation (where paradoxical contraction of the rectal sphincter occurs on bearing down and abnormal perineal descent).  Physical findings such as fever, abdominal mass, hepatosplenomegaly, lymph node enlargement, weight loss, peritoneal signs and ascites are absent and help rule out organic causes.
-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 of patients with IBS is usually normal.
-*Mild tenderness in the abdomen may be present.  A digital rectal examination must be performed in all patients to rule out rectal growths, hemooccult positive stool and evaluate for dyssynergic defecation(where paradoxical contraction of the rectal sphincter occurs on bearing down and abnormal perineal descent).  Physical findings such as fever, abdominal mass, hepatosplenomegaly, lymph node enlargement, weight loss, peritoneal signs and ascites.  Alarm features to rule out organic diseases are as follows:  •Progressive pain in the abdomen  Family historyof IBD or colorectal cancer  •Weight loss   Age more than 50 years  Blood in stool  Nocturnal diarrhea  Lab abnormalities(elevated CRP or fecal calprotectin, IDA)
 ===Appearance of the Patient===