Irritable bowel syndrome physical examination: Difference between revisions
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===Lungs=== | ===Lungs=== | ||
* | * Normal chest expansion | ||
* | *Normal vesicular breath sounds in B/L lung fields | ||
*Normal [[tactile fremitus]] | |||
*Normal | |||
===Heart=== | ===Heart=== | ||
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]] /[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]] normal | |||
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]] | |||
===Abdomen=== | ===Abdomen=== | ||
Revision as of 21:06, 6 November 2017
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Irritable bowel syndrome Microchapters |
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Differentiating Irritable bowel syndrome from other Diseases |
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Diagnosis |
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Treatment |
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Irritable bowel syndrome physical examination On the Web |
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American Roentgen Ray Society Images of Irritable bowel syndrome physical examination |
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Risk calculators and risk factors for Irritable bowel syndrome physical examination |
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.
- patients have regular pulse, tachycardia may be present in case of dehydration
- Respiratory rate normal
Skin
- skin turgor is normal in most patients
- skin turgor is reduced in IBS-diarrhea patients with dehydration as a complication
HEENT
WNL
Neck
WNL
Lungs
- Normal chest expansion
- Normal vesicular breath sounds in B/L lung fields
- Normal tactile fremitus
Heart
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