Irritable bowel syndrome physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Patients with IBS usually appear normal. Physical examination of patients with IBS may elicit tenderness in | Patients with IBS usually appear normal on physical exam. Physical examination of patients with IBS may elicit abdominal tenderness in some patients. 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 straining, leading to constipation). Physical findings such as fever, abdominal mass, hepatosplenomegaly, lymph node enlargement, weight loss, peritoneal signs and ascites are absent in IBS and help rule out organic causes. | ||
==Physical Examination== | ==Physical Examination== | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
| Line 11: | Line 11: | ||
===Vital Signs=== | ===Vital Signs=== | ||
* | *Afebrile | ||
* | *Regular pulse | ||
* | *Normal BP | ||
* | *Normal RR | ||
*IBS-diarrhea patients with dehydration/hypovolemia as a complication develop: | |||
**tachycardia | |||
**low blood pressure | |||
**postural hypotension | |||
===Skin=== | ===Skin=== | ||
* | * Skin turgor is normal in most patients | ||
* | * IBS-diarrhea patients with dehydration/hypovolemia as a complication develop: | ||
* | ** decreased skin turgor | ||
** dryness of tongue and oral mucosa due to decreased salivary secretions | |||
===HEENT=== | ===HEENT=== | ||
| Line 35: | Line 39: | ||
===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]] /[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]] normal | ||
*No additional sounds | |||
===Abdomen=== | ===Abdomen=== | ||
Revision as of 21:55, 6 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Patients with IBS usually appear normal on physical exam. Physical examination of patients with IBS may elicit abdominal tenderness in some patients. 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 straining, leading to constipation). Physical findings such as fever, abdominal mass, hepatosplenomegaly, lymph node enlargement, weight loss, peritoneal signs and ascites are absent in IBS and help rule out organic causes.
Physical Examination
Appearance of the Patient
- Patients with IBS usually appear normal/mildly distressed.
Vital Signs
- Afebrile
- Regular pulse
- Normal BP
- Normal RR
- IBS-diarrhea patients with dehydration/hypovolemia as a complication develop:
- tachycardia
- low blood pressure
- postural hypotension
Skin
- Skin turgor is normal in most patients
- IBS-diarrhea patients with dehydration/hypovolemia as a complication develop:
- decreased skin turgor
- dryness of tongue and oral mucosa due to decreased salivary secretions
HEENT
WNL
Neck
WNL
Lungs
- Normal chest expansion
- Normal vesicular breath sounds in B/L lung fields
- Normal tactile fremitus
Heart
Abdomen
- Examination results are usually normal
- Abdominal distention may be present
- Abdominal tenderness may be elicited in different quadrants
- Absence of abdominal masses, organomegaly
- Normal bowel sounds
- To rule out organic causes, rectal exam must be done in patients to evaluate for:
- presence of stool and its consistency
- Rectal tenderness
- Strictures
- Masses
- rectal prolapse
- Fistulas
- Hemorrhoids
- Abscesses
- Fissures
- impaired sphincter function due to a neurologic disorder
- responses of the puborectalis and external anal sphincter muscles while straining to rule out dyssynergic defecation
Genitourinary
- WNL
Neuromuscular
- Patient is usually oriented to persons, place, and time
Extremities
- WNL