Irritable bowel syndrome physical examination: Difference between revisions
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==Overview== | ==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. | Patients with [[Irritable bowel syndrome|IBS]] usually appear normal on [[Physical examination|physical exam]]. [[Physical examination]] of patients with [[Irritable bowel syndrome|IBS]] may elicit [[Tenderness (medicine)|abdominal tenderness]] in some patients. A [[Rectal examination|digital rectal examination]] must be performed in all patients to rule out [[rectal]] growths, blood in [[Human feces|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]], [[Peritoneum|peritoneal]] signs and [[ascites]] are absent in [[Irritable bowel syndrome|IBS]] and help rule out organic causes. | ||
==Physical Examination== | ==Physical Examination== | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*Patients with IBS usually appear normal/mildly distressed. | *Patients with [[Irritable bowel syndrome|IBS]] usually appear normal/mildly distressed. | ||
===Vital Signs=== | ===Vital Signs=== | ||
*Afebrile | *Afebrile | ||
*Regular pulse | *Regular [[pulse]] | ||
*Normal | *Normal [[blood pressure]] | ||
*Normal | *Normal [[respiratory rate]] | ||
*IBS-diarrhea patients with dehydration/hypovolemia as a complication develop: | *IBS-diarrhea patients with [[dehydration]]/[[hypovolemia]] as a complication develop: | ||
**tachycardia | **[[tachycardia]] | ||
**low blood pressure | **low [[blood pressure]] | ||
**postural hypotension | **[[Orthostatic hypotension|postural hypotension]] | ||
===Skin=== | ===Skin=== | ||
* Skin turgor is normal in most patients | * Skin turgor is normal in most patients | ||
* IBS-diarrhea patients with dehydration/hypovolemia as a complication develop: | * [[Irritable bowel syndrome|IBS]]-[[diarrhea]] patients with [[dehydration]]/[[hypovolemia]] as a complication develop: | ||
** decreased skin turgor | ** decreased skin turgor | ||
** dryness of tongue and oral mucosa due to decreased salivary secretions | ** dryness of tongue and oral [[Mucous membrane|mucosa]] due to decreased [[Salivary gland|salivary]] secretions | ||
===Lungs=== | ===Lungs=== | ||
* Normal chest expansion | * Normal chest expansion | ||
*Normal vesicular breath sounds in B/L lung fields | *Normal [[Vesicular breathing|vesicular]] breath sounds in B/L lung fields | ||
*Normal [[tactile fremitus]] | *Normal [[tactile fremitus]] | ||
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* [[Abdominal distention]] may be present | * [[Abdominal distention]] may be present | ||
*[[Abdominal tenderness]] may be elicited in different quadrants | *[[Abdominal tenderness]] may be elicited in different quadrants | ||
*Absence of abdominal masses, | *Absence of abdominal masses, [[Splenomegaly|hepatospleenomegaly]] | ||
*Normal bowel sounds | *Normal [[Intestine|bowel]] sounds | ||
=== Rectal exam === | === Rectal exam === | ||
*IBS patients usually have a normal rectal exam.To rule out organic causes of constipation and diarrhea, rectal exam must be done in patients to evaluate for: | *IBS patients usually have a normal [[rectal]] exam.To rule out organic causes of [[constipation]] and [[diarrhea]], rectal exam must be done in patients to evaluate for: | ||
** presence of [[stool]] and its consistency | ** presence of [[stool]] and its consistency | ||
**Rectal tenderness | **[[Rectal]] tenderness | ||
**Strictures | **Strictures | ||
** Masses | ** Masses | ||
**rectal prolapse | **rectal [[prolapse]] | ||
** [[Fistula|Fistulas]] | ** [[Fistula|Fistulas]] | ||
** [[Hemorrhoid|Hemorrhoids]] | ** [[Hemorrhoid|Hemorrhoids]] | ||
** [[Abscess|Abscesses]] | ** [[Abscess|Abscesses]] | ||
** [[Fissure|Fissures]] | ** [[Fissure|Fissures]] | ||
**impaired sphincter function due to a neurologic disorder | **impaired [[sphincter]] function due to a [[Neurology|neurologic]] disorder | ||
**responses of the puborectalis and external anal sphincter muscles while straining to rule out dyssynergic defecation | **responses of the [[puborectalis]] and [[External anal sphincter|external anal sphincter muscles]] while straining to rule out dyssynergic [[defecation]] | ||
==References== | ==References== | ||
Revision as of 22:05, 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 blood pressure
- Normal respiratory rate
- IBS-diarrhea patients with dehydration/hypovolemia as a complication develop:
Skin
- Skin turgor is normal in most patients
- IBS-diarrhea patients with dehydration/hypovolemia as a complication develop:
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, hepatospleenomegaly
- Normal bowel sounds
Rectal exam
- IBS patients usually have a normal rectal exam.To rule out organic causes of constipation and diarrhea, 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