Gastrointestinal stromal tumor physical examination: Difference between revisions

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===Skin===
===Skin===
*[[Jaundice]]  
*[[Jaundice]] (seen in obstructive duodenal GIST)
* [[Pallor]]
* [[Pallor]] (seen with abdominal bleeding)


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===Neck===
===Neck===
*[[Lymphadenopathy]] (rare)
*[[Lymphadenopathy]] (rare)
===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]]
*[[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]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|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===
===Abdomen===
*[[Abdominal distention]]  
*[[Abdominal distention]]  
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*Succussion splash (gastric outlet obstruction with GIST in pylorus)
*[[Rebound tenderness]] (positive Blumberg sign)
*Hemoperitoneum (intraperitoneal rupture of large GIST)  
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Palpable abdominal mass (location depends upon the site of GIST)
*Guarding may be present
*Severe cases may have abdominal perforation with signs of peritonitis such as:
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
**[[Abdominal tenderness]]  
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
**Rigidity
 
**Guarding
===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===
===Extremities===
*[[Clubbing]]
*Pitting [[edema]] of the lower extremities
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity




Revision as of 17:54, 8 December 2017

Gastrointestinal stromal tumor Microchapters

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melena hematochezia hematemesis, abdominal fullness, palpable mass. dysphagia (GISTs in proximal stomach) gastric outlet obstruction( tumors in pylorus) hemoperitoneum(intraperitoneal rupture of large tumor).

GISTs can occur as part of a syndrome; Carneys triad (gastric GIST, pulmonary chondroma, paraganglioma), or neurofibromatosis type 1 (mostly spindle cell GIST)[27].

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].

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 [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
  • The presence of [finding(s)] on physical examination is diagnostic of [disease name].
  • The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Appearance of the Patient

  • Patients with GIST usually appear tired.

Vital Signs

Skin

  • Jaundice (seen in obstructive duodenal GIST)
  • Pallor (seen with abdominal bleeding)

HEENT

  • Icteric sclera (seen in obstructive duodenal GIST)

Neck

Abdomen

  • Abdominal distention
  • Succussion splash (gastric outlet obstruction with GIST in pylorus)
  • Hemoperitoneum (intraperitoneal rupture of large GIST)
  • Palpable abdominal mass (location depends upon the site of GIST)
  • Severe cases may have abdominal perforation with signs of peritonitis such as:

Extremities

  • Pitting edema of the lower extremities


References


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