Mesenteric ischemia physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Physical examination of patients with mesenteric ischemia can be normal in early stages or there may be mild abdominal distention in the absence of peritonitis which presents as rebound tenderness and guarding. As the ischemia progresses to involve all the layers of the intestine (transmural infarction), abdomen becomes distended, feculent ordor to the breath is present, peritoneal signs develop and bowel sounds become absent. Signs of dehydration and shock may also appear if not treated in time. | Physical examination of patients with [[Mesenteric ischemia|mesenteric]] ischemia can be normal in early stages or there may be mild [[Abdominal distension|abdominal]] distention in the absence of [[peritonitis]] which presents as [[rebound tenderness]] and [[Abdominal guarding|guarding]]. As the [[ischemia]] progresses to involve all the layers of the intestine (transmural infarction), abdomen becomes [[Abdominal distension|distended]], feculent ordor to the breath is present, [[Peritoneum|peritoneal]] signs develop and bowel sounds become absent. Signs of [[dehydration]] and [[shock]] may also appear if not treated in time. | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*Patients presenting with acute occlusive mesenteric ischemia are in acute distress while patients with chronic mesenteric ischemia may look malnourished due to sitophobia (fear of eating). | *Patients presenting with acute occlusive mesenteric ischemia are in acute distress while patients with chronic mesenteric ischemia may look malnourished due to sitophobia (fear of eating). | ||
Revision as of 14:00, 12 January 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Feham Tariq, MD [2]
Overview
Physical examination of patients with mesenteric ischemia can be normal in early stages or there may be mild abdominal distention in the absence of peritonitis which presents as rebound tenderness and guarding. As the ischemia progresses to involve all the layers of the intestine (transmural infarction), abdomen becomes distended, feculent ordor to the breath is present, peritoneal signs develop and bowel sounds become absent. Signs of dehydration and shock may also appear if not treated in time.
Appearance of the Patient
- Patients presenting with acute occlusive mesenteric ischemia are in acute distress while patients with chronic mesenteric ischemia may look malnourished due to sitophobia (fear of eating).
Vital Signs
- Tachycardia with irregular pulse in case of atrial fibrillation
- Tachypnea
- Weak/bounding pulse
Skin
Neck
- Jugular venous distension in case of congestive heart failure
- Carotid bruits may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope in patients having atherosclerosis
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
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)