Mesenteric ischemia physical examination: Difference between revisions
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===Vital Signs=== | ===Vital Signs=== | ||
The following findings are present if the patient presents in a state of shock or hemodyanamic instability: | |||
*[[Tachycardia]] with irregular pulse in case of atrial fibrillation | *[[Tachycardia]] with irregular pulse in case of atrial fibrillation | ||
*Tachypnea | *Tachypnea | ||
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===Neck=== | ===Neck=== | ||
*[[Jugular venous distension]] in case of congestive heart failure | *[[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 | *[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope in patients having atherosclerosis. | ||
===Heart=== | ===Heart=== | ||
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]] is loud if the patient presents in shock | |||
*[[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#Second heart tone S2 the "dub"(components A2 and P2)|S2]] | ||
*[[Heart sounds#Third heart sound S3|S3]] | *[[Heart sounds#Third heart sound S3|S3]] can be present in case of congestibe heart failure. | ||
*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 | *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 examination shows the following findings in later stages stages of ischemia when transmural infarction has occured: | |||
*[[Abdominal distention]] | *[[Abdominal distention]] | ||
*[[Abdominal tenderness]] | *Generalized [[Abdominal tenderness]] | ||
*[[Rebound tenderness]] | *[[Rebound tenderness]] | ||
*Guarding may be present | *Guarding may be present | ||
===Extremities=== | ===Extremities=== | ||
Revision as of 18:13, 13 January 2018
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Mesenteric ischemia Microchapters |
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Risk calculators and risk factors for Mesenteric ischemia physical examination |
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
The following findings are present if the patient presents in a state of shock or hemodyanamic instability:
- 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.
Heart
- S1 is loud if the patient presents in shock
- S2
- S3 can be present in case of congestibe heart failure.
- 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 examination shows the following findings in later stages stages of ischemia when transmural infarction has occured:
- Abdominal distention
- Generalized Abdominal tenderness
- Rebound tenderness
- Guarding may be present