Acute diarrhea physical examination: Difference between revisions

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==Overview==
==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].
Patients with Acute diarrhea  usually appear [[Ill feeling|ill]], dehydrated or lethargic. Common physical examination findings of Acute diarrhea  include hypotension and other signs of volume depletion(depressed consciousness, sunken anterior fontanel, dry mucous membranes, poor skin turgor and delayed capillary refill), abdominal tenderness and distension, increased peristalytic activity(borborygmi).
 
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==
* Physical examination of patients with [disease name] is usually normal.
*Physical examination of patients with Acute diarrhea shows signs of dehydration( dry mouth and tongue, sunken eyes, sunken anterior fontanel, Poor skin turgor, hypotension,altered consciousness,absent tears), abdominal tenderness and distension, increased peristalytic activity,perineal erythema and signs of malnutrition.
OR
*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===
===Appearance of the Patient===
*Patients with acute diarrhea may appear [[Ill feeling|ill]], [[dehydrated]], or [[lethargic]] depending upon the seveority of diarrhea.   
*Patients with acute diarrhea may appear [[Ill feeling|ill]], [[dehydrated]], or [[lethargic]] depending upon the severity of diarrhea.   


===Vital Signs===
===Vital Signs===
* [[Hypotension]]
* [[Hypotension]]
* [[Fever]]
* [[Fever]]
* [[Orthostasis]]
* [[Orthostasis]]
 
*Tachycardia or bradycardia
===Assessment of dehydration===
===Assessment of dehydration===
*Dehydration is the major cause of morbidity and mortality in diarrhea.
*Dehydration is the major cause of morbidity and mortality in diarrhea.
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|Poor
|Poor
|}
|}
===Skin===
===Skin===
* Skin examination of patients with diarrhea can be done by pinch test.
* Skin examination of patients with diarrhea can be done by pinch test.
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**Moderate dehydration(5-10%): Pinch retracts slowly
**Moderate dehydration(5-10%): Pinch retracts slowly
**Severe dehydration(>10%): Pinch remain folded
**Severe dehydration(>10%): Pinch remain folded
 
*Delayed capillary refill
===Neck===
===Heart===
* Neck examination of patients with [disease name] is usually normal.
OR
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]
 
===Lungs===
* Pulmonary examination of patients with Acute diarrhea is usually normal.
 
'''Heart'''
*Hypotension
*Hypotension
*Tachycardia/ Bradycardia
*Tachycardia/ Bradycardia
*Decreased jugular venous pressure
*Decreased jugular venous pressure
===Abdomen===
===Abdomen===
*[[Abdominal distention]]  
*[[Abdominal distention]]  
*Diffuse [[Abdominal tenderness]]   
*Diffuse [[Abdominal tenderness]]   
*Borborygmi
*Borborygmi
*Rebound abdominal tenderness
*Rebound abdominal tenderness
*[[Hepatospleenomegaly]] is associated with  certain infections.  
*[[Hepatospleenomegaly]] is associated with  certain infections (eg: Mycobacterium Avium complex, Salmonellosis)
**
'''Perineal erythema'''
*In children mostly, frequent passage of stools cause perineal skin breakdown.
*Secondary carbohydrate malabsorption can cause acidic stools.
*Secondary bile acid malabsorption can result in  diaper dermatitis that is severe, often characterized as a "burn."
'''Failure to thrive and malnutrition'''
*Reductions in muscle and fat mass or peripheral edema may be present in  presence of  underlying carbohydrate, fat, and/or protein malabsorption.
*Giardia organisms can cause intermittent diarrhea and fat malabsorption.


===Genitourinary===
===HEENT===
*Perineal erythema
*Sunken anterior fontanel
**In children mostly, frequent passage of stools cause perineal skin breakdown.
*Oral mucosal lesions and angular stomatitis in Tropical sprue.
**Secondary carbohydrate malabsorption can cause acidic stools.
*Dry mucous membranes and tongue.
**Secondary bile acid malabsorption can result in  diaper dermatitis that is severe, often characterized as a "burn."


===Neuromuscular===


* Altered mental status
* Convulsions
*  sunken anterior fontanel






===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

Revision as of 23:46, 9 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]

Overview

Patients with Acute diarrhea usually appear ill, dehydrated or lethargic. Common physical examination findings of Acute diarrhea include hypotension and other signs of volume depletion(depressed consciousness, sunken anterior fontanel, dry mucous membranes, poor skin turgor and delayed capillary refill), abdominal tenderness and distension, increased peristalytic activity(borborygmi).

Physical Examination

  • Physical examination of patients with Acute diarrhea shows signs of dehydration( dry mouth and tongue, sunken eyes, sunken anterior fontanel, Poor skin turgor, hypotension,altered consciousness,absent tears), abdominal tenderness and distension, increased peristalytic activity,perineal erythema and signs of malnutrition.

Appearance of the Patient

  • Patients with acute diarrhea may appear ill, dehydrated, or lethargic depending upon the severity of diarrhea.

Vital Signs

Assessment of dehydration

  • Dehydration is the major cause of morbidity and mortality in diarrhea.
  • Every patient with diarrhea should be assessed for signs, symptoms, and severity.
  • Common findings on physical exam: Lethargy, depressed consciousness, diminshed skin turgor, sunken anterior fontanel, dry mucous membranes, sunken eyes, lack of tears, and delayed capillary refill are obvious and important signs of dehydration.
Mild dehydration (<5%) Moderate dehydration (5-10%) Severe dehydration
Eyes Normal Sunken Very sunken
Mouth Moist Dry Very dry
Tears Present Absent Absent
Thirst Normal Thirsty Poor

Skin

  • Skin examination of patients with diarrhea can be done by pinch test.
  • If the skin on the thigh, calf, or forearm is pinched , it will immediately return to its normally flat state when the pinch is released in normal patients.
    • Mild dehydration(0-5%): Pinch retracts immediately
    • Moderate dehydration(5-10%): Pinch retracts slowly
    • Severe dehydration(>10%): Pinch remain folded
  • Delayed capillary refill

Heart

  • Hypotension
  • Tachycardia/ Bradycardia
  • Decreased jugular venous pressure

Abdomen

Perineal erythema

  • In children mostly, frequent passage of stools cause perineal skin breakdown.
  • Secondary carbohydrate malabsorption can cause acidic stools.
  • Secondary bile acid malabsorption can result in diaper dermatitis that is severe, often characterized as a "burn."

Failure to thrive and malnutrition

  • Reductions in muscle and fat mass or peripheral edema may be present in presence of underlying carbohydrate, fat, and/or protein malabsorption.
  • Giardia organisms can cause intermittent diarrhea and fat malabsorption.

HEENT

  • Sunken anterior fontanel
  • Oral mucosal lesions and angular stomatitis in Tropical sprue.
  • Dry mucous membranes and tongue.




References

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