Ascending cholangitis 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 ascending cholangitis usually appear sick and fatigued. Physical examination of patients is usually remarkable for fever, abdominal tenderness and jaundice. Other findings that may be seen include hypotension, tachycardia and altered mental status in patients with septic shock or elderly
 
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.
The presence of Fever > 39C, jaundice and right upper quadrant tenderness on physical examination is highly suggestive of acute cholangitis<ref name="pmid175561493">{{cite journal| author=Kinney TP| title=Management of ascending cholangitis. | journal=Gastrointest Endosc Clin N Am | year= 2007 | volume= 17 | issue= 2 | pages= 289-306, vi | pmid=17556149 | doi=10.1016/j.giec.2007.03.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17556149  }}</ref>
 
OR
 
Physical examination of patients with [disease name] is usually remarkable for [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].


=== Appearance of the Patient ===
=== Appearance of the Patient ===
* Patients with [disease name] usually appear [general appearance].
* Patients with ascending cholangitis usually appear ill and faitigued.


=== Vital Signs ===
=== Vital Signs ===
* High-grade / low-grade fever
* High-grade fever
* [[Hypothermia]] / hyperthermia may be present
* [[Tachycardia]] with regular pulse may be seen in acute suppurative cholangitis
* [[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
* Low blood pressure - may be seen in acute suppurative cholangitis and in elderly<ref name="pmid17556149">{{cite journal| author=Kinney TP| title=Management of ascending cholangitis. | journal=Gastrointest Endosc Clin N Am | year= 2007 | volume= 17 | issue= 2 | pages= 289-306, vi | pmid=17556149 | doi=10.1016/j.giec.2007.03.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17556149  }}</ref>
* [[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
* Tachypnea / bradypnea
* Kussmal respirations may be present in _____ (advanced disease state)
* Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
* High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


=== Skin ===
=== Skin ===
* Skin examination of patients with [disease name] is usually normal.
* Skin examination of patients with ascending can show [[jaundice]]<ref name="pmid175561492">{{cite journal| author=Kinney TP| title=Management of ascending cholangitis. | journal=Gastrointest Endosc Clin N Am | year= 2007 | volume= 17 | issue= 2 | pages= 289-306, vi | pmid=17556149 | doi=10.1016/j.giec.2007.03.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17556149  }}</ref>
OR
* [[Cyanosis]]
* [[Jaundice]]
* [[Pallor]]
* Bruises
*  
*  
=== HEENT ===
=== HEENT ===
* HEENT examination of patients with [disease name] is usually normal.
* HEENT examination of patients with acute cholangitis may show yellowness of the eyes
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
* Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
* Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
* [[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
* [[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
* Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
 
=== Neck ===
=== Neck ===
* Neck examination of patients with [disease name] is usually normal.
* Neck examination of patients with acute cholangitis 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 ===
=== Lungs ===
* Pulmonary examination of patients with [disease name] is usually normal.
* Pulmonary examination of patients with ascending is usually normal.
OR
* However abnormalities may be seen in case of complicated suppurrative cholangitis
* Asymmetric chest expansion OR decreased chest expansion
* Lungs are hyporesonant OR hyperresonant
* Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
* Rhonchi
* Vesicular breath sounds OR distant breath sounds
* Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
* [[Wheezing]] may be present
* [[Egophony]] present/absent
* [[Bronchophony]] present/absent
* Normal/reduced [[tactile fremitus]]
 
=== Heart ===
=== Heart ===
* Cardiovascular examination of patients with [disease name] is usually normal.
* Cardiovascular examination of patients with ascending cholangitis is usually normal.
OR
* Tachycardia and arrythmias seen in complicated cases
* 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 S1.2C the .22lub.22.28components M1 and T1.29|S1]]
* [[Heart sounds#Second heart tone S2 the .22dub.22.28components A2 and P2.29|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 stethoscope
 
=== Abdomen ===
=== Abdomen ===
* Abdominal examination of patients with [disease name] is usually normal.
* [[Abdominal tenderness]] in the left upper abdominal quadrant
OR
* [[Abdominal distention]]
* [[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
* [[Rebound tenderness]] (positive Blumberg sign)
* [[Rebound tenderness]] (positive Blumberg sign)
* A palpable abdominal mass in the right/left upper/lower abdominal quadrant
* Guarding may be present
* Guarding may be present
* [[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
* Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


=== Back ===
=== Back ===
* Back examination of patients with [disease name] is usually normal.
* Back examination of patients with ascending cholangitis is usually normal.
OR
* Point tenderness over __ vertebrae (e.g. L3-L4)
* Sacral edema
* Costovertebral angle tenderness bilaterally/unilaterally
* Buffalo hump
 
=== Genitourinary ===
=== Genitourinary ===
* Genitourinary examination of patients with [disease name] is usually normal.
* Genitourinary examination of patients with ascending cholangitis is usually normal.
OR
=== Neuromuscular ===
* A pelvic/adnexal mass may be palpated
* Neuromuscular examination of patients with ascending is usually normal.
* Inflamed mucosa
* Clear/(color), foul-smelling/odorless penile/vaginal discharge


=== Neuromuscular ===
* Confusion and altered mental status can be seen in elderly or complicated cholangitis with septic shock
* Neuromuscular examination of patients with [disease name] is usually normal.
OR
* 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 ===
* Extremities examination of patients with [disease name] is usually normal.
* Extremities examination of patients with ascending cholangitis 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 16:04, 28 September 2018

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Overview

Patients with ascending cholangitis usually appear sick and fatigued. Physical examination of patients is usually remarkable for fever, abdominal tenderness and jaundice. Other findings that may be seen include hypotension, tachycardia and altered mental status in patients with septic shock or elderly

Physical Examination

The presence of Fever > 39C, jaundice and right upper quadrant tenderness on physical examination is highly suggestive of acute cholangitis[1]

Appearance of the Patient

  • Patients with ascending cholangitis usually appear ill and faitigued.

Vital Signs

  • High-grade fever
  • Tachycardia with regular pulse may be seen in acute suppurative cholangitis
  • Low blood pressure - may be seen in acute suppurative cholangitis and in elderly[2]

Skin

  • Skin examination of patients with ascending can show jaundice[3]

HEENT

  • HEENT examination of patients with acute cholangitis may show yellowness of the eyes

Neck

  • Neck examination of patients with acute cholangitis is usually normal.

Lungs

  • Pulmonary examination of patients with ascending is usually normal.
  • However abnormalities may be seen in case of complicated suppurrative cholangitis

Heart

  • Cardiovascular examination of patients with ascending cholangitis is usually normal.
  • Tachycardia and arrythmias seen in complicated cases

Abdomen

Back

  • Back examination of patients with ascending cholangitis is usually normal.

Genitourinary

  • Genitourinary examination of patients with ascending cholangitis is usually normal.

Neuromuscular

  • Neuromuscular examination of patients with ascending is usually normal.
  • Confusion and altered mental status can be seen in elderly or complicated cholangitis with septic shock

Extremities

  • Extremities examination of patients with ascending cholangitis is usually normal.

References

  1. ↑ Kinney TP (2007). "Management of ascending cholangitis". Gastrointest Endosc Clin N Am. 17 (2): 289–306, vi. doi:10.1016/j.giec.2007.03.006. PMID 17556149.
  2. ↑ Kinney TP (2007). "Management of ascending cholangitis". Gastrointest Endosc Clin N Am. 17 (2): 289–306, vi. doi:10.1016/j.giec.2007.03.006. PMID 17556149.
  3. ↑ Kinney TP (2007). "Management of ascending cholangitis". Gastrointest Endosc Clin N Am. 17 (2): 289–306, vi. doi:10.1016/j.giec.2007.03.006. PMID 17556149.
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