Spontaneous bacterial peritonitis physical examination: Difference between revisions
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* Initially they appear alert, restless and irritable. | * Initially they appear alert, restless and irritable. | ||
* They may later become apathetic and delirious. | * They may later become apathetic and delirious. | ||
* They are often noticed lying quietly supine,on the bed with the knees flexed and with frequent limited intercostal respirations because any motion intensifies the abdominal pain. | * They are often noticed lying quietly [[supine]],on the bed with the knees flexed and with frequent limited intercostal respirations because any motion intensifies the abdominal pain. | ||
===Vital Signs=== | ===Vital Signs=== | ||
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====Pulse==== | ====Pulse==== | ||
* Tachycardia with weak, thready peripheral pulses represents decreased effective circulating blood volume, indicating a stage of shock later in the disease. | * [[Tachycardia]] with weak, thready peripheral pulses represents decreased effective circulating blood volume, indicating a stage of [[shock]] later in the disease. | ||
* May be normal or increased in rate due to [[infection]]. | * May be normal or increased in rate due to [[infection]]. | ||
* It may be low in volume due to [[dehydration]]. | * It may be low in volume due to [[dehydration]]. | ||
====Respiration==== | ====Respiration==== | ||
*Tachypnea due to infection and increased demand. | *[[Tachypnea]] due to infection and increased demand. | ||
===Skin=== | ===Skin=== | ||
* Skin over abdomen is tense due to [[ascites]]. | * Skin over abdomen is tense due to [[ascites]]. | ||
* Skin changes such as [[spider nevus]], palmar erythema, large abdominal wall collateral veins are suggestive of parenchymal liver disease and portal hypertension | * Skin changes such as [[Spider naevus|spider nevus]], [[palmar erythema]], large abdominal wall collateral veins are suggestive of [[Liver disease|parenchymal liver disease]] and [[portal hypertension]] | ||
===Eyes=== | ===Eyes=== | ||
* [[Jaundice]] may be seen in cases of liver [[cirrhosis]]. | * [[Jaundice]] may be seen in cases of liver [[cirrhosis]]. | ||
* [[Periorbital puffiness]] may be noticed in cases of [[renal failure]]. | * [[Periorbital edema|Periorbital puffiness]] may be noticed in cases of [[renal failure]]. | ||
===Neck=== | ===Neck=== | ||
* [[Jugular venous distension]] may be seen in cases of [[heart failure]] causing [[ascites]]. | * [[Jugular venous distension]] may be seen in cases of [[heart failure]] causing [[ascites]]. | ||
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* Signs of any [[infection]], or signs of volume overload in lungs due to [[heart failure]]. | * Signs of any [[infection]], or signs of volume overload in lungs due to [[heart failure]]. | ||
===Neurologic=== | ===Neurologic=== | ||
Following may be noticed when [[spontaneous bacterial peritonitis]] complicates or due to underlying liver or renal failure. | Following may be noticed when [[spontaneous bacterial peritonitis]] complicates or due to underlying [[Hepatic failure|liver]] or [[renal failure]]. | ||
* [[Stupor]] | * [[Stupor]] | ||
* [[Confusion]] | * [[Confusion]] | ||
* [[Seizures]] | * [[Seizures]] | ||
===Abdomen=== | ===Abdomen=== | ||
* Usually tense and distended due to ascites | * Usually tense and distended due to [[ascites]] | ||
* Marked [[abdominal tenderness]] to palpation is present. | * Marked [[abdominal tenderness]] to palpation is present. | ||
* [[Shifting dullness]] on percussion is noted in patients with ascites, but may be painful due to infection. | * [[Shifting dullness]] on percussion is noted in patients with [[ascites]], but may be painful due to infection. | ||
* Bowel sounds vary along the course of peritonitis, are initially hypoactive, and may disappear later. | * Bowel sounds vary along the course of peritonitis, are initially hypoactive, and may disappear later. | ||
* Absence of bowel sounds may be the only manifestation of peritonitis in some patients, and a high index of suspicion is necessary | * Absence of bowel sounds may be the only manifestation of [[peritonitis]] in some patients, and a high index of suspicion is necessary | ||
* The absence of any of these findings does not exclude peritonitis. | * The absence of any of these findings does not exclude [[peritonitis]]. | ||
===Extremities=== | ===Extremities=== | ||
* When present, peripheral edema in patients with liver disease is usually found in the lower extremities and occasionally may involve the abdominal wall. Patients with nephrotic syndrome or cardiac failure may have total body edema (anasarca). | * When present, [[peripheral edema]] in patients with [[liver disease]] is usually found in the lower extremities and occasionally may involve the [[Abdominal wall|abdominal wall.]] Patients with [[nephrotic syndrome]] or [[cardiac failure]] may have [[Anasarca|total body edema (anasarca)]]. | ||
==References== | ==References== | ||
Revision as of 11:30, 25 April 2017
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Spontaneous bacterial peritonitis Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]
Overview
Physical Examination
Appearance of the patient
- Patients with peritonitis are usually ill-appearing.
- Initially they appear alert, restless and irritable.
- They may later become apathetic and delirious.
- They are often noticed lying quietly supine,on the bed with the knees flexed and with frequent limited intercostal respirations because any motion intensifies the abdominal pain.
Vital Signs
Temperature
- Hyperthermia (temperatures as high as 42° C) is a sign of infection and hypothermia (temperatures as low as 35° C) indicates septic shock.
- Hypothermia is a grave sign,seen late in the course of the disease in patients with on-going intra-abdominal sepsis or septic shock.
Blood Pressure
- Hypertension can be seen if associated with any heart condition or renal disease.
- The blood pressure is maintained within normal limits early in the disease process but as peritonitis progresses, the blood pressure decreases due to volume lossdiarrhea or severe ascites.
Pulse
- Tachycardia with weak, thready peripheral pulses represents decreased effective circulating blood volume, indicating a stage of shock later in the disease.
- May be normal or increased in rate due to infection.
- It may be low in volume due to dehydration.
Respiration
- Tachypnea due to infection and increased demand.
Skin
- Skin over abdomen is tense due to ascites.
- Skin changes such as spider nevus, palmar erythema, large abdominal wall collateral veins are suggestive of parenchymal liver disease and portal hypertension
Eyes
- Jaundice may be seen in cases of liver cirrhosis.
- Periorbital puffiness may be noticed in cases of renal failure.
Neck
- Jugular venous distension may be seen in cases of heart failure causing ascites.
Heart
- Signs of heart failure may be seen like S3.
Lungs
- Signs of any infection, or signs of volume overload in lungs due to heart failure.
Neurologic
Following may be noticed when spontaneous bacterial peritonitis complicates or due to underlying liver or renal failure.
Abdomen
- Usually tense and distended due to ascites
- Marked abdominal tenderness to palpation is present.
- Shifting dullness on percussion is noted in patients with ascites, but may be painful due to infection.
- Bowel sounds vary along the course of peritonitis, are initially hypoactive, and may disappear later.
- Absence of bowel sounds may be the only manifestation of peritonitis in some patients, and a high index of suspicion is necessary
- The absence of any of these findings does not exclude peritonitis.
Extremities
- When present, peripheral edema in patients with liver disease is usually found in the lower extremities and occasionally may involve the abdominal wall. Patients with nephrotic syndrome or cardiac failure may have total body edema (anasarca).