Peptic ulcer physical examination: Difference between revisions
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**Hypoactive bowel sounds | **Hypoactive bowel sounds | ||
{{CMG}} {{AE}} {{MKK}} | |||
==Overview== | |||
Peptic ulcer disease patient appears in severe stress due to [[abdominal pain]]. Common physical examination findings of peptic ulcer disease include epigastric tenderness, [[tachycardia]].Perforated peptic ulcer disease patient presents with classic triad of severe epigastric tenderness, [[tachycardia]], and abdominal rigidity. Clinical signs of perforated peptic ulcer comes in 3 stages: In the initial stage within first 2 hours, the patient presents with [[tachycardia]], [[epigastric pain]] and [[cool extremities]].In next 2 to 12 hours, the patient presents with lower right quadrant tenderness and [[abdominal rigidity]]. In more than 12 hours, the patient presents with [[abdominal distension]], [[hypotension]], and [[pyrexia]] with [[acute circulatory collapse]].<ref>{{cite journal |vauthors=Chung KT, Shelat VG |title=Perforated peptic ulcer - an update |journal=World J Gastrointest Surg |volume=9 |issue=1 |pages=1–12 |year=2017 |pmid=28138363 |pmc=5237817 |doi=10.4240/wjgs.v9.i1.1 |url=}}</ref> | |||
==Physical Examination== | |||
===Appearance of the Patient=== | |||
*Patient usually appear in severe distress due to severe [[Abdominal pain|abdominal pain.]] | |||
===Vital Signs=== | |||
*Patient has normal vital signs in initial stages of peptic ulcer. | |||
*In peptic ulcer perforations vital signs may include :<ref>{{cite journal |vauthors=Bertleff MJ, Lange JF |title=Perforated peptic ulcer disease: a review of history and treatment |journal=Dig Surg |volume=27 |issue=3 |pages=161–9 |year=2010 |pmid=20571260 |doi=10.1159/000264653 |url=}}</ref> | |||
**[[Tachycardia]] with regular pulse | |||
**Weak pulse | |||
**low [[blood pressure]] with normal pulse pressure | |||
**High-grade [[fever]] is present at later stage of peptic ulcer perforation | |||
===Skin=== | |||
*Pallor is present in patients presents with [[hematemesis]] and [[melena]]. | |||
<gallery widths="150"> | |||
File:Iron deficiency anemia blood film.jpg|Source- Dr Graham Beards (Own work) <ref>CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons</ref> | |||
File:Anemia.jpg|The hand of a person with severe anemia (on the left) compared to one without (on the right) Source -James Heilman, MD - Own work<ref> CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=10313974</ref> | |||
</gallery> | |||
===HEENT=== | |||
* Pallor on the lower [[conjunctiva]] can be seen. | |||
===Lungs=== | |||
* Normal B/L vesicular [[breath sounds.]] | |||
===Heart=== | |||
*S1 and S2 normal ,no murmur/rubs/gallops. | |||
===Abdomen=== | |||
*[[Abdominal tenderness]] at the epigastrium | |||
*Perforated peptic ulcer presents with<ref>{{cite journal |vauthors=Bertleff MJ, Lange JF |title=Perforated peptic ulcer disease: a review of history and treatment |journal=Dig Surg |volume=27 |issue=3 |pages=161–9 |year=2010 |pmid=20571260 |doi=10.1159/000264653 |url=}} </ref> | |||
**[[Rebound tenderness]] | |||
**Decreased [[bowel sound]]<nowiki/>s | |||
**Lower right quadrant tenderness | |||
**Abdominal rigdity | |||
**[[Abdominal distension]] <ref>{{cite journal |vauthors=Chung KT, Shelat VG |title=Perforated peptic ulcer - an update |journal=World J Gastrointest Surg |volume=9 |issue=1 |pages=1–12 |year=2017 |pmid=28138363 |pmc=5237817 |doi=10.4240/wjgs.v9.i1.1 |url=}}</ref> | |||
==References== | |||
* References should be cited for the material that you have put on your page. Type in <nowiki>{{reflist|2}}</nowiki>.This will generate your references in small font, in two columns, with links to the original article and abstract. | |||
* For information on how to add references into your page, click [[References|here]]. | |||
{{reflist|2}} | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 19:14, 18 October 2017
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Peptic ulcer Microchapters |
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Diagnosis |
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Treatment |
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Surgery |
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Case Studies |
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2017 ACG Guidelines for Peptic Ulcer Disease |
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Guidelines for the Indications to Test for, and to Treat, H. pylori Infection |
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Guidlines for factors that predict the successful eradication when treating H. pylori infection |
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Guidelines to document H. pylori antimicrobial resistance in the North America |
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Guidelines for evaluation and testing of H. pylori antibiotic resistance |
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Guidelines for when to test for treatment success after H. pylori eradication therapy |
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Guidelines for penicillin allergy in patients with H. pylori infection |
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Peptic ulcer physical examination On the Web |
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American Roentgen Ray Society Images of Peptic ulcer physical examination |
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Risk calculators and risk factors for Peptic ulcer physical examination |
Overview
Physical examination
In the initial evaluation look for:[1]
- Signs of active blood loss:
- Anemia: skin pallor, palpitations, tachycardia, hypotension, systolic murmur.
- Hematemesis.
- Melena.
- Heme-positive stool.
- Weight loss (suggest cancer).
- Sings of acute abdomen (perforation):
- Rebound tenderness
- Board-like-abdomen
- Hypoactive bowel sounds
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]
Overview
Peptic ulcer disease patient appears in severe stress due to abdominal pain. Common physical examination findings of peptic ulcer disease include epigastric tenderness, tachycardia.Perforated peptic ulcer disease patient presents with classic triad of severe epigastric tenderness, tachycardia, and abdominal rigidity. Clinical signs of perforated peptic ulcer comes in 3 stages: In the initial stage within first 2 hours, the patient presents with tachycardia, epigastric pain and cool extremities.In next 2 to 12 hours, the patient presents with lower right quadrant tenderness and abdominal rigidity. In more than 12 hours, the patient presents with abdominal distension, hypotension, and pyrexia with acute circulatory collapse.[2]
Physical Examination
Appearance of the Patient
- Patient usually appear in severe distress due to severe abdominal pain.
Vital Signs
- Patient has normal vital signs in initial stages of peptic ulcer.
- In peptic ulcer perforations vital signs may include :[3]
- Tachycardia with regular pulse
- Weak pulse
- low blood pressure with normal pulse pressure
- High-grade fever is present at later stage of peptic ulcer perforation
Skin
- Pallor is present in patients presents with hematemesis and melena.
-
![Source- Dr Graham Beards (Own work) [4]](/images/f/f2/Iron_deficiency_anemia_blood_film.jpg)
Source- Dr Graham Beards (Own work) [4] -
![The hand of a person with severe anemia (on the left) compared to one without (on the right) Source -James Heilman, MD - Own work[5]](/images/1/1f/Anemia.jpg)
The hand of a person with severe anemia (on the left) compared to one without (on the right) Source -James Heilman, MD - Own work[5]
![Source- Dr Graham Beards (Own work) [4]](/index.php/File:Iron_deficiency_anemia_blood_film.jpg)
![The hand of a person with severe anemia (on the left) compared to one without (on the right) Source -James Heilman, MD - Own work[5]](/index.php/File:Anemia.jpg)
HEENT
- Pallor on the lower conjunctiva can be seen.
Lungs
- Normal B/L vesicular breath sounds.
Heart
- S1 and S2 normal ,no murmur/rubs/gallops.
Abdomen
- Abdominal tenderness at the epigastrium
- Perforated peptic ulcer presents with[6]
- Rebound tenderness
- Decreased bowel sounds
- Lower right quadrant tenderness
- Abdominal rigdity
- Abdominal distension [7]
References
- References should be cited for the material that you have put on your page. Type in {{reflist|2}}.This will generate your references in small font, in two columns, with links to the original article and abstract.
- For information on how to add references into your page, click here.
- ↑ Ramakrishnan K, Salinas RC (2007). "Peptic ulcer disease". Am Fam Physician. 76 (7): 1005–12. PMID 17956071.
- ↑ Chung KT, Shelat VG (2017). "Perforated peptic ulcer - an update". World J Gastrointest Surg. 9 (1): 1–12. doi:10.4240/wjgs.v9.i1.1. PMC 5237817. PMID 28138363.
- ↑ Bertleff MJ, Lange JF (2010). "Perforated peptic ulcer disease: a review of history and treatment". Dig Surg. 27 (3): 161–9. doi:10.1159/000264653. PMID 20571260.
- ↑ CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
- ↑ CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=10313974
- ↑ Bertleff MJ, Lange JF (2010). "Perforated peptic ulcer disease: a review of history and treatment". Dig Surg. 27 (3): 161–9. doi:10.1159/000264653. PMID 20571260.
- ↑ Chung KT, Shelat VG (2017). "Perforated peptic ulcer - an update". World J Gastrointest Surg. 9 (1): 1–12. doi:10.4240/wjgs.v9.i1.1. PMC 5237817. PMID 28138363.