Pancreatic cancer physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Patients with pancreatic cancer are usually in the sixth decade of life and appear cachectic, with signs of malnutrition. Patients mostly present with palpable abdominal mass, epigastric tenderness radiating to the back, hepatospleenomegaly and signs of metastasis in advanced stages. These signs of metastasis include left supraclavicular lymphadenopathy (Virchow's node), palpable periumbilical mass (Sister Mary Joseph's node), metastatic palpable mass in the rectal pouch (Blumer's shelf) and the involvement of other nodes in the cervical area. | [[Patient|Patients]] with [[pancreatic cancer]] are usually in the sixth decade of life and appear [[Cachexia|cachectic]], with [[Medical sign|signs]] of [[malnutrition]]. Patients mostly present with [[Palpation|palpable]] [[abdominal mass]], [[epigastric]] [[tenderness]] radiating to the back, [[Organomegaly|hepatospleenomegaly]] and [[Medical sign|signs]] of [[metastasis]] in advanced stages. These [[Medical sign|signs]] of [[metastasis]] include left [[Supraclavicular lymph nodes|supraclavicular]] [[lymphadenopathy]] ([[Virchow's node]]), [[Palpation|palpable]] periumbilical mass (Sister Mary Joseph's node), [[Metastasis|metastatic]] palpable mass in the [[rectal]] pouch (Blumer's shelf) and the involvement of other [[Lymph node|nodes]] in the [[cervical]] area. | ||
==Physical Examination== | ==Physical Examination== | ||
*Physical examination of patients with pancreatic cancer is usually remarkable for: epigastric tenderness, jaundice, and palpable intra abdominal mass. | *Physical examination of patients with [[pancreatic cancer]] is usually remarkable for: epigastric tenderness, jaundice, and palpable intra abdominal mass. | ||
*The presence of left supraclavicular lymphadenopathy (Virchow's node), palpable periumbilical mass (Sister Mary Joseph's node), metastatic palpable mass in the rectal pouch (Blumer's shelf) on physical examination is diagnostic of metastasis. | *The presence of left supraclavicular lymphadenopathy (Virchow's node), palpable periumbilical mass (Sister Mary Joseph's node), metastatic palpable mass in the rectal pouch (Blumer's shelf) on physical examination is diagnostic of metastasis. | ||
*The presence of ascites and a palpable, non tender gall bladder on physical examination is a common finding in pancreatic cancer patients. | *The presence of ascites and a palpable, non tender gall bladder on physical examination is a common finding in pancreatic cancer patients. | ||
Revision as of 18:32, 15 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]
Overview
Patients with pancreatic cancer are usually in the sixth decade of life and appear cachectic, with signs of malnutrition. Patients mostly present with palpable abdominal mass, epigastric tenderness radiating to the back, hepatospleenomegaly and signs of metastasis in advanced stages. These signs of metastasis include left supraclavicular lymphadenopathy (Virchow's node), palpable periumbilical mass (Sister Mary Joseph's node), metastatic palpable mass in the rectal pouch (Blumer's shelf) and the involvement of other nodes in the cervical area.
Physical Examination
- Physical examination of patients with pancreatic cancer is usually remarkable for: epigastric tenderness, jaundice, and palpable intra abdominal mass.
- The presence of left supraclavicular lymphadenopathy (Virchow's node), palpable periumbilical mass (Sister Mary Joseph's node), metastatic palpable mass in the rectal pouch (Blumer's shelf) on physical examination is diagnostic of metastasis.
- The presence of ascites and a palpable, non tender gall bladder on physical examination is a common finding in pancreatic cancer patients.
Appearance of the Patient
- Patients with pancreatic cancer are usually in the sixth decade of life and appear cachectic, with signs of malnutrition. Patients mostly present with palpable abdominal mass, epigastric tenderness radiating to the back, hepatospleenomegaly and signs of metastasis in advanced stages. These signs of metastasis include left supraclavicular lymphadenopathy (Virchow's node), palpable periumbilical mass (Sister Mary Joseph's node), metastatic palpable mass in the rectal pouch (Blumer's shelf) and the involvement of other nodes in the cervical area.
Vital Signs
- regular pulse
- normal blood pressure
- afebrile
Skin
- Jaundice: Yellowish discoloration of skin, sclera
- Associated with palpable, non-tender and distended gallbladder at the right costal margin (Courvoisier's sign)
- Excoriations of the skin from unrelenting pruritus
- Darkening of the urine
- Acholic stools
- Pallor ±
- Skin manifestations may include:
- Bullous pemphigoid
- Cicatricial pemphigoid
- Migratory superficial thrombophlebitis (classic Trousseau's syndrome)
- Pancreatic panniculitis:
- Associated with acinar cell variant of pancreatic cancer
- Located mostly on the legs
- Appears as an erythematous subcutaneous area of nodular fat necrosis
-
Description (Adapted from Dermatology Atlas)
-
Description (Adapted from Dermatology Atlas)
Neck
- Signs of metastatic disease include:
- Left supraclavicular lymphadenopathy (Virchow's node)
- Palpable periumbilical mass (Sister Mary Joseph's node)
- Metastatic palpable mass in the rectal pouch (Blumer's shelf)
- Involvement of other nodes in the cervical area
Abdomen
- Abdominal distention
- Abdominal tenderness:
- Site: tenderness in mid epigastric region
- Onset: insidious
- Character: gnawing, visceral quality
- Radiation- mid/lower back due to tumor invasion of the retroperitoneal splanchnic nerve plexus
- Relieving factors: relieved on lying down in a curled or fetal position may improve the pain
- Aggravating factors: worse on lying supine or eating
- Timing: intermittent
- Severity- mild-moderate, worse at night
- An abdominal mass may be palpable in the epigastrium.
- Hepatomegaly may arise from liver metastasis
- splenomegaly may arise from portal vein obstruction
- hepatosplenomegaly
- Fluid thrill and dullness to percussion may be present due to ascites
Genitourinary
- In advanced stages of pancreatic cancer, metastatic palpable mass may be present in the rectal pouch.(Blumer's shelf)