Peptic ulcer physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Peptic ulcer}} | {{Peptic ulcer}} | ||
{{CMG}} {{AE}} {{MKK}} | {{CMG}} {{AE}} {{MKK}} | ||
==Overview== | ==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> | 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== | ==Physical Examination== | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*Patient usually appear in severe distress due to severe [[Abdominal pain|abdominal pain.]] | *Patient usually appear in severe distress due to severe [[Abdominal pain|abdominal pain.]] | ||
===Vital Signs=== | ===Vital Signs=== | ||
*Patient has normal vital signs in initial stages of peptic ulcer. | *Patient has normal vital signs in initial stages of peptic ulcer. | ||
| Line 34: | Line 14: | ||
**low [[blood pressure]] with normal pulse pressure | **low [[blood pressure]] with normal pulse pressure | ||
**High-grade [[fever]] is present at later stage of peptic ulcer perforation | **High-grade [[fever]] is present at later stage of peptic ulcer perforation | ||
===Skin=== | ===Skin=== | ||
*Pallor is present in patients presents with [[hematemesis]] and [[melena]]. | *Pallor is present in patients presents with [[hematemesis]] and [[melena]]. | ||
| Line 41: | Line 20: | ||
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> | 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> | </gallery> | ||
===HEENT=== | ===HEENT=== | ||
* Pallor on the lower [[conjunctiva]] can be seen. | * Pallor on the lower [[conjunctiva]] can be seen. | ||
===Lungs=== | ===Lungs=== | ||
* Normal B/L vesicular [[breath sounds.]] | * Normal B/L vesicular [[breath sounds.]] | ||
| Line 57: | Line 34: | ||
**Abdominal rigdity | **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> | **[[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== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 16:33, 16 November 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 |
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.[1]
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 :[2]
- 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) [3]](/images/f/f2/Iron_deficiency_anemia_blood_film.jpg)
Source- Dr Graham Beards (Own work) [3] -
![The hand of a person with severe anemia (on the left) compared to one without (on the right) Source -James Heilman, MD - Own work[4]](/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[4]
![Source- Dr Graham Beards (Own work) [3]](/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[4]](/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[5]
- Rebound tenderness
- Decreased bowel sounds
- Lower right quadrant tenderness
- Abdominal rigdity
- Abdominal distension [6]
References
- ↑ 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.