Constipation physical examination: Difference between revisions
Jump to navigation
Jump to search
mNo edit summary |
No edit summary |
||
| Line 1: | Line 1: | ||
__NOTOC__ | __NOTOC__ | ||
{{Constipation}} | {{Constipation}} | ||
{{CMG}} {{AE}} | {{CMG}} {{AE}}{{EG}} | ||
{{ | |||
==Overview== | ==Overview== | ||
Physical examination of patients with constipation is usually remarkable for [[anal fissure]] or palpable lumpy [[mass]] in [[abdomen]], particularly in left quadrant. The presence of [[thrombosed]] [[Hemorrhoid|external hemorrhoids]], [[skin tags]], [[rectal prolapse]], [[anal fissure]], [[Anal wart|anal warts]], [[excoriation]] or evidence of [[pruritus ani]] due to fecal soiling on [[physical examination]] are suggestive of constipation. Patients with chronic constipation usually appear to be discomfort while sit because of [[anal pain]]. | |||
== Physical Examination == | == Physical Examination == | ||
=== | *Physical examination of patients with constipation is usually remarkable for [[anal fissure]] or palpable lumpy [[mass]] in [[abdomen]], particularly in left quadrant. | ||
*The presence of [[thrombosed]] [[Hemorrhoid|external hemorrhoids]], [[skin tags]], [[rectal prolapse]], [[anal fissure]], [[Anal wart|anal warts]], [[excoriation]] or evidence of [[pruritus ani]] due to fecal soiling on [[physical examination]] are suggestive of constipation.<ref name="pmid21382584">{{cite journal| author=Rao SS, Meduri K| title=What is necessary to diagnose constipation? | journal=Best Pract Res Clin Gastroenterol | year= 2011 | volume= 25 | issue= 1 | pages= 127-40 | pmid=21382584 | doi=10.1016/j.bpg.2010.11.001 | pmc=3063397 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21382584 }}</ref> | |||
===Appearance of the Patient=== | |||
*Patients with chronic constipation usually appear to be discomfort while sit because of [[anal pain]]. | |||
===Skin=== | |||
*[[Dry skin]] may be seen in systemic sclerosis | |||
* | === HEENT === | ||
* | *[[Extraocular muscle|Extra-ocular]] movements may be abnormal | ||
* | ===Neck=== | ||
* | *[[Thyromegaly]]/[[Thyroid nodule|thyroid nodules]] may be seen in [[hypothyroidism]] | ||
* | ===Abdomen=== | ||
* | *[[Abdominal distention]] | ||
*[[Abdominal tenderness]] in the left lower abdominal quadrant | |||
*A palpable [[abdominal mass]] in the left lower abdominal quadrant | |||
===Neuromuscular=== | |||
*Patient is maybe not oriented to persons, place, and time | |||
*[[Altered mental status]] | |||
*[[Clonus]] may be present | |||
*[[Hyperreflexia]] | |||
*Positive (abnormal) [[Babinski's Reflex|Babinski]] | |||
*[[Muscle rigidity]] | |||
*[[Gait abnormality|Abnormal gait]] ([[Parkinsonian]] [[gait]]) | |||
*Unilateral/bilateral [[tremor]] (pill-rolling) | |||
=== | === Digital rectal examination (DRE)<ref name="pmid20656061">{{cite journal |vauthors=Tantiphlachiva K, Rao P, Attaluri A, Rao SS |title=Digital rectal examination is a useful tool for identifying patients with dyssynergia |journal=Clin. Gastroenterol. Hepatol. |volume=8 |issue=11 |pages=955–60 |year=2010 |pmid=20656061 |doi=10.1016/j.cgh.2010.06.031 |url=}}</ref> === | ||
{| class="wikitable" | |||
! colspan="2" |DRE steps respectively | |||
!Method | |||
!Findings | |||
|- | |||
| colspan="2" |'''''[[Inspection (medicine)|Inspection]]''''' | |||
| | |||
* Patient in left lateral decubitus, hips 90° flexed | |||
* Looking to the [[Perineal|perineal area]] under reasonable light | |||
| | |||
* Skin [[excoriation]] | |||
* [[Skin tags]] | |||
* [[Anal fissure]] | |||
* [[Scars]] | |||
* [[Hemorrhoids]] | |||
|- | |||
| colspan="2" |[[Sensation|'''''External sensation''''']] | |||
| | |||
* Using a stick with cotton head | |||
* Tapping and touching all 4 quadrants centripetally (anocutaneous reflex) | |||
| | |||
* Slight [[contraction]] of the [[skin]] and the [[external anal sphincter]] (normal reflex) | |||
* No [[contraction]] with cotton head but slight [[contraction]] with wooden head (decreased reflex) | |||
* No [[contraction]] with either of heads (absent reflex) | |||
|- | |||
| rowspan="4" |'''''Internal examination''''' | |||
| colspan="1" rowspan="1" |Digital palpation | |||
| | |||
* Inserting the index finger into the patient [[anus]] | |||
* Palpating the parts, such as [[mucosa]], [[muscle]], [[bone]], [[uterus]], or [[prostate]] | |||
| | |||
* [[Tenderness]] | |||
* [[Mass]] | |||
* [[Stricture]] | |||
* [[Stool]] consistency | |||
|- | |||
|[[Sphincter]] tonometry | |||
| | |||
* Evaluating the resting tone of the [[anal sphincter]] | |||
| | |||
* Normal | |||
* Decreased | |||
* Increased | |||
|- | |||
| colspan="1" rowspan="1" |Squeeze maneuver | |||
| | |||
* Evaluating the voluntary squeezing pressure of the [[anal sphincter]] | |||
* Asking to hold up to 30 seconds | |||
| | |||
* Normal | |||
* Decreased | |||
* Increased | |||
|- | |||
| colspan="1" rowspan="1" |[[Defecation]] maneuver | |||
| | |||
* Asking to push as if to defecate | |||
* Evaluating the push effort with a hand on the [[abdomen]] | |||
| | |||
* Push effort (Normal, decreased, excessive) | |||
* [[Anal]] relaxation (normal, impaired, paradoxical contraction) | |||
* [[Perineal]] descent (Normal, excessive, absent) | |||
|} | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 20:33, 13 December 2017
|
Constipation Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Constipation On the Web |
|
American Roentgen Ray Society Images of Constipation |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]
Overview
Physical examination of patients with constipation is usually remarkable for anal fissure or palpable lumpy mass in abdomen, particularly in left quadrant. The presence of thrombosed external hemorrhoids, skin tags, rectal prolapse, anal fissure, anal warts, excoriation or evidence of pruritus ani due to fecal soiling on physical examination are suggestive of constipation. Patients with chronic constipation usually appear to be discomfort while sit because of anal pain.
Physical Examination
- Physical examination of patients with constipation is usually remarkable for anal fissure or palpable lumpy mass in abdomen, particularly in left quadrant.
- The presence of thrombosed external hemorrhoids, skin tags, rectal prolapse, anal fissure, anal warts, excoriation or evidence of pruritus ani due to fecal soiling on physical examination are suggestive of constipation.[1]
Appearance of the Patient
- Patients with chronic constipation usually appear to be discomfort while sit because of anal pain.
Skin
- Dry skin may be seen in systemic sclerosis
HEENT
- Extra-ocular movements may be abnormal
Neck
- Thyromegaly/thyroid nodules may be seen in hypothyroidism
Abdomen
- Abdominal distention
- Abdominal tenderness in the left lower abdominal quadrant
- A palpable abdominal mass in the left lower abdominal quadrant
Neuromuscular
- Patient is maybe not oriented to persons, place, and time
- Altered mental status
- Clonus may be present
- Hyperreflexia
- Positive (abnormal) Babinski
- Muscle rigidity
- Abnormal gait (Parkinsonian gait)
- Unilateral/bilateral tremor (pill-rolling)
Digital rectal examination (DRE)[2]
| DRE steps respectively | Method | Findings | |
|---|---|---|---|
| Inspection |
|
||
| External sensation |
|
| |
| Internal examination | Digital palpation |
| |
| Sphincter tonometry |
|
| |
| Squeeze maneuver |
|
| |
| Defecation maneuver |
|
||
References
- ↑ Rao SS, Meduri K (2011). "What is necessary to diagnose constipation?". Best Pract Res Clin Gastroenterol. 25 (1): 127–40. doi:10.1016/j.bpg.2010.11.001. PMC 3063397. PMID 21382584.
- ↑ Tantiphlachiva K, Rao P, Attaluri A, Rao SS (2010). "Digital rectal examination is a useful tool for identifying patients with dyssynergia". Clin. Gastroenterol. Hepatol. 8 (11): 955–60. doi:10.1016/j.cgh.2010.06.031. PMID 20656061.