Gastrointestinal perforation physical examination: Difference between revisions

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{{CMG}}; {{AE}} {{MAD}}
{{CMG}}; {{AE}} {{MAD}}


==Overview==
==Overview==
Appearance of the Patient[edit | edit source]
 
Patients may appear tired, weak, diaphoretic and anxious.[1]
=== Appearance of the Patient ===
Patients may appear quite well if the disease is asymptomatic.
* Patients may appear tired, weak, [[diaphoretic]] and [[anxious]] especially if sepsis developed.
Patients may appear flushed due to associated increase in erythropoietin secretion.[2]
* [[Immunocompromised]] patients may appear quite well at first.
Patients may appear obese due to associated type2 diabetes mellitus and Cushing's syndrome.[3]
 
Vital Signs[edit | edit source]
=== Vital Signs ===
Tachycardia with a regular pulse. Irregular pulse may occurr in supraventricular tachycardia.
* [[Tachycardia]]
Tachypnea if malignant secondaries are found in the lung. Dyspnea occurs in patients with complicated heart failure and cardiomyopathy.
* Rapid weak [[pulse]]
Rapid strong equal pulse.
* [[Hypotension]] occurs due to fluid contraction
High blood pressure with normal pulse pressure.
 
Hypotension occurs due to fluid contraction.
=== Skin ===
Skin[edit | edit source]
* [[Jaundice]] secondary to deranged [[liver]] function if sepsis developed.
Jaundice secondary to deranged liver function in case of metastasis to the liver.
 
Head[edit | edit source]
=== Head ===
Facial flushing.
* [[Icterus|Scleral icterus]] in case of [[liver failure]]
Scleral icterus in case of metastasis to the liver.
 
MEN2 patients associated with mucosal neuromas show multiple lips and tongue neuromas.
=== Lungs ===
Neck[edit | edit source]
* Asymmetric [[chest]] expansion/ decreased [[chest]] expansion in esophageal perforation patients
Congested neck veins in patients with cardiomyopathy.[4]
 
Painless lymphadenopathy if malignant secondaries found in the neck (rapid increase in the size of the node. Prevalence of malignancy in lymph node biopsies performed is 60%.[5]
=== Heart ===
Thyromegaly/thyroid nodules if MEN patients due to medullary thyroid cancer.[6]
* Chest [[tenderness]] in esophageal perforation patients
Lungs[edit | edit source]
 
Asymmetric chest expansion / decreased chest expansion if malignant secondaries are found in the lung.
=== Abdomen ===
Heart[edit | edit source]
* [[Abdominal distention]] 
Chest tenderness upon palpation in MEN1 patients due to hyperparathyroidism.
* [[Abdominal tenderness]]
Palpation: Precordial heave especially at apex due to left ventricular hypertrophy in long standing patients.
* A palpable [[abdominal mass]] in the lower [[abdominal]] quadrant especially with perforated [[colon]]
Auscultation: normal S1 and accentuated S2 due to high systemic resistance.
* [[Abdominal guarding|Guarding]] may be present
Abdomen[edit | edit source]
* [[Cutaneous]] [[fistula]] may be present
Abdominal distention in patients with primary hyperparathyroidism associated constipation or Hirschsprung disease.
Abdominal tenderness in the lower abdominal quadrants in MEN2 patients with Hirschsprung disease.[7]
A palpable abdominal mass in the lower abdominal quadrant.
Guarding may be present.
Hepatomegaly if malignant secondaries found in liver.
Diarrhea caused by gastrointestinal secretion of fluid and electrolytes, and flushing in medullary thyroid cancer patients.[8]
Back[edit | edit source]
Point tenderness in MEN1 patients with hyperparathyroidism.


==References==
==References==

Revision as of 18:49, 8 January 2018


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]

Overview

Appearance of the Patient

Vital Signs

Skin

  • Jaundice secondary to deranged liver function if sepsis developed.

Head

Lungs

  • Asymmetric chest expansion/ decreased chest expansion in esophageal perforation patients

Heart

  • Chest tenderness in esophageal perforation patients

Abdomen

References

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