Rectal prolapse physical examination: Difference between revisions

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=== HEENT[edit | edit source] ===
=== HEENT[edit | edit source] ===
* HEENT examination of patients with [disease name] is usually normal.
* HEENT examination of patients with [disease name] is usually normal.
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
* Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
* Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
* [[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
* [[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
* Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
=== Neck[edit | edit source] ===
=== Neck[edit | edit source] ===
* Neck examination of patients with [disease name] is usually normal.
* Neck examination of patients with [disease name] is usually normal.
OR
* [[Jugular venous distension]]
* [[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
* [[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
* [[Thyromegaly]] / thyroid nodules
* [[Hepatojugular reflux]]
=== Lungs[edit | edit source] ===
=== Lungs[edit | edit source] ===
* Pulmonary examination of patients with [disease name] is usually normal.
* Pulmonary examination of patients with [disease name] is usually normal.
OR
* Asymmetric chest expansion / Decreased chest expansion
* Lungs are hypo/hyperresonant
* Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
* Rhonchi
* Vesicular breath sounds / Distant breath sounds
* Expiratory/inspiratory wheezing with normal / delayed expiratory phase
* [[Wheezing]] may be present
* [[Egophony]] present/absent
* [[Bronchophony]] present/absent
* Normal/reduced [[tactile fremitus]]
=== Heart[edit | edit source] ===
=== Heart[edit | edit source] ===
* Cardiovascular examination of patients with [disease name] is usually normal.
* Cardiovascular examination of patients with [disease name] is usually normal.
OR
* Chest tenderness upon palpation
* PMI within 2 cm of the sternum (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
* [[Heave]] / [[thrill]]
* [[Friction rub]]
* [[Heart sounds#First heart tone S1.2C the .22lub.22.28components M1 and T1.29|S1]]
* [[Heart sounds#Second heart tone S2 the .22dub.22.28components A2 and P2.29|S2]]
* [[Heart sounds#Third heart sound S3|S3]]
* [[Heart sounds#Fourth heart sound S4|S4]]
* [[Heart sounds#Summation Gallop|Gallops]]
* A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope
=== Abdomen[edit | edit source] ===
=== Abdomen[edit | edit source] ===
Abdominal examination of patients with [disease name] is usually normal.
Abdominal examination of patients with [disease name] is usually normal.
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=== Extremities[edit | edit source] ===
=== Extremities[edit | edit source] ===
* Extremities examination of patients with [disease name] is usually normal.
* Extremities examination of patients with [disease name] is usually normal.
OR
* [[Clubbing]]
* [[Cyanosis]]
* Pitting/non-pitting [[edema]] of the upper/lower extremities
* Muscle atrophy
* Fasciculations in the upper/lower extremity
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Revision as of 21:20, 29 January 2018

Rectal prolapse Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Rectal Prolapse from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Abdominal X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

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

Overview

Patients with rectal prolapse usually have rectal mass or bulge in physical examination.

Physical Examination

Rectal prolapse can be diagnosed in outpatient clinics by history taking and inspection of the protruded rectum.[1] Physical examination of patients with rectal prolapse is usually remarkable for a large rectal mass or bulge that may or may not spontaneously reduce at the completion of a bowel movement or straining.[2] Anal inspection may reveal normal anal area, skin excoriation or irritation and the patulous anus and prolapsed rectum can become visible in a sitting position.[3]

  • Physical examination of patients with [disease name] is usually normal.

OR

  • Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
  • The presence of [finding(s)] on physical examination is diagnostic of [disease name].
  • The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Appearance of the Patient[edit | edit source]

  • Patients with [disease name] usually appear [general appearance].

Vital Signs[edit | edit source]

  • High-grade / low-grade fever
  • Hypothermia / hyperthermia may be present
  • Tachycardia with regular pulse or (ir)regularly irregular pulse
  • Bradycardia with regular pulse or (ir)regularly irregular pulse
  • Tachypnea / bradypnea
  • Kussmal respirations may be present in _____ (advanced disease state)
  • Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
  • High/low blood pressure with normal pulse pressure / wide pulse pressure / narrow pulse pressure

Skin[edit | edit source]

  • Skin examination of patients with [disease name] is usually normal.

OR

HEENT[edit | edit source]

  • HEENT examination of patients with [disease name] is usually normal.

Neck[edit | edit source]

  • Neck examination of patients with [disease name] is usually normal.

Lungs[edit | edit source]

  • Pulmonary examination of patients with [disease name] is usually normal.

Heart[edit | edit source]

  • Cardiovascular examination of patients with [disease name] is usually normal.

Abdomen[edit | edit source]

Abdominal examination of patients with [disease name] is usually normal.

OR

Back[edit | edit source]

  • Back examination of patients with [disease name] is usually normal.

OR

  • Point tenderness over __ vertebrae (e.g. L3-L4)
  • Sacral edema
  • Costovertebral angle tenderness bilaterally/unilaterally
  • Buffalo hump

Genitourinary[edit | edit source]

  • Genitourinary examination of patients with [disease name] is usually normal.

OR

  • A pelvic/adnexal mass may be palpated
  • Inflamed mucosa
  • Clear/(color), foul-smelling/odorless penile/vaginal discharge

Neuromuscular[edit | edit source]

  • Neuromuscular examination of patients with [disease name] is usually normal.

OR

  • Patient is usually oriented to persons, place, and time
  • Altered mental status
  • Glasgow coma scale is ___ / 15
  • Clonus may be present
  • Hyperreflexia / hyporeflexia / areflexia
  • Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
  • Muscle rigidity
  • Proximal/distal muscle weakness unilaterally/bilaterally
  • ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
  • Unilateral/bilateral upper/lower extremity weakness
  • Unilateral/bilateral sensory loss in the upper/lower extremity
  • Positive straight leg raise test
  • Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
  • Positive/negative Trendelenburg sign
  • Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
  • Normal finger-to-nose test / Dysmetria
  • Absent/present dysdiadochokinesia (palm tapping test)

Extremities[edit | edit source]

  • Extremities examination of patients with [disease name] is usually normal.

References

  1. Shin EJ (2011). "Surgical treatment of rectal prolapse". J Korean Soc Coloproctol. 27 (1): 5–12. doi:10.3393/jksc.2011.27.1.5. PMC 3053504. PMID 21431090.
  2. Bordeianou L, Hicks CW, Kaiser AM, Alavi K, Sudan R, Wise PE (2014). "Rectal prolapse: an overview of clinical features, diagnosis, and patient-specific management strategies". J. Gastrointest. Surg. 18 (5): 1059–69. doi:10.1007/s11605-013-2427-7. PMID 24352613.
  3. Patcharatrakul T, Rao S (2017). "Update on the Pathophysiology and Management of Anorectal Disorders". Gut Liver. doi:10.5009/gnl17172. PMID 29050194. Vancouver style error: initials (help)

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