Gastrointestinal perforation physical examination: Difference between revisions
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=== Vital Signs === | === Vital Signs === | ||
* [[Tachycardia]] | * [[Tachycardia]] | ||
* Rapid weak [[pulse]] | * Rapid weak [[pulse]]<ref name="pmid29355160" /> | ||
* [[Hypotension]] occurs due to fluid contraction | * [[Hypotension]] occurs due to fluid contraction | ||
=== Skin === | === Skin === | ||
* [[Jaundice]] secondary to deranged [[liver]] function if sepsis developed. | * [[Jaundice]] secondary to deranged [[liver]] function if sepsis developed.<ref name="pmid29355160">{{cite journal| author=Bankole AO, Osinowo AO, Adesanya AA| title=Predictive factors of management outcome in adult patients with mechanical intestinal obstruction. | journal=Niger Postgrad Med J | year= 2017 | volume= 24 | issue= 4 | pages= 217-223 | pmid=29355160 | doi=10.4103/npmj.npmj_143_17 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29355160 }}</ref> | ||
=== Head === | === Head === | ||
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=== Lungs === | === Lungs === | ||
* Asymmetric [[chest]] expansion/ decreased [[chest]] expansion in esophageal perforation patients | * Asymmetric [[chest]] expansion/ decreased [[chest]] expansion in esophageal perforation patients<ref name="pmid29108538">{{cite journal| author=Neesgaard B, Sejling AS, Ostenfeld-Møller LA| title=[Upper abdominal pain caused by oesophageal perforation]. | journal=Ugeskr Laeger | year= 2017 | volume= 179 | issue= 45 | pages= | pmid=29108538 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29108538 }}</ref> | ||
=== Heart === | === Heart === | ||
* Chest [[tenderness]] in esophageal perforation patients | * Chest [[tenderness]] in esophageal perforation patients<ref name="pmid29108538" /> | ||
=== Abdomen === | === Abdomen === | ||
* [[Abdominal distention]] | * [[Abdominal distention]]<ref name="pmid29364805">{{cite journal| author=Devaraj NK| title=Letter to the Editor: Colonic Perforation. | journal=Acta Med Port | year= 2017 | volume= 30 | issue= 12 | pages= 891 | pmid=29364805 | doi=10.20344/amp.9556 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29364805 }}</ref> | ||
* [[Abdominal tenderness]] | * [[Abdominal tenderness]]<ref name="pmid28439845">{{cite journal| author=Rami Reddy SR, Cappell MS| title=A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction. | journal=Curr Gastroenterol Rep | year= 2017 | volume= 19 | issue= 6 | pages= 28 | pmid=28439845 | doi=10.1007/s11894-017-0566-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28439845 }}</ref> | ||
* A palpable [[abdominal mass]] in the lower [[abdominal]] quadrant especially with perforated [[colon]] | * A palpable [[abdominal mass]] in the lower [[abdominal]] quadrant especially with perforated [[colon]] | ||
* [[Abdominal guarding|Guarding]] may be present | * [[Abdominal guarding|Guarding]] may be present<ref name="pmid29364805" /> | ||
* [[Cutaneous]] [[fistula]] may be present | * [[Cutaneous]] [[fistula]] may be present<ref name="pmid28439845" /> | ||
=== Presentation in neonatal perforation: === | === Presentation in neonatal perforation: === | ||
* Infants with spontaneous [[Gastrointestinal perforation|intestinal perforation]] (SIP) present with an acute onset of [[abdominal distension]] and [[hypotension]]. | * Infants with spontaneous [[Gastrointestinal perforation|intestinal perforation]] (SIP) present with an acute onset of [[abdominal distension]] and [[hypotension]].<ref name="pmid3397802">{{cite journal| author=Aschner JL, Deluga KS, Metlay LA, Emmens RW, Hendricks-Munoz KD| title=Spontaneous focal gastrointestinal perforation in very low birth weight infants. | journal=J Pediatr | year= 1988 | volume= 113 | issue= 2 | pages= 364-7 | pmid=3397802 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3397802 }}</ref> | ||
* [[Abdominal distension|Abdominal distention]] usually occurs without the abdominal wall [[erythema]], [[crepitus]], and [[induration]] commonly seen in patients with [[Necrotizing enterocolitis|necrotitzing enterocolitis]]. | * [[Abdominal distension|Abdominal distention]] usually occurs without the abdominal wall [[erythema]], [[crepitus]], and [[induration]] commonly seen in patients with [[Necrotizing enterocolitis|necrotitzing enterocolitis]]. | ||
* A black-bluish discoloration of the abdominal wall is often seen in SIP, and is not typical of [[Necrotizing enterocolitis|necrotitzing enterocolitis]]. | * A black-bluish discoloration of the abdominal wall is often seen in SIP, and is not typical of [[Necrotizing enterocolitis|necrotitzing enterocolitis]].<ref name="pmid16034475">{{cite journal| author=Adesanya OA, O'Shea TM, Turner CS, Amoroso RM, Morgan TM, Aschner JL| title=Intestinal perforation in very low birth weight infants: growth and neurodevelopment at 1 year of age. | journal=J Perinatol | year= 2005 | volume= 25 | issue= 9 | pages= 583-9 | pmid=16034475 | doi=10.1038/sj.jp.7211360 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16034475 }}</ref> | ||
==References== | ==References== | ||
Revision as of 04:30, 4 February 2018
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
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Overview
Gastrointestinal perforation physical examination
Appearance of the Patient
- Patients may appear tired, weak, diaphoretic and anxious especially if sepsis developed.
- Immunocompromised patients may appear quite well at first.
Vital Signs
- Tachycardia
- Rapid weak pulse[1]
- Hypotension occurs due to fluid contraction
Skin
Head
- Scleral icterus in case of liver failure
Lungs
Heart
- Chest tenderness in esophageal perforation patients[2]
Abdomen
- Abdominal distention[3]
- Abdominal tenderness[4]
- A palpable abdominal mass in the lower abdominal quadrant especially with perforated colon
- Guarding may be present[3]
- Cutaneous fistula may be present[4]
Presentation in neonatal perforation:
- Infants with spontaneous intestinal perforation (SIP) present with an acute onset of abdominal distension and hypotension.[5]
- Abdominal distention usually occurs without the abdominal wall erythema, crepitus, and induration commonly seen in patients with necrotitzing enterocolitis.
- A black-bluish discoloration of the abdominal wall is often seen in SIP, and is not typical of necrotitzing enterocolitis.[6]
References
- ↑ 1.0 1.1 Bankole AO, Osinowo AO, Adesanya AA (2017). "Predictive factors of management outcome in adult patients with mechanical intestinal obstruction". Niger Postgrad Med J. 24 (4): 217–223. doi:10.4103/npmj.npmj_143_17. PMID 29355160.
- ↑ 2.0 2.1 Neesgaard B, Sejling AS, Ostenfeld-Møller LA (2017). "[Upper abdominal pain caused by oesophageal perforation]". Ugeskr Laeger. 179 (45). PMID 29108538.
- ↑ 3.0 3.1 Devaraj NK (2017). "Letter to the Editor: Colonic Perforation". Acta Med Port. 30 (12): 891. doi:10.20344/amp.9556. PMID 29364805.
- ↑ 4.0 4.1 Rami Reddy SR, Cappell MS (2017). "A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction". Curr Gastroenterol Rep. 19 (6): 28. doi:10.1007/s11894-017-0566-9. PMID 28439845.
- ↑ Aschner JL, Deluga KS, Metlay LA, Emmens RW, Hendricks-Munoz KD (1988). "Spontaneous focal gastrointestinal perforation in very low birth weight infants". J Pediatr. 113 (2): 364–7. PMID 3397802.
- ↑ Adesanya OA, O'Shea TM, Turner CS, Amoroso RM, Morgan TM, Aschner JL (2005). "Intestinal perforation in very low birth weight infants: growth and neurodevelopment at 1 year of age". J Perinatol. 25 (9): 583–9. doi:10.1038/sj.jp.7211360. PMID 16034475.