Acute diarrhea physical examination

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

Overview

Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Physical Examination

• 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

• Patients with acute diarrhea may appear ill, dehydrated, or lethargic depending upon the seveority of diarrhea.

Vital Signs

• Hypotension
• Fever
• Orthostasis

Assessment of dehydration

• Dehydration is the major cause of morbidity and mortality in diarrhea.
• Every patient with diarrhea should be assessed for signs, symptoms, and severity.
• Common findings on physical exam: Lethargy, depressed consciousness, diminshed skin turgor, sunken anterior fontanel, dry mucous membranes, sunken eyes, lack of tears, and delayed capillary refill are obvious and important signs of dehydration.

	Mild dehydration (<5%)	Moderate dehydration (5-10%)	Severe dehydration
Eyes	Normal	Sunken	Very sunken
Mouth	Moist	Dry	Very dry
Tears	Present	Absent	Absent
Thirst	Normal	Thirsty	Poor

Skin

• Skin examination of patients with diarrhea can be done by pinch test.
  • Mild dehydration(0-5%): Pinch retracts immediately
  • Moderate dehydration(5-10%): Pinch retracts slowly
  • Severe dehydration(>10%): Pinch remain folded

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HEENT

• 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

• 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

• Pulmonary examination of patients with Acute diarrhea is usually normal.

Heart

• Hypotension
• Tachycardia/ Bradycardia

Abdomen

• Abdominal distention
• Diffuse Abdominal tenderness
• Borborygmi
• Rebound abdominal tenderness
• Hepatospleenomegaly is associated with certain infections.

Genitourinary

• Perineal erythema
  • In children mostly, frequent passage of stools cause perineal skin breakdown.
  • Secondary carbohydrate malabsorption can cause acidic stools.
  • Secondary bile acid malabsorption can result in diaper dermatitis that is severe, often characterized as a "burn."

Neuromuscular

• Altered mental status
• Convulsions
• sunken anterior fontanel

Extremities

• 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