Diffuse esophageal spasm physical examination

Diffuse esophageal spasm Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Madhu Sigdel M.B.B.S.[2]

Overview

Patients with primary diffuse esophageal spasm usually appear normal. Physical examination of patients with DES is usually remarkable for findings related to secondary diseases.

Physical Examination

• Physical examination of patients with DES is usually remarkable for presence of features related to secondary diseases.

Appearance of the Patient

• Patients with primary DES usually appear normal.

Vital Signs

• High-grade / low-grade fever in infectious cause of DES
• 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
• Weak/bounding pulse
• High/low blood pressure with normal pulse pressure

Skin

• Tight, hardened skin in limited scleroderma
• Red spots or lines in skin of face and hand due to telengectasia in scleroderma
• Bumps under the skin due to deposition of calcium in scleroderma.
• Ulcers of finger and toes may be present in scleroderma
• Insect bite wound may be seen in Chaga's disease with excoriation at the bite site.

• Description (Adapted from Dermatology Atlas)

  Description (Adapted from Dermatology Atlas)

• 

  Description (Adapted from Dermatology Atlas)

HEENT

• Romana's sign is seen in Chaga's disease (swelling of eyelid at the site of parasite entry)
• Ophthalmoscopic exam may be abnormal with findings of diabetic retinopathy in diabetics as well as cataract changes.
• Lower extremities edema in Chaga's disease.
• Dry mouth and dry eye in scleroderma.

Neck

• Lymphadenopathy (Chaga's disease)
• Thyromegaly / thyroid nodules

Lungs

• Asymmetric chest expansion / Decreased chest expansion
• Lungs are hyperresonant in scleroderma.
• Fine/coarse crackles upon auscultation of the lung bases/apices bilaterally seen in scleroderma.

Heart

Heart involvement in Chagas's cardiomyopathy are:

Displaced point of maximal impulse (PMI) suggestive of ____

• S3, S4
• 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

• Abdominal distention
• Abdominal tenderness in the right/left upper/lower abdominal quadrant
• Rebound tenderness (positive Blumberg sign)
• A palpable abdominal mass in the right/left upper/lower abdominal quadrant
• Guarding may be present
• Hepatomegaly / splenomegaly / hepatosplenomegaly
• Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test

Back

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

Genitourinary

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

Neuromuscular

• 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

• Clubbing
• Cyanosis
• Pitting/non-pitting edema of the upper/lower extremities
• Muscle atrophy
• Fasciculations in the upper/lower extremity