Anal fissure physical examination

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

Physical Examination

• 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 anal fissure usually appear in pain.

Vital Signs

• 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

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

OR

• Cyanosis
• Jaundice
• Pallor
• Bruises

HEENT

• HEENT examination of patients with anal fissure is usually normal.

Neck

• Neck examination of patients with anal fissure is usually normal.

Lungs

• Pulmonary examination of patients with anal fissure is usually normal.

Heart

• Cardiovascular examination of patients with anal fissure is usually normal.

Abdomen

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

Back

• 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

• 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

Local/anal examination

By Bernardo Gui - Own work, Public Domain

By Jonathanlund - Own work, Public Domain

The examination should be done when the patient is lying in the lateral position. The digital rectal examination is contraindicated in many patients considering the amount of pain. Anoscopy/proctoscopy can be done with topical anesthesia with lidocaine jelly to examine/rule out internal hemorrhoids.

Inspection

• On inspection, there is a breach in the skin. A laceration can be seen usually in the posterior midline in 90% of patients while in the remaining 10% of patients in the anterior midline.
• Chronic anal fissures may have a skin tag also.

Palpation

Anal fissures are usually exquisitely tender and the patient is scared to touch them or let physician examine.

Neuromuscular

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

Extremities

• Extermities 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

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