Gastrointestinal perforation physical examination
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
Overview
Appearance of the Patient[edit | edit source] Patients may appear tired, weak, diaphoretic and anxious.[1] Patients may appear quite well if the disease is asymptomatic. Patients may appear flushed due to associated increase in erythropoietin secretion.[2] Patients may appear obese due to associated type2 diabetes mellitus and Cushing's syndrome.[3] Vital Signs[edit | edit source] Tachycardia with a regular pulse. Irregular pulse may occurr in supraventricular tachycardia. Tachypnea if malignant secondaries are found in the lung. Dyspnea occurs in patients with complicated heart failure and cardiomyopathy. Rapid strong equal pulse. High blood pressure with normal pulse pressure. Hypotension occurs due to fluid contraction. Skin[edit | edit source] Jaundice secondary to deranged liver function in case of metastasis to the liver. Head[edit | edit source] Facial flushing. Scleral icterus in case of metastasis to the liver. MEN2 patients associated with mucosal neuromas show multiple lips and tongue neuromas. Neck[edit | edit source] Congested neck veins in patients with cardiomyopathy.[4] Painless lymphadenopathy if malignant secondaries found in the neck (rapid increase in the size of the node. Prevalence of malignancy in lymph node biopsies performed is 60%.[5] Thyromegaly/thyroid nodules if MEN patients due to medullary thyroid cancer.[6] Lungs[edit | edit source] Asymmetric chest expansion / decreased chest expansion if malignant secondaries are found in the lung. Heart[edit | edit source] Chest tenderness upon palpation in MEN1 patients due to hyperparathyroidism. Palpation: Precordial heave especially at apex due to left ventricular hypertrophy in long standing patients. Auscultation: normal S1 and accentuated S2 due to high systemic resistance. Abdomen[edit | edit source] Abdominal distention in patients with primary hyperparathyroidism associated constipation or Hirschsprung disease. Abdominal tenderness in the lower abdominal quadrants in MEN2 patients with Hirschsprung disease.[7] A palpable abdominal mass in the lower abdominal quadrant. Guarding may be present. Hepatomegaly if malignant secondaries found in liver. Diarrhea caused by gastrointestinal secretion of fluid and electrolytes, and flushing in medullary thyroid cancer patients.[8] Back[edit | edit source] Point tenderness in MEN1 patients with hyperparathyroidism.