Celiac disease physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Patients with celiac disease usually appear tired. Common physical examination findings of celiac disease include hepatosplenomegaly, abdominal tenderness with distention and scaly rash on extensor surfaces.

Physical Examination

Appearance

The patient may appear pale and fatigued.^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]

Skin/Mucous Membrane

Dermatitis herpetiformis
Alopecia
Scaly dermatitis
Easy bruisability

HEENT

Heart

Normal heart sounds

Lungs

Normal bilateral vesicular breath sounds

Abdomen

Pale, voluminous and malodorous diarrhoea.
Hepatosplenomegaly
Abdominal pain and cramping
Abdominal distention^[10]
Increased bowel sounds^[11]^[12]

Musculoskeletal

Non-specific bone and/or joint pain
Fractures - Osteopenia
Tetany
Decreased range of motion

Neurological

Peripheral neuropathy(decreased sensations)
Ataxia

Systemic

Extermities

Pallar nails
Edema

Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]

References

↑ Crabbé P, Heremans J (1967). "Selective IgA deficiency with steatorrhea. A new syndrome". Am J Med. 42 (2): 319–26. PMID 4959869.
↑ Collin P, Mäki M, Keyriläinen O, Hällström O, Reunala T, Pasternack A (1992). "Selective IgA deficiency and coeliac disease". Scand J Gastroenterol. 27 (5): 367–71. PMID 1529270.
↑ Marks J, Shuster S, Watson A (1966). "Small-bowel changes in dermatitis herpetiformis". Lancet. 2 (7476): 1280–2. PMID 4163419.
↑ Pengiran Tengah D, Wills A, Holmes G (2002). "Neurological complications of coeliac disease". Postgrad Med J. 78 (921): 393–8. PMID 12151653.
↑ Ferguson A, Hutton M, Maxwell J, Murray D (1970). "Adult coeliac disease in hyposplenic patients". Lancet. 1 (7639): 163–4. PMID 4189238.
↑ Holmes G (2001). "Coeliac disease and Type 1 diabetes mellitus - the case for screening". Diabet Med. 18 (3): 169–77. PMID 11318836.
↑ Collin P, Kaukinen K, Välimäki M, Salmi J (2002). "Endocrinological disorders and celiac disease". Endocr Rev. 23 (4): 464–83. PMID 12202461.
↑ Kingham J, Parker D (1998). "The association between primary biliary cirrhosis and coeliac disease: a study of relative prevalences". Gut. 42 (1): 120–2. PMID 9518232.
↑ Matteoni C, Goldblum J, Wang N, Brzezinski A, Achkar E, Soffer E (2001). "Celiac disease is highly prevalent in lymphocytic colitis". J Clin Gastroenterol. 32 (3): 225–7. PMID 11246349.
↑ Ferguson R, Basu M, Asquith P, Cooke W (1976). "Jejunal mucosal abnormalities in patients with recurrent aphthous ulceration". Br Med J. 1 (6000): 11–13. PMID 1247715.
↑ Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS. "Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis". Gastroenterology. 126 (7): 1721–32. PMID 15188167.
↑ "American Gastroenterological Association medical position statement: Celiac Sprue". Gastroenterology. 120 (6): 1522–5. 2001. PMID 11313323.
↑ Tursi A, Brandimarte G, Giorgetti G (2003). "High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal". Am J Gastroenterol. 98 (4): 839–43. PMID 12738465.
↑ ^14.00 ^14.01 ^14.02 ^14.03 ^14.04 ^14.05 ^14.06 ^14.07 ^14.08 ^14.09 ^14.10 ^14.11 ^14.12 ^14.13 ^14.14 ^14.15 ^14.16 ^14.17 ^14.18 ^14.19 ^14.20 ^14.21 ^14.22 ^14.23 ^14.24 ^14.25 ^14.26 ^14.27 ^14.28 ^14.29 ^14.30 ^14.31 ^14.32 ^14.33 ^14.34 ^14.35 ^14.36 ^14.37 ^14.38 ^14.39 ^14.40 ^14.41 ^14.42 ^14.43 ^14.44 ^14.45 ^14.46 ^14.47 ^14.48 ^14.49 ^14.50 ^14.51 "Dermatology Atlas".

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[1] Crabbé P, Heremans J (1967). "Selective IgA deficiency with steatorrhea. A new syndrome". Am J Med. 42 (2): 319–26. PMID 4959869.

[2] Collin P, Mäki M, Keyriläinen O, Hällström O, Reunala T, Pasternack A (1992). "Selective IgA deficiency and coeliac disease". Scand J Gastroenterol. 27 (5): 367–71. PMID 1529270.

[Marks-3] Marks J, Shuster S, Watson A (1966). "Small-bowel changes in dermatitis herpetiformis". Lancet. 2 (7476): 1280–2. PMID 4163419.

[4] Pengiran Tengah D, Wills A, Holmes G (2002). "Neurological complications of coeliac disease". Postgrad Med J. 78 (921): 393–8. PMID 12151653.

[Ferguson-5] Ferguson A, Hutton M, Maxwell J, Murray D (1970). "Adult coeliac disease in hyposplenic patients". Lancet. 1 (7639): 163–4. PMID 4189238.

[Holmes-6] Holmes G (2001). "Coeliac disease and Type 1 diabetes mellitus - the case for screening". Diabet Med. 18 (3): 169–77. PMID 11318836.

[7] Collin P, Kaukinen K, Välimäki M, Salmi J (2002). "Endocrinological disorders and celiac disease". Endocr Rev. 23 (4): 464–83. PMID 12202461.

[8] Kingham J, Parker D (1998). "The association between primary biliary cirrhosis and coeliac disease: a study of relative prevalences". Gut. 42 (1): 120–2. PMID 9518232.

[9] Matteoni C, Goldblum J, Wang N, Brzezinski A, Achkar E, Soffer E (2001). "Celiac disease is highly prevalent in lymphocytic colitis". J Clin Gastroenterol. 32 (3): 225–7. PMID 11246349.

[10] Ferguson R, Basu M, Asquith P, Cooke W (1976). "Jejunal mucosal abnormalities in patients with recurrent aphthous ulceration". Br Med J. 1 (6000): 11–13. PMID 1247715.

[Spiegel-11] Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS. "Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis". Gastroenterology. 126 (7): 1721–32. PMID 15188167.

[AGA-12] "American Gastroenterological Association medical position statement: Celiac Sprue". Gastroenterology. 120 (6): 1522–5. 2001. PMID 11313323.

[Tursi-13] Tursi A, Brandimarte G, Giorgetti G (2003). "High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal". Am J Gastroenterol. 98 (4): 839–43. PMID 12738465.

[Dermatology_Atlas-14] 14.00 ^14.01 ^14.02 ^14.03 ^14.04 ^14.05 ^14.06 ^14.07 ^14.08 ^14.09 ^14.10 ^14.11 ^14.12 ^14.13 ^14.14 ^14.15 ^14.16 ^14.17 ^14.18 ^14.19 ^14.20 ^14.21 ^14.22 ^14.23 ^14.24 ^14.25 ^14.26 ^14.27 ^14.28 ^14.29 ^14.30 ^14.31 ^14.32 ^14.33 ^14.34 ^14.35 ^14.36 ^14.37 ^14.38 ^14.39 ^14.40 ^14.41 ^14.42 ^14.43 ^14.44 ^14.45 ^14.46 ^14.47 ^14.48 ^14.49 ^14.50 ^14.51 "Dermatology Atlas".

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