Esophageal stricture physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Patients with esophageal cancer can usually appear normal. Physical examination of patients with esophageal stricture due to malignant causes is usually remarkable for cachectic and pale
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
Esophageal stricture has many causes. Physical examination due to different causes include:
- 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 esophageal stricture due to malignant causes usually appear cachectic and pale
Vital Signs
- Hypertension spicking specially in patients already with hypertension in gastroesophageal reflux disease[1]
- 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
- Bullous skin eruptions in epidermolysis bullosa dystrophica as a cause of esophageal stricture [2]
-
Epidermolysis bullosa dystrofic dominant. Adapted from Dermatology Atlas.[3]
-
Epidermolysis bullosa dystrofic dominant. Adapted from Dermatology Atlas.[3]
- Pallor in malignant causes
HEENT
Esophageal stricture due to gastroesophageal reflux disease:
- Hoarse voice
- Oropharyngeal erythema
- Dental erosions
Neck
- Left supraclavicular lymphadenopathy (Virchow node) due to malignant causes of esophageal stricture
- 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
- Wheezing
- Bronchitis[4]
- Asymmetric chest expansion / Decreased chest expansion
- Lungs are hypo/hyperresonant
- Fine/coarse crackles upon auscultation of the lung bases/apices unilaterally/bilaterally
- Rhonchi
- Vesicular breath sounds / Distant breath sounds
- Expiratory/inspiratory wheezing with normal / delayed expiratory phase
- Wheezing may be present
- Egophony present/absent
- Bronchophony present/absent
- Normal/reduced tactile fremitus
Heart
- Chest tenderness upon palpation
- PMI within 2 cm of the sternum (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
- Heave / thrill
- Friction rub
- S1
- S2
- S3
- S4
- Gallops
- 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
- Epigastric tenderness due to gastroesophageal reflux
- 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
References
- ↑ Li ZT, Ji F, Han XW, Wang L, Yue YQ, Wang ZG (2017). "The Role of Gastroesophageal Reflux in Provoking High Blood Pressure Episodes in Patients With Hypertension". J Clin Gastroenterol. doi:10.1097/MCG.0000000000000933. PMID 28961574.
- ↑ Luedtke P, Levine MS, Rubesin SE, Weinstein DS, Laufer I (2003). "Radiologic diagnosis of benign esophageal strictures: a pattern approach". Radiographics. 23 (4): 897–909. doi:10.1148/rg.234025717. PMID 12853664.
- ↑ 3.0 3.1 "Dermatology Atlas".
- ↑ Hom C, Vaezi MF (2013). "Extraesophageal manifestations of gastroesophageal reflux disease". Gastroenterol Clin North Am. 42 (1): 71–91. doi:10.1016/j.gtc.2012.11.004. PMID 23452632.