Pancreatic fistula 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 [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].
OR
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
Physical Examination
Physical examination of patients with internal pancreatic fistulas is usually normal or asymptomatic, on the other hand patients with external pancreatic fistulas can present with drainage of fluid.
Appearance of the Patient
- Most of the patients with pancreatic fistulas usually appear normal, but some might show the following the features:
- Dehydration
- Weight loss from malnourishment
Vital Signs
- Patients with pancreatic fistulas may present with fever when there is an infection.
- Tachycardia with regular pulse may present in some patients.
Skin
- Skin examination of patients with pancreatic fistulas is usually normal.
HEENT
- HEENT examination of patients with pancreatic fistulas is usually normal.
Neck
- Neck examination of patients with pancreatic fistulas is usually normal.
Lungs
- Pulmonary examination of patients with pancreatic fistulas may shows the following due to large pleural effusions:[1]
- Dyspnea
- Cough
- Wheezing
- Pleuritic chest pain
- Reduced breath sounds
- Dullness to percussion
Heart
- Cardiovascular examination of patients with pancreatic fistulas is usually normal.
Abdomen
- Abdominal examination of patients with pancreatic fistulas is usually shows the following:
- Abdominal distension due to fluid accumulation which can lead to ascites
- The ascites have the following physical examination findings:
- Fluid wave
- Shifting dullness
- Dullness to percussion at the flanks
- 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
- 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
Neuromuscular
- Neuromuscular examination of patients with [disease name] is usually normal.
OR
- 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
- Extremities 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
- ↑ Fulcher AS, Capps GW, Turner MA (1999). "Thoracopancreatic fistula: clinical and imaging findings". J Comput Assist Tomogr. 23 (2): 181–7. doi:10.1097/00004728-199903000-00004. PMID 10096323.