Acute diarrhea physical examination: Difference between revisions

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{{Acute diarrhea}}
{{Acute diarrhea}}


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==Overview==
==Overview==
Patients with acute diarrhea usually appear [[Ill feeling|ill]], [[Dehydration|dehydrated]] or [[Fatigue|lethargic]]. Common physical examination findings of acute diarrhea include [[hypotension]] and other signs of [[Hypovolemia|volume depletion]] (depressed [[consciousness]], sunken anterior fontanel, dry mucous membranes, sunken eyes, poor skin turgor and delayed capillary refill), [[Tenderness (medicine)|abdominal tenderness]] and [[distension]], increased [[Peristalsis|peristaltic]] activity ([[Borborygmus|borborygmi]]).
Patients with acute diarrhea usually appear [[Ill feeling|ill]], [[Dehydration|dehydrated]] or [[Fatigue|lethargic]]. Common [[physical examination]] findings of acute diarrhea include [[hypotension]] and other signs of [[Hypovolemia|volume depletion]] (depressed [[consciousness]], sunken [[anterior fontanelle]], dry [[mucous membranes]], sunken eyes, poor skin turgor and [[Capillary refill time|delayed capillary refill]]), [[abdominal tenderness]] and [[distension]], increased [[Peristalsis|peristaltic]] activity ([[Borborygmus|borborygmi]]).


==Physical Examination==
==Physical Examination==
*Physical examination of patients with acute diarrhea shows signs of [[dehydration]] (dry mouth and tongue, sunken eyes, sunken anterior fontanel, poor skin turgor, [[hypotension]], [[Altered mental state|altered consciousness]], absent tears), [[Tenderness (medicine)|abdominal tenderness]] and [[distension]], increased [[Peristalsis|peristaltic]] activity, [[perineal]] [[erythema]] and signs of [[malnutrition]].
[[Physical examination]] of patients with acute diarrhea shows signs of [[dehydration]] ([[dry mouth]] and [[tongue]], sunken eyes, sunken [[anterior fontanelle]], poor skin turgor, [[hypotension]], [[Altered mental state|altered consciousness]], absent tears), [[Tenderness (medicine)|abdominal tenderness]] and [[distension]], increased [[Peristalsis|peristaltic]] activity, [[perineal]] [[erythema]] and signs of [[malnutrition]].


===Appearance of the Patient===
===Appearance of the patient===
*Patients with acute diarrhea may appear [[Ill feeling|ill]], [[dehydrated]], or [[lethargic]] depending upon the severity of diarrhea.   
*Patients with acute diarrhea may appear [[Ill feeling|ill]], [[dehydrated]], or [[lethargic]] depending upon the severity of diarrhea.   


===Vital Signs===
===Vital signs===
* [[Hypotension]]
* [[Hypotension]]
* [[Fever]]
* [[Fever]]
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*[[Tachycardia]] or [[bradycardia]]
*[[Tachycardia]] or [[bradycardia]]
*[[Tachypnea]]
*[[Tachypnea]]
'''Assessment of dehydration:'''<ref name="pmid28613793">{{cite journal |vauthors=Vega RM, Bhimji SS |title= |journal= |volume= |issue= |pages= |year= |pmid=28613793 |doi= |url=}}</ref> <ref name="pmid28846339">{{cite journal |vauthors=Nemeth V, Pfleghaar N |title= |journal= |volume= |issue= |pages= |year= |pmid=28846339 |doi= |url=}}</ref>
'''Assessment of dehydration:'''<ref name="pmid28613793">{{cite journal |vauthors=Vega RM, Bhimji SS |title= |journal= |volume= |issue= |pages= |year= |pmid=28613793 |doi= |url=}}</ref><ref name="pmid28846339">{{cite journal |vauthors=Nemeth V, Pfleghaar N |title= |journal= |volume= |issue= |pages= |year= |pmid=28846339 |doi= |url=}}</ref>
*[[Dehydration]] is the major cause of morbidity and [[Mortality rate|mortality]] in diarrhea.
*[[Dehydration]] is the major cause of [[morbidity]] and [[Mortality rate|mortality]] in diarrhea.
*Every patient with diarrhea should be assessed for signs, symptoms, and severity.
*Every patient with diarrhea should be assessed for [[Medical sign|signs]], [[symptoms]], and severity.
*Common findings of [[Hypovolemia|volume depletion]] on physical examination include [[lethargy]], depressed consciousness, diminshed skin turgor, sunken anterior fontanel, dry mucous membranes, sunken eyes, lack of tears, and delayed [[capillary refill]] are obvious and important signs of [[dehydration]].  
*Common findings of [[Hypovolemia|volume depletion]] on physical examination include [[lethargy]], depressed consciousness, diminshed skin turgor, sunken [[anterior fontanelle]], dry [[mucous membranes]], sunken eyes, lack of tears, and delayed [[capillary refill]] are obvious and important signs of [[dehydration]].  
{| class="wikitable"
{| class="wikitable"
! style="background:#4479BA; color: #FFFFFF" |
! style="background:#4479BA; color: #FFFFFF" |
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| style="background:#DCDCDC; + " |Respirations
| style="background:#DCDCDC; + " |Respirations
|Normal
|Normal
|Tachypnea
|[[Tachypnea]]
|Tachypnea
|[[Tachypnea]]
|-
|-
| style="background:#DCDCDC; + " |Mental status
| style="background:#DCDCDC; + " |Mental status
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| style="background:#DCDCDC; + " |Blood pressure
| style="background:#DCDCDC; + " |Blood pressure
|Normal
|Normal
|Hypotension
|[[Hypotension]]
|Hypotension
|[[Hypotension]]
|}
|}


===Skin===
===Skin===
* Skin examination of patients with diarrhea can be done by pinch test.
* [[Skin]] examination of patients with diarrhea can be done by pinch test.
* If the skin on the thigh, calf, or forearm is pinched , it will immediately return to its normally flat state when the pinch is released in normal patients.
* If the [[skin]] on the [[thigh]], [[Calf muscle|calf]], or [[forearm]] is pinched, it will immediately return to its normal flat state when the pinch is released in normal patients.
**Mild dehydration (0-5%): Pinch retracts immediately
**Mild dehydration (0-5%): Pinch retracts immediately
**Moderate dehydration (5-10%): Pinch retracts slowly
**Moderate dehydration (5-10%): Pinch retracts slowly
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===Abdomen===
===Abdomen===
*[[Abdominal distention]]  
*[[Abdominal distention]]  
*Diffuse [[Abdominal tenderness]]   
*Diffuse [[abdominal tenderness]]   
*[[Borborygmus|Borborygmi]]
*[[Borborygmus|Borborygmi]]
*Rigidity and rebound [[Tenderness (medicine)|abdominal tenderness]]
*Rigidity and [[Rebound tenderness|rebound abdominal tenderness]]
*[[Organomegaly|Hepatospleenomegaly]] is associated with certain [[Infection|infections]] ([[Mycobacterium avium intracellulare|Mycobacterium Avium complex]], [[Salmonellosis]])
*[[Organomegaly|Hepatospleenomegaly]] is associated with certain [[Infection|infections]] ([[Mycobacterium avium intracellulare|Mycobacterium Avium complex]], [[Salmonellosis]])
'''Perineal erythema'''
'''Perineal erythema'''
*In children mostly, frequent passage of [[Human feces|stools]] cause [[perineal]] skin breakdown.
*In children mostly, frequent passage of [[Human feces|stools]] cause [[perineal]] skin breakdown.
*[[Malabsorption|Carbohydrate malabsorption]] seconadary to diarrhea may be responsible for more acidic stools that results in [[erythema]].
*[[Malabsorption|Carbohydrate malabsorption]] secondary to diarrhea may be responsible for more acidic [[stools]], that results in [[erythema]].
*[[Bile acid malabsorption]] leads to [[Dermatitis|diaper dermatitis]] that is severe, appears as burnt perianal skin.
*[[Bile acid malabsorption]] leads to [[Dermatitis|diaper dermatitis]] that is severe, appears as burnt perianal [[skin]].
'''Failure to thrive and malnutrition'''
'''Failure to thrive and malnutrition'''
*Reductions in muscle and fat mass or peripheral [[edema]] may be present in presence of underlying [[carbohydrate]], [[fat]], and/or [[protein]] [[malabsorption]].
*Reductions in [[muscle]] and [[fat]] mass or peripheral [[edema]] may be present in presence of underlying [[carbohydrate]], [[fat]], and/or [[protein]] [[malabsorption]].
*[[Giardia lamblia|Giardia]] can cause intermittent diarrhea and fat malabsorption.
*[[Giardia lamblia|Giardia]] can cause intermittent diarrhea and fat malabsorption.
===Lungs===
===Lungs===
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===HEENT===
===HEENT===
*Sunken [[anterior fontanelle]]
*Sunken [[anterior fontanelle]]
*Oral mucosal lesions and [[Stomatitis|angular stomatitis]] in tropical sprue
*Oral mucosal lesions and [[Stomatitis|angular stomatitis]] in [[tropical sprue]]
*Dry [[Mucous membrane|mucous membranes]] and tongue
*Dry [[Mucous membrane|mucous membranes]] and [[tongue]]
===Neuromuscular===
===Neuromuscular===
*Irritability or lethargy
*[[Muscle weakness]] and [[Seizure|convulsions]] because of moderate to severe [[Electrolyte disturbance|electrolyte imbalance]]
*[[Muscle weakness]] and [[Seizure|convulsions]] because of moderate to severe [[Electrolyte disturbance|electrolyte imbalance]]


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{{WH}}
{{WH}}
{{WS}}
{{WS}}
<references />
[[Category:Medicine]]
[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Primary care]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date]]
<references />

Latest revision as of 20:16, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]

Overview

Patients with acute diarrhea usually appear ill, dehydrated or lethargic. Common physical examination findings of acute diarrhea include hypotension and other signs of volume depletion (depressed consciousness, sunken anterior fontanelle, dry mucous membranes, sunken eyes, poor skin turgor and delayed capillary refill), abdominal tenderness and distension, increased peristaltic activity (borborygmi).

Physical Examination

Physical examination of patients with acute diarrhea shows signs of dehydration (dry mouth and tongue, sunken eyes, sunken anterior fontanelle, poor skin turgor, hypotension, altered consciousness, absent tears), abdominal tenderness and distension, increased peristaltic activity, perineal erythema and signs of malnutrition.

Appearance of the patient

  • Patients with acute diarrhea may appear ill, dehydrated, or lethargic depending upon the severity of diarrhea.

Vital signs

Assessment of dehydration:[1][2]

Mild dehydration (<5%) Moderate dehydration (5-10%) Severe dehydration
Eyes Normal Sunken Very sunken
Tears Present Absent Absent
Thirst Normal Thirsty Poor
Mouth Moist Dry Very dry
Urine output Normal Decreased Oliguric
Fontanelle Normal Sunken Sunken
Respirations Normal Tachypnea Tachypnea
Mental status Normal Irritable Altered
Blood pressure Normal Hypotension Hypotension

Skin

  • Skin examination of patients with diarrhea can be done by pinch test.
  • If the skin on the thigh, calf, or forearm is pinched, it will immediately return to its normal flat state when the pinch is released in normal patients.
    • Mild dehydration (0-5%): Pinch retracts immediately
    • Moderate dehydration (5-10%): Pinch retracts slowly
    • Severe dehydration (>10%): Pinch remain folded
  • Delayed capillary refill

Heart

Abdomen

Perineal erythema

Failure to thrive and malnutrition

Lungs

HEENT

Neuromuscular


References

  1. ↑ Vega RM, Bhimji SS. PMID 28613793. Missing or empty |title= (help)
  2. ↑ Nemeth V, Pfleghaar N. PMID 28846339. Missing or empty |title= (help)


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