Diverticulitis physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Diverticulitis diagnosis depends on taking a | Patients with diverticulitis usually appear toxic due to pain. Common physical examination findings include [[tachycardia]], [[fever]], [[abdominal tenderness]], [[guarding]] and [[rebound tenderness]], and presence of a palpable [[mass]]. Diverticulitis diagnosis depends on taking a proper [[History & Symptoms|history]] and performing a [[physical examination]]. The known [[diagnostic criteria]] for diverticulitis include [[abdominal tenderness]], especially in the [[Left lower quadrant abdominal pain resident survival guide|left lower quadrant]], and [[leukocytosis]]. [[CT scan]] findings help in [[disease]] confirmation. | ||
==Physical Examination== | ==Physical Examination== | ||
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===Diagnostic criteria=== | ===Diagnostic criteria=== | ||
Patients with acute diverticulitis usually present with the following:<ref name="pmid3536213">{{cite journal| author=Thompson WG, Patel DG| title=Clinical picture of diverticular disease of the colon. | journal=Clin Gastroenterol | year= 1986 | volume= 15 | issue= 4 | pages= 903-16 | pmid=3536213 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3536213 }} </ref> | Patients with acute diverticulitis usually present with the following:<ref name="pmid3536213">{{cite journal| author=Thompson WG, Patel DG| title=Clinical picture of diverticular disease of the colon. | journal=Clin Gastroenterol | year= 1986 | volume= 15 | issue= 4 | pages= 903-16 | pmid=3536213 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3536213 }} </ref> | ||
*[[Abdominal pain]] and left quadrant [[tenderness]] | *[[Abdominal pain]] and left quadrant [[tenderness]] in physical examination. | ||
*[[Leukocytosis]] in the lab findings. | *[[Leukocytosis]] in the lab findings. | ||
*CT scan confirms the disease. It usually shows dilated loops, extra-colonic air in case of [[fistula]], [[abscess]] and air fluid level. | *[[CT scan]] confirms the disease. It usually shows dilated loops, extra-colonic air in case of [[fistula]], [[abscess]], and air fluid level. | ||
===Appearance of the patient=== | ===Appearance of the patient=== | ||
Patients with diverticulitis | *Patients with diverticulitis appear toxic due to [[pain]] and [[infection]]. | ||
===Vital signs=== | ===Vital signs=== | ||
[[Fever]] | * [[Tachycardia]] | ||
* [[Fever]] | |||
===Abdomen=== | ===Abdomen=== | ||
Abdominal examination in the diverticulitis cases shows the following:<ref name="pmid10566700">{{cite journal| author=Stollman NH, Raskin JB| title=Diagnosis and management of diverticular disease of the colon in adults. Ad Hoc Practice Parameters Committee of the American College of Gastroenterology. | journal=Am J Gastroenterol | year= 1999 | volume= 94 | issue= 11 | pages= 3110-21 | pmid=10566700 | doi=10.1111/j.1572-0241.1999.01501.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10566700 }} </ref> | Abdominal examination in the diverticulitis cases shows the following:<ref name="pmid10566700">{{cite journal| author=Stollman NH, Raskin JB| title=Diagnosis and management of diverticular disease of the colon in adults. Ad Hoc Practice Parameters Committee of the American College of Gastroenterology. | journal=Am J Gastroenterol | year= 1999 | volume= 94 | issue= 11 | pages= 3110-21 | pmid=10566700 | doi=10.1111/j.1572-0241.1999.01501.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10566700 }} </ref> | ||
*[[Abdominal tenderness]] in the left lower quadrant. It | *[[Abdominal tenderness]] in the left lower quadrant. It rarely occurs on the right side. | ||
*[[Abdominal guarding|Guarding]] or [[rebound tenderness]] may be present. | *[[Abdominal guarding|Guarding]] or [[rebound tenderness]] may be present. | ||
* | *A palpable [[mass]] may be felt. | ||
*[[Bowel sounds]]: | *[[Bowel sounds]]: | ||
** | **Usually decreased | ||
**Normal in the mild cases | **Normal in the mild cases | ||
**Increased in cases of [[intestinal obstruction]] | **Increased in cases of [[intestinal obstruction]] | ||
*Mass may be palpable | *Mass may be palpable on [[rectal examination]] | ||
===Genitourinary=== | ===Genitourinary=== | ||
As a result of the colonic [[inflammation]], [[Urinary bladder|bladder]] [[inflammation]] may occur in small percentage of the patients. Clinical manifestations of [[cystitis]] will appear.<ref name="pmid13903556">{{cite journal| author=HAFNER CD, PONKA JL, BRUSH BE| title=Genitourinary manifestations of diverticulitis of the colon. A study of 500 cases. | journal=JAMA | year= 1962 | volume= 179 | issue= | pages= 76-8 | pmid=13903556 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13903556 }} </ref> | |||
* As a result of the colonic [[inflammation]], [[Urinary bladder|bladder]] [[inflammation]] may occur in a small percentage of the patients. Clinical manifestations of [[cystitis]] will appear.<ref name="pmid13903556">{{cite journal| author=HAFNER CD, PONKA JL, BRUSH BE| title=Genitourinary manifestations of diverticulitis of the colon. A study of 500 cases. | journal=JAMA | year= 1962 | volume= 179 | issue= | pages= 76-8 | pmid=13903556 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13903556 }} </ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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[[Category:Surgery]] | [[Category:Surgery]] | ||
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[[Category:Needs overview]] | [[Category:Needs overview]] | ||
[[Category:Needs content]] | [[Category:Needs content]] | ||
[[Category:Emergency medicine]] | |||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
Latest revision as of 21:26, 29 July 2020
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Diverticulitis Microchapters |
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Diverticulitis physical examination On the Web |
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American Roentgen Ray Society Images of Diverticulitis physical examination |
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Risk calculators and risk factors for Diverticulitis physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]
Overview
Patients with diverticulitis usually appear toxic due to pain. Common physical examination findings include tachycardia, fever, abdominal tenderness, guarding and rebound tenderness, and presence of a palpable mass. Diverticulitis diagnosis depends on taking a proper history and performing a physical examination. The known diagnostic criteria for diverticulitis include abdominal tenderness, especially in the left lower quadrant, and leukocytosis. CT scan findings help in disease confirmation.
Physical Examination
Diagnostic criteria
Patients with acute diverticulitis usually present with the following:[1]
- Abdominal pain and left quadrant tenderness in physical examination.
- Leukocytosis in the lab findings.
- CT scan confirms the disease. It usually shows dilated loops, extra-colonic air in case of fistula, abscess, and air fluid level.
Appearance of the patient
Vital signs
Abdomen
Abdominal examination in the diverticulitis cases shows the following:[2]
- Abdominal tenderness in the left lower quadrant. It rarely occurs on the right side.
- Guarding or rebound tenderness may be present.
- A palpable mass may be felt.
- Bowel sounds:
- Usually decreased
- Normal in the mild cases
- Increased in cases of intestinal obstruction
- Mass may be palpable on rectal examination
Genitourinary
- As a result of the colonic inflammation, bladder inflammation may occur in a small percentage of the patients. Clinical manifestations of cystitis will appear.[3]
References
- ↑ Thompson WG, Patel DG (1986). "Clinical picture of diverticular disease of the colon". Clin Gastroenterol. 15 (4): 903–16. PMID 3536213.
- ↑ Stollman NH, Raskin JB (1999). "Diagnosis and management of diverticular disease of the colon in adults. Ad Hoc Practice Parameters Committee of the American College of Gastroenterology". Am J Gastroenterol. 94 (11): 3110–21. doi:10.1111/j.1572-0241.1999.01501.x. PMID 10566700.
- ↑ HAFNER CD, PONKA JL, BRUSH BE (1962). "Genitourinary manifestations of diverticulitis of the colon. A study of 500 cases". JAMA. 179: 76–8. PMID 13903556.