Granulomatosis with polyangiitis physical examination: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
 
(18 intermediate revisions by 2 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Wegener's granulomatosis}}
{{Wegener's granulomatosis}}
{{CMG}}{{APM}}{{AE}}{{KW}}
{{CMG}}{{APM}}{{AE}}{{ADS}}{{KW}}


==Overview==
==Overview==
A complete medical history and a comprehensive renal, pulmonary, and ENT examination must be preformed to help identify and properly diagnose Granulomatosis with polyangiitis from other diseases.
The important physical exam findings are [[Ulcerations]], palpable [[purpura]] and subcutaneous [[nodules]] in the skin; [[conjunctivitis]], [[uveitis]], [[sinusitis]], [[purulent]] exudate from nares,[[saddle nose]] deformity, reduced hearing in the head and neck; [[pleuritic chest pain]] ans signs of [[atelectasis]] in lung examination; and signs of [[mononeuritis multiplex]] on neural exam.


==Physical Examination==
==Physical Examination==
A complete medical history and a comprehensive renal, pulmonary, and ENT examination must be preformed to help identify and properly diagnose Granulomatosis with polyangiitis form other diseases. A thorough physical examination can provide insight into possible causes and associated underlying conditions. The following findings may be present during a physical examination of Granulomatosis with polyangiitis:
*Physical examination of patients with Granulomatosis with polyangiitis is usually remarkable for:<ref name="pmid15210387">{{cite journal |vauthors=Seo P, Stone JH |title=The antineutrophil cytoplasmic antibody-associated vasculitides |journal=Am. J. Med. |volume=117 |issue=1 |pages=39–50 |date=July 2004 |pmid=15210387 |doi=10.1016/j.amjmed.2004.02.030 |url=}}</ref><ref name="pmid17106496">{{cite journal |vauthors=Graves N |title=Wegener granulomatosis |journal=Proc (Bayl Univ Med Cent) |volume=19 |issue=4 |pages=342–4 |date=October 2006 |pmid=17106496 |pmc=1618758 |doi= |url=}}</ref>


* Sinusitis
===Vital Signs===
* Scleritis
* Keratitis
* Uveitis
* Conjunctivitis
* Saddle nose deformity
* Atelectasis
* Pleural effusion
* Dyspnea
* Hemoptysis
* Pericardial rub
* Mononeuritis multiplex
* Cranial nerve paralysis
* Palpable purpura
* Subcutaneous nodules
* ulcerations


*They usually have normal vital signs until infected.


===Skin===
The skin findings are seen in 14% of patients:<ref name="pmid8089286">{{cite journal |vauthors=Daoud MS, Gibson LE, DeRemee RA, Specks U, el-Azhary RA, Su WP |title=Cutaneous Wegener's granulomatosis: clinical, histopathologic, and immunopathologic features of thirty patients |journal=J. Am. Acad. Dermatol. |volume=31 |issue=4 |pages=605–12 |date=October 1994 |pmid=8089286 |doi= |url=}}</ref>
*[[Ulcerations]]
*Palpable [[purpura]]
*Subcutaneous [[nodules]]


===HEENT===
* [[Scleritis]]
* [[Keratitis]]
* [[Uveitis]]
* [[Conjunctivitis]]
* [[Proptosis]]
* [[Xanthelasma]]
* [[Purulent]] exudate from the nares
* [[Sinusitis]]<ref name="pmid19263410">{{cite journal |vauthors=Cannady SB, Batra PS, Koening C, Lorenz RR, Citardi MJ, Langford C, Hoffman GS |title=Sinonasal Wegener granulomatosis: a single-institution experience with 120 cases |journal=Laryngoscope |volume=119 |issue=4 |pages=757–61 |date=April 2009 |pmid=19263410 |doi=10.1002/lary.20161 |url=}}</ref>
* [[Saddle nose]] deformity
* [[Otitis Media]]
* Hearing acuity may be reduced<ref name="pmid15210387" />
*[[Weber test]] may be abnormal
*[[Rinne test]] may be positive
*[[Gingival hyperplasia]] or necrotizing [[gingivitis]]<ref name="pmid251963202">{{cite journal |vauthors=Genuis K, Pewarchuk J |title=Granulomatosis with polyangiitis (Wegener's) as a necrotizing gingivitis mimic: a case report |journal=J Med Case Rep |volume=8 |issue= |pages=297 |date=September 2014 |pmid=25196320 |pmc=4168997 |doi=10.1186/1752-1947-8-297 |url=}}</ref> can be seen
===Neck===
* Neck examination of patients with granulomatosis with polyangiitis is usually normal.
===Lungs===
Examination may show signs of:
*[[Pleuritic pain]]
*[[Atelectasis physical examination|Atelectasis]]
* [[Pleural effusion physical examination|Pleural effusion]]
* [[Pulmonary hypertension physical examination|Pulmonary hypertension]]- bibasilar crackles
* [[Subglottic stenosis]]
===Heart===
*[[Friction rub]]/ [[Pericardial friction rub|Pericardial rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
===Abdomen===
*[[Abdominal tenderness]] may be present<ref name="pmid15758841">{{cite journal |vauthors=Pagnoux C, Mahr A, Cohen P, Guillevin L |title=Presentation and outcome of gastrointestinal involvement in systemic necrotizing vasculitides: analysis of 62 patients with polyarteritis nodosa, microscopic polyangiitis, Wegener granulomatosis, Churg-Strauss syndrome, or rheumatoid arthritis-associated vasculitis |journal=Medicine (Baltimore) |volume=84 |issue=2 |pages=115–28 |date=March 2005 |pmid=15758841 |doi= |url=}}</ref>
*Guarding may be present
===Back===
* Back examination of patients with granulomatosis with polyangiitis is usually normal.
===Genitourinary===
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
===Neuromuscular===
*Patient is usually oriented to persons, place, and time
*[[Mononeuritis multiplex]]<ref name="pmid28273992">{{cite journal |vauthors=Anadure R, Narayanan C, Varadraj G, Nandeesh B |title=ANCA Associated Mononeuritis Multiplex with Overlap in Vasculitic Syndromes |journal=J Clin Diagn Res |volume=11 |issue=1 |pages=OD01–OD03 |date=January 2017 |pmid=28273992 |pmc=5324437 |doi=10.7860/JCDR/2017/22252.9149 |url=}}</ref>- Loss of sensory and motor functions
*Cranial nerve paralysis
===Extremities===
* Extremities examination of patients with granulomatosis with polyangiitis is usually normal.
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 17:42, 11 April 2018

Granulomatosis with polyangiitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Granulomatosis with polyangiitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Chest X Ray

CT

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Granulomatosis with polyangiitis physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Granulomatosis with polyangiitis physical examination

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Granulomatosis with polyangiitis physical examination

CDC on Granulomatosis with polyangiitis physical examination

Granulomatosis with polyangiitis physical examination in the news

Blogs on Granulomatosis with polyangiitis physical examination

Directions to Hospitals Treating Granulomatosis with polyangiitis

Risk calculators and risk factors for Granulomatosis with polyangiitis physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Ali Poyan Mehr, M.D. [2]Associate Editor(s)-in-Chief: Amandeep Singh M.D.[3]Krzysztof Wierzbicki M.D. [4]

Overview

The important physical exam findings are Ulcerations, palpable purpura and subcutaneous nodules in the skin; conjunctivitis, uveitis, sinusitis, purulent exudate from nares,saddle nose deformity, reduced hearing in the head and neck; pleuritic chest pain ans signs of atelectasis in lung examination; and signs of mononeuritis multiplex on neural exam.

Physical Examination

  • Physical examination of patients with Granulomatosis with polyangiitis is usually remarkable for:[1][2]

Vital Signs

  • They usually have normal vital signs until infected.

Skin

The skin findings are seen in 14% of patients:[3]

HEENT

Neck

  • Neck examination of patients with granulomatosis with polyangiitis is usually normal.

Lungs

Examination may show signs of:

Heart

Abdomen

Back

  • Back examination of patients with granulomatosis with polyangiitis is usually normal.

Genitourinary

  • A pelvic/adnexal mass may be palpated
  • Inflamed mucosa

Neuromuscular

  • Patient is usually oriented to persons, place, and time
  • Mononeuritis multiplex[7]- Loss of sensory and motor functions
  • Cranial nerve paralysis

Extremities

  • Extremities examination of patients with granulomatosis with polyangiitis is usually normal.

References

  1. ↑ 1.0 1.1 Seo P, Stone JH (July 2004). "The antineutrophil cytoplasmic antibody-associated vasculitides". Am. J. Med. 117 (1): 39–50. doi:10.1016/j.amjmed.2004.02.030. PMID 15210387.
  2. ↑ Graves N (October 2006). "Wegener granulomatosis". Proc (Bayl Univ Med Cent). 19 (4): 342–4. PMC 1618758. PMID 17106496.
  3. ↑ Daoud MS, Gibson LE, DeRemee RA, Specks U, el-Azhary RA, Su WP (October 1994). "Cutaneous Wegener's granulomatosis: clinical, histopathologic, and immunopathologic features of thirty patients". J. Am. Acad. Dermatol. 31 (4): 605–12. PMID 8089286.
  4. ↑ Cannady SB, Batra PS, Koening C, Lorenz RR, Citardi MJ, Langford C, Hoffman GS (April 2009). "Sinonasal Wegener granulomatosis: a single-institution experience with 120 cases". Laryngoscope. 119 (4): 757–61. doi:10.1002/lary.20161. PMID 19263410.
  5. ↑ Genuis K, Pewarchuk J (September 2014). "Granulomatosis with polyangiitis (Wegener's) as a necrotizing gingivitis mimic: a case report". J Med Case Rep. 8: 297. doi:10.1186/1752-1947-8-297. PMC 4168997. PMID 25196320.
  6. ↑ Pagnoux C, Mahr A, Cohen P, Guillevin L (March 2005). "Presentation and outcome of gastrointestinal involvement in systemic necrotizing vasculitides: analysis of 62 patients with polyarteritis nodosa, microscopic polyangiitis, Wegener granulomatosis, Churg-Strauss syndrome, or rheumatoid arthritis-associated vasculitis". Medicine (Baltimore). 84 (2): 115–28. PMID 15758841.
  7. ↑ Anadure R, Narayanan C, Varadraj G, Nandeesh B (January 2017). "ANCA Associated Mononeuritis Multiplex with Overlap in Vasculitic Syndromes". J Clin Diagn Res. 11 (1): OD01–OD03. doi:10.7860/JCDR/2017/22252.9149. PMC 5324437. PMID 28273992.
Retrieved from "https://www.wikidoc.org/index.php?title=Granulomatosis_with_polyangiitis_physical_examination&oldid=1461709"