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{{ physical examination of peptic ulcer disease}}
 
{{physical examination of peptic ulcer disease}}


{{CMG}} {{AE}} {{MKK}}
{{CMG}} {{AE}} {{MKK}}
==Introduction to the Physical Examination Page==
* The page name should be '''"(Disease name) physical examination"''', with only the first letter of the title capitalized.
* '''Goal:'''To describe in detail the various aspects of the physical examination with attention to how the disease you are describing may present.
* Remember this section is to describe what characteristics may be found on physical examination, not how to do a physical exam (unless you are including specialized signs, eg Chvostek's sign, in which case you may give a brief description).
*You may describe a physical exam finding that is commonly present in a disease without adding additional information (e.g. appendicitis physical exam - RLQ abdominal tenderness). In some cases, some unique findings are suggestive of specific aspects / complications of the disease. If present, it is preferable that you mention what these unique findings suggest or when they may be present (e.g. appendicitis physical exam - rebound tenderness may be suggestive of peritonitis).
* As with all microchapter pages linking to the main page, at the top of the edit box put <nowiki>{{CMG}}</nowiki>, your name template, and the microchapter navigation template you created at the beginning.
* Remember to create links within Wikidoc by placing <nowiki>[[square brackets]]</nowiki> around key words which you want to link to other pages. Make sure you makes your links as specific as possible. For example if a sentence contained the phrase anterior spinal artery syndrome, the link should be to [[anterior spinal artery syndrome]] not [[anterior]] or [[artery]] or [[syndrome]].  For more information on how to create links click [[Help|here]].
* Remember to follow the same format and capitalization of letters  as outlined in the template below.
* Below you will see examples of what you may describe as part of the physical examination.


==Overview==
==Overview==
* The overview section should include the disease name in the first sentence.
Peptic ulcer disease patient appears in severe stress due to [[abdominal pain]]. Common physical examination findings of peptic ulcer disease include epigastric tenderness, [[tachycardia]].Perforated peptic ulcer disease patient presents with classic triad of severe epigastric tenderness, [[tachycardia]], and abdominal rigidity. Clinical signs of perforated peptic ulcer occurs in 3 stages: In the initial stage within first 2 hours, the patient presents with [[tachycardia]], [[epigastric pain]] and [[cool extremities]].In next 2 to 12 hours, the patient presents with lower right quadrant tenderness and [[abdominal rigidity]]. In more than 12 hours, the patient presents with [[abdominal distension]], [[hypotension]], and [[pyrexia]] with [[acute circulatory collapse]].<ref>{{cite journal |vauthors=Chung KT, Shelat VG |title=Perforated peptic ulcer - an update |journal=World J Gastrointest Surg |volume=9 |issue=1 |pages=1–12 |year=2017 |pmid=28138363 |pmc=5237817 |doi=10.4240/wjgs.v9.i1.1 |url=}}</ref>
* The goal is to summarize the physical examination page in several sentences. This section can be the same as the physical examination segment on the overview page.
* To see an example of an overview section on a physical examination page, click [[Gastric cancer physical examination|here]].
===Template===
*'''First Sentences:'''
: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].
 
*'''Examples:'''
:Example 1: Patients with shigellosis usually appear lethargic. Physical examination of patients with shigellosis is usually remarkable for high-grade [[fever]] and signs of dehydration, such as [[tachycardia]], [[tachypnea]], [[hypotension]], and dry mucus membranes.
:Example 2: Common physical examination findings of cholecystitis include right upper abdominal tenderness and a positive Murphy sign.
:Example 3: The presence of both upper motor neuron and lower motor neuron involvement on physical examination is diagnostic of amyotrophic lateral sclerosis.
:Example 4: The presence of facial tenderness and fever on physical examination is highly suggestive of acute sinusitis.
 
==Preferred Template Statements==
*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].
*Common physical examination findings of [disease name] include [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].


==Physical Examination==
==Physical Examination==
===Appearance of the Patient===
===Appearance of the Patient===
*Patient usually appear in severe distress due to severe abdominal pain.
*Patient usually appear in severe distress due to severe [[Abdominal pain|abdominal pain.]]


===Vital Signs===
===Vital Signs===
*Patient has normal vital signs in initial stages of peptic ulcer.  
*Patient has normal vital signs in initial stages of peptic ulcer.  
*In peptic ulcer perforations vital signs may include :{{cite journal |vauthors=Bertleff MJ, Lange JF |title=Perforated peptic ulcer disease: a review of history and treatment |journal=Dig Surg |volume=27 |issue=3 |pages=161–9 |year=2010 |pmid=20571260 |doi=10.1159/000264653 |url=}}
*In peptic ulcer perforations vital signs may include :<ref>{{cite journal |vauthors=Bertleff MJ, Lange JF |title=Perforated peptic ulcer disease: a review of history and treatment |journal=Dig Surg |volume=27 |issue=3 |pages=161–9 |year=2010 |pmid=20571260 |doi=10.1159/000264653 |url=}}</ref>
**Tachycardia with regular pulse
**[[Tachycardia]] with regular pulse
**Weak pulse
**Weak pulse
**low blood pressure with normal pulse pressure
**low [[blood pressure]] with normal pulse pressure
**High-grade fever is present at later stage of peptic ulcer perforation
**High-grade [[fever]] is present at later stage of peptic ulcer perforation


===Skin===  
===Skin===  
*Pallor is present in patients presents with hematemesis and melena.
*Pallor is present in patients presents with [[hematemesis]] and [[melena]].
<gallery widths=150px>
<gallery widths="150">
 
File:Iron deficiency anemia blood film.jpg|Source- Dr Graham Beards (Own work) <ref>CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons</ref>  
Iron deficiency anemia blood film.jpg|By Dr Graham Beards (Own work) <ref>CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons</ref>  
File:Anemia.jpg|The hand of a person with severe anemia (on the left) compared to one without (on the right) Source -James Heilman, MD - Own work<ref> CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=10313974</ref>
 
 
Anemia.jpg|The hand of a person with severe anemia (on the left) compared to one without (on the right)By James Heilman, MD - Own work<ref> CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=10313974</ref>
</gallery>
</gallery>


===HEENT===
===HEENT===
* Pallor on the lower conjunctiva can be seen.
* Pallor on the lower [[conjunctiva]] can be seen.


===Neck===
*Supple ,trachea is centrally placed and no lyphadenopathy
===Lungs===
===Lungs===
* Normal  B/L vesicular breath sounds.
* Normal  B/L vesicular [[breath sounds.]]
===Heart===
===Heart===
*S1 and S2 normal ,no murmur/rubs/gallops.
*S1 and S2 normal ,no murmur/rubs/gallops.
===Abdomen===
===Abdomen===
*Abdominal tenderness at the epigastrium   
*[[Abdominal tenderness]] at the epigastrium   
*Perforated peptic ulcer {{cite journal |vauthors=Bertleff MJ, Lange JF |title=Perforated peptic ulcer disease: a review of history and treatment |journal=Dig Surg |volume=27 |issue=3 |pages=161–9 |year=2010 |pmid=20571260 |doi=10.1159/000264653 |url=}}
*Perforated peptic ulcer presents with<ref>{{cite journal |vauthors=Bertleff MJ, Lange JF |title=Perforated peptic ulcer disease: a review of history and treatment |journal=Dig Surg |volume=27 |issue=3 |pages=161–9 |year=2010 |pmid=20571260 |doi=10.1159/000264653 |url=}} </ref>
**Rebound tenderness
**[[Rebound tenderness]]
**Decreased bowel sounds
**Decreased [[bowel sound]]<nowiki/>s
 
**Lower right quadrant tenderness  
===Back===
**Abdominal rigdity
*NO redness ,visible deformity ,no tenderness
**[[Abdominal distension]] <ref>{{cite journal |vauthors=Chung KT, Shelat VG |title=Perforated peptic ulcer - an update |journal=World J Gastrointest Surg |volume=9 |issue=1 |pages=1–12 |year=2017 |pmid=28138363 |pmc=5237817 |doi=10.4240/wjgs.v9.i1.1 |url=}}</ref>
 
===Genitourinary===
*
 
===Extremities===
*Pallor is present at the palms of hand
 
===Neuromuscular===
*Patient is usually oriented to persons, place, and time


==References==
==References==

Latest revision as of 13:13, 23 October 2017


Template:Physical examination of peptic ulcer disease

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

Overview

Peptic ulcer disease patient appears in severe stress due to abdominal pain. Common physical examination findings of peptic ulcer disease include epigastric tenderness, tachycardia.Perforated peptic ulcer disease patient presents with classic triad of severe epigastric tenderness, tachycardia, and abdominal rigidity. Clinical signs of perforated peptic ulcer occurs in 3 stages: In the initial stage within first 2 hours, the patient presents with tachycardia, epigastric pain and cool extremities.In next 2 to 12 hours, the patient presents with lower right quadrant tenderness and abdominal rigidity. In more than 12 hours, the patient presents with abdominal distension, hypotension, and pyrexia with acute circulatory collapse.[1]

Physical Examination

Appearance of the Patient

Vital Signs

  • Patient has normal vital signs in initial stages of peptic ulcer.
  • In peptic ulcer perforations vital signs may include :[2]
    • Tachycardia with regular pulse
    • Weak pulse
    • low blood pressure with normal pulse pressure
    • High-grade fever is present at later stage of peptic ulcer perforation

Skin

  • Source- Dr Graham Beards (Own work) [3]

    Source- Dr Graham Beards (Own work) [3]

  • The hand of a person with severe anemia (on the left) compared to one without (on the right) Source -James Heilman, MD - Own work[4]

    The hand of a person with severe anemia (on the left) compared to one without (on the right) Source -James Heilman, MD - Own work[4]

HEENT

Lungs

Heart

  • S1 and S2 normal ,no murmur/rubs/gallops.

Abdomen

References

  • References should be cited for the material that you have put on your page. Type in {{reflist|2}}.This will generate your references in small font, in two columns, with links to the original article and abstract.
  • For information on how to add references into your page, click here.
  1. ↑ Chung KT, Shelat VG (2017). "Perforated peptic ulcer - an update". World J Gastrointest Surg. 9 (1): 1–12. doi:10.4240/wjgs.v9.i1.1. PMC 5237817. PMID 28138363.
  2. ↑ Bertleff MJ, Lange JF (2010). "Perforated peptic ulcer disease: a review of history and treatment". Dig Surg. 27 (3): 161–9. doi:10.1159/000264653. PMID 20571260.
  3. ↑ CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
  4. ↑ CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=10313974
  5. ↑ Bertleff MJ, Lange JF (2010). "Perforated peptic ulcer disease: a review of history and treatment". Dig Surg. 27 (3): 161–9. doi:10.1159/000264653. PMID 20571260.
  6. ↑ Chung KT, Shelat VG (2017). "Perforated peptic ulcer - an update". World J Gastrointest Surg. 9 (1): 1–12. doi:10.4240/wjgs.v9.i1.1. PMC 5237817. PMID 28138363.
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