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


{{CMG}} {{AE}} {{MKK}}
{{CMG}} {{AE}} {{MKK}}


==Overview==
==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  
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>
*Clinical signs of perforated peptic ulcer comes 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>


==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 :<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>  
*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.


===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 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>
*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  
**Lower right quadrant tenderness  
**Abdominal rigdity  
**Abdominal rigdity  
**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>
**[[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>


==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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