Meckel's diverticulum physical examination: Difference between revisions

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==Overview==
==Overview==
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].
Patients with Meckel's diverticulum usually appear normal on [[physical examination]]. [[Abdominal examination]] of [[Patient|patients]] with Meckel's diverticulum is usually normal, even in patients with [[gastrointestinal bleeding]]. Patient develop [[Medical sign|signs]] of [[acute abdomen]] due to [[diverticular]] [[inflammation]] or [[perforation]] in complicated cases. These [[Medical sign|signs]] include [[Abdominal distention]], [[Tenderness (medicine)|abdominal tenderness]], [[rebound tenderness]] and [[Abdominal guarding|guarding]].
 
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].


==Physical Examination==
==Physical Examination==
* Physical examination of patients with [disease name] is usually normal.
OR
*Physical examination of patients with [disease name] is usually remarkable for:[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].
===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*Patients with Meckel's diverticulum usually appear normal on [[physical examination]].  


===Vital Signs===
===Vital Signs===
 
In [[Patient|patients]] with complications such as Meckel's [[diverticulitis]]:
*High-grade / low-grade fever
*[[Fever]]  
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]]
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Hypotension]]
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Tachypnea]]
*Tachypnea / bradypnea
**[[Breathing|Breathing patterns]] may be altered by [[patient]] to compensate for [[abdominal pain]]<ref>Hardin, M. Acute Appendicitis: Review and Update. ''Am Fam Physician".1999, Nov 1;60(7):2027-2034''</ref>
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


===Skin===
===Skin===
* Skin examination of patients with [disease name] is usually normal.
*[[Diaphoresis]]
OR
*[[Pallor]]
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>
 
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
 
===Neck===
* Neck examination of patients with [disease name] is usually normal.
OR
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]
 
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
OR
* Asymmetric chest expansion / Decreased chest expansion
*Lungs are hypo/hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds / Distant breath sounds
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]
 
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
OR
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction 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]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope
 
===Abdomen===
===Abdomen===
Abdominal examination of patients with [disease name] is usually normal.
* Abdominal examination of patients with Meckel's diverticulum is usually normal.  
 
* Abdominal examination is typically benign even in patients with [[gastrointestinal bleeding]].
Abdominal examination is typically benign in patients with gastrointestinal bleeding.
* Patient may develop signs of [[acute abdomen]] due to [[diverticular]] [[inflammation]] or [[perforation]] in complicated cases:<ref name="pmid29255748">{{cite journal |vauthors=Capelão G, Santos M, Hilário S, Laureano M, Nobre J, Gonçalves I |title=Intestinal Obstruction by Giant Meckel's Diverticulum |journal=GE Port J Gastroenterol |volume=24 |issue=4 |pages=183–187 |year=2017 |pmid=29255748 |pmc=5729947 |doi=10.1159/000452690 |url=}}</ref><ref name="pmid29168644">{{cite journal |vauthors=Xue BY, Tang QY |title=Hemorrhage and intestinal obstruction secondary to a Meckel's diverticulum: a case report |journal=Rev Esp Enferm Dig |volume=110 |issue= |pages= |year=2017 |pmid=29168644 |doi=10.17235/reed.2017.5219/2017 |url=}}</ref><ref name="pmid29279643">{{cite journal |vauthors=Darlington CD, Anitha GFS |title=Meckel's Diverticulitis Masquerading as Acute Pancreatitis: A Diagnostic Dilemma |journal=Indian J Crit Care Med |volume=21 |issue=11 |pages=789–792 |year=2017 |pmid=29279643 |pmc=5699010 |doi=10.4103/ijccm.IJCCM_317_17 |url=}}</ref><ref name="pmid28920033">{{cite journal |vauthors=Louati H, Zouari M, Jallouli M, Dhaou MB, Zitouni H, Mhiri R |title=Perforated Meckel's Diverticulum causing Intussusception in a Neonate |journal=J Neonatal Surg |volume=6 |issue=3 |pages=73 |year=2017 |pmid=28920033 |pmc=5593492 |doi=10.21699/jns.v6i3.568 |url=}}</ref><ref name="pmid28899672">{{cite journal |vauthors=van Malderen K, Camilleri M |title=Large Meckel's Diverticulum and Dilated Adjacent Small Intestine Presenting With Intestinal Obstruction |journal=Clin. Gastroenterol. Hepatol. |volume=16 |issue=1 |pages=A33 |year=2018 |pmid=28899672 |doi=10.1016/j.cgh.2017.09.003 |url=}}</ref><ref name="pmid28744739">{{cite journal |vauthors=Colvin RW, Al-Katib S, Ebersole J |title=Perforated Meckel's Diverticulitis |journal=J. Gastrointest. Surg. |volume=21 |issue=12 |pages=2126–2128 |year=2017 |pmid=28744739 |doi=10.1007/s11605-017-3511-1 |url=}}</ref><ref name="pmid28731997">{{cite journal |vauthors=Gatto J, Takada J, Otoch JP, Kreve F, Loss FS, Artifon ELA |title=Perforated Meckel's diverticulum |journal=Rev Gastroenterol Peru |volume=37 |issue=2 |pages=162–164 |year=2017 |pmid=28731997 |doi= |url=}}</ref><ref name="pmid28585600">{{cite journal |vauthors=Aamery A, Al-Shehhi R, Malik K, Al-Harthy A |title=Perforation of Meckel's diverticulum with a foreign body mimicking acute appendicitis: A rare complication |journal=J Pak Med Assoc |volume=67 |issue=6 |pages=942–944 |year=2017 |pmid=28585600 |doi= |url=}}</ref><ref name="pmid28571210">{{cite journal |vauthors=Symeonidis N, Kofinas A, Psarras K, Pavlidis E, Pavlidis T |title=Meckel's Diverticulum Enterolith: An Extremely Rare Cause of Intestinal Obstruction |journal=J Clin Diagn Res |volume=11 |issue=4 |pages=PD11–PD12 |year=2017 |pmid=28571210 |pmc=5449856 |doi=10.7860/JCDR/2017/25941.9751 |url=}}</ref><ref name="pmid28350977">{{cite journal |vauthors=Carbotta G, Laforgia R, Milella M, Sederino MG, Minafra M, Fortarezza F, Piscitelli D, Palasciano N |title=Small bowel obstruction caused by Anisakis and Meckel's diverticulum: a rare case |journal=G Chir |volume=37 |issue=6 |pages=281–283 |year=2016 |pmid=28350977 |pmc=5505488 |doi= |url=}}</ref><ref name="pmid27787281">{{cite journal |vauthors=Swickard A, Grosel JM |title=Complicated Meckel diverticulum in a 15-year-old boy |journal=JAAPA |volume=29 |issue=11 |pages=1–4 |year=2016 |pmid=27787281 |doi=10.1097/01.JAA.0000502860.28599.8f |url=}}</ref><ref name="pmid27815920">{{cite journal |vauthors=Irie T, Shinji S, Arai H, Kan H, Yamada T, Koizumi M, Yokoyama Y, Takahashi G, Iwai T, Okusa M, Ohta K, Uchida E |title=Intestinal hemorrhage caused by Meckel's diverticulum with ectopic gastric mucosa on polypoid lesion: a case report |journal=Surg Case Rep |volume=2 |issue=1 |pages=124 |year=2016 |pmid=27815920 |pmc=5097056 |doi=10.1186/s40792-016-0252-4 |url=}}</ref><ref name="pmid27888219">{{cite journal |vauthors=Leng S, Ghionzoli M, Caporalini C, Buccoliero AM |title=Long-term intestinal bleeding in a child: a rare case of heterotopic gastric mucosa in the jejunum |journal=BMJ Case Rep |volume=2016 |issue= |pages= |year=2016 |pmid=27888219 |doi=10.1136/bcr-2016-216949 |url=}}</ref><ref name="pmid27957297">{{cite journal |vauthors=Frooghi M, Bahador A, Golchini A, Haghighat M, Ataollahi M, Javaherizadeh H |title=Perforated Meckel's Diverticulum in a 3-day-old Neonate; A Case Report |journal=Middle East J Dig Dis |volume=8 |issue=4 |pages=323–326 |year=2016 |pmid=27957297 |pmc=5145301 |doi=10.15171/mejdd.2016.43 |url=}}</ref>
acute abdominal complaints
** [[Abdominal distention]]  
diverticular inflammation (ie, Meckel's diverticulitis)
** [[Abdominal tenderness]]  
acute appendicitis, particularly when the appendix has already been removed
** [[Rebound tenderness]]  
 
** [[Abdominal guarding|Guarding]] may be present
perforation
 
 
*[[Abdominal distention]]  
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
 
===Back===
* Back examination of patients with [disease name] is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
 
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
 
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
OR
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)
 
===Extremities===
* Extermities examination of patients with [disease name] is usually normal.
OR
*[[Clubbing]]  
*[[Cyanosis]]  
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

Latest revision as of 18:02, 2 January 2018

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

Overview

Patients with Meckel's diverticulum usually appear normal on physical examination. Abdominal examination of patients with Meckel's diverticulum is usually normal, even in patients with gastrointestinal bleeding. Patient develop signs of acute abdomen due to diverticular inflammation or perforation in complicated cases. These signs include Abdominal distention, abdominal tenderness, rebound tenderness and guarding.

Physical Examination

Appearance of the Patient

Vital Signs

In patients with complications such as Meckel's diverticulitis:

Skin

Abdomen

References

  1. ↑ Hardin, M. Acute Appendicitis: Review and Update. Am Fam Physician".1999, Nov 1;60(7):2027-2034
  2. ↑ Capelão G, Santos M, Hilário S, Laureano M, Nobre J, Gonçalves I (2017). "Intestinal Obstruction by Giant Meckel's Diverticulum". GE Port J Gastroenterol. 24 (4): 183–187. doi:10.1159/000452690. PMC 5729947. PMID 29255748.
  3. ↑ Xue BY, Tang QY (2017). "Hemorrhage and intestinal obstruction secondary to a Meckel's diverticulum: a case report". Rev Esp Enferm Dig. 110. doi:10.17235/reed.2017.5219/2017. PMID 29168644.
  4. ↑ Darlington CD, Anitha G (2017). "Meckel's Diverticulitis Masquerading as Acute Pancreatitis: A Diagnostic Dilemma". Indian J Crit Care Med. 21 (11): 789–792. doi:10.4103/ijccm.IJCCM_317_17. PMC 5699010. PMID 29279643. Vancouver style error: initials (help)
  5. ↑ Louati H, Zouari M, Jallouli M, Dhaou MB, Zitouni H, Mhiri R (2017). "Perforated Meckel's Diverticulum causing Intussusception in a Neonate". J Neonatal Surg. 6 (3): 73. doi:10.21699/jns.v6i3.568. PMC 5593492. PMID 28920033.
  6. ↑ van Malderen K, Camilleri M (2018). "Large Meckel's Diverticulum and Dilated Adjacent Small Intestine Presenting With Intestinal Obstruction". Clin. Gastroenterol. Hepatol. 16 (1): A33. doi:10.1016/j.cgh.2017.09.003. PMID 28899672.
  7. ↑ Colvin RW, Al-Katib S, Ebersole J (2017). "Perforated Meckel's Diverticulitis". J. Gastrointest. Surg. 21 (12): 2126–2128. doi:10.1007/s11605-017-3511-1. PMID 28744739.
  8. ↑ Gatto J, Takada J, Otoch JP, Kreve F, Loss FS, Artifon E (2017). "Perforated Meckel's diverticulum". Rev Gastroenterol Peru. 37 (2): 162–164. PMID 28731997. Vancouver style error: initials (help)
  9. ↑ Aamery A, Al-Shehhi R, Malik K, Al-Harthy A (2017). "Perforation of Meckel's diverticulum with a foreign body mimicking acute appendicitis: A rare complication". J Pak Med Assoc. 67 (6): 942–944. PMID 28585600.
  10. ↑ Symeonidis N, Kofinas A, Psarras K, Pavlidis E, Pavlidis T (2017). "Meckel's Diverticulum Enterolith: An Extremely Rare Cause of Intestinal Obstruction". J Clin Diagn Res. 11 (4): PD11–PD12. doi:10.7860/JCDR/2017/25941.9751. PMC 5449856. PMID 28571210.
  11. ↑ Carbotta G, Laforgia R, Milella M, Sederino MG, Minafra M, Fortarezza F, Piscitelli D, Palasciano N (2016). "Small bowel obstruction caused by Anisakis and Meckel's diverticulum: a rare case". G Chir. 37 (6): 281–283. PMC 5505488. PMID 28350977.
  12. ↑ Swickard A, Grosel JM (2016). "Complicated Meckel diverticulum in a 15-year-old boy". JAAPA. 29 (11): 1–4. doi:10.1097/01.JAA.0000502860.28599.8f. PMID 27787281.
  13. ↑ Irie T, Shinji S, Arai H, Kan H, Yamada T, Koizumi M, Yokoyama Y, Takahashi G, Iwai T, Okusa M, Ohta K, Uchida E (2016). "Intestinal hemorrhage caused by Meckel's diverticulum with ectopic gastric mucosa on polypoid lesion: a case report". Surg Case Rep. 2 (1): 124. doi:10.1186/s40792-016-0252-4. PMC 5097056. PMID 27815920.
  14. ↑ Leng S, Ghionzoli M, Caporalini C, Buccoliero AM (2016). "Long-term intestinal bleeding in a child: a rare case of heterotopic gastric mucosa in the jejunum". BMJ Case Rep. 2016. doi:10.1136/bcr-2016-216949. PMID 27888219.
  15. ↑ Frooghi M, Bahador A, Golchini A, Haghighat M, Ataollahi M, Javaherizadeh H (2016). "Perforated Meckel's Diverticulum in a 3-day-old Neonate; A Case Report". Middle East J Dig Dis. 8 (4): 323–326. doi:10.15171/mejdd.2016.43. PMC 5145301. PMID 27957297.

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