Linitis plastica physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

Patients with linitis plastica in the early stages may appear to be normal. When metastasis occurs, the patient usually appears fatigued and cachexic. Physical examination of patients with linitis plastica and metastasis may be remarkable for lymphadenopathy, weight loss, and signs of ascites.

Physical Examination

Physical examination of patients with metastatic linitis plastica is usually remarkable for: lymphadenopaty, ascites, and organomegaly.

Appearance of the Patient

Patients with linitis plastica in the early stages may appear to be normal. When metastasis occurs, the patient usually appears fatigued and cachexic.

Vital Signs

Low-grade fever

Skin

• Jaundice is present with liver metastasis.
• Diffuse seborrheic keratoses (sign of Leser-Trélat)
• Acanthosis nigricans

Diffuse seborrheic keratoses (sign of Leser-Trélat) is shown. By James Heilman, MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=24076793

HEENT

Icteric sclera with liver metastasis

Neck

• Lymphadenopathy may be noted in several regions, in the neck region there may be:
  • Virchow's node (left supraclavicular lymph node)

Lungs

• Massive ascites leads to:
  • Decreased chest expansion
  • Fine crackles upon auscultation of the lung bases bilaterally

Abdomen

• Abdominal distention
• Abdominal tenderness in the left upper quadrant and flanks.
• Sister Mary Joseph nodule (palpable nodule bulging into the umbilicus)

Signs of ascites:

• Hepatomegaly / splenomegaly / hepatosplenomegaly
• Flank fullness
• Shifting dullness (difference in percussion note in the flanks that shifts when the patient is turned on the side)
• If the ascites is massive, a fluid thrill or fluid wave may be present.

Massive ascites is shown.By James Heilman, MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15335623

Genitourinary

• A pelvic/adnexal mass may be palpated:
  • Krukenberg's tumor (peritoneal spread results in an enlarged ovary)
  • Blumer's shelf (mass in the cul-de-sac on per rectal exam)

Extremities

• Pitting/non-pitting edema of the upper/lower extremities
• Irish node (left axillary node)

References

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