Diffuse esophageal spasm physical examination

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

Overview

Patients with primary diffuse esophageal spasm usually appear normal. Physical examination of patients with DES is usually remarkable for findings related to secondary diseases.

Physical Examination

  • Physical examination of patients with DES is usually remarkable for presence of features related to secondary diseases.

Appearance of the Patient

  • Patients with primary DES usually appear normal.

Vital Signs

  • High-grade / low-grade fever in infectious cause of DES
  • Hypothermia / hyperthermia may be present
  • Tachycardia with regular pulse or (ir)regularly irregular pulse
  • Bradycardia with regular pulse or (ir)regularly irregular pulse
  • Tachypnea / bradypnea
  • Kussmal respirations
  • Weak/bounding pulse
  • High/low blood pressure with normal pulse pressure

Skin

  • Tight, hardened skin in limited scleroderma
  • Red spots or lines in skin of face and hand due to telengectasia in scleroderma
  • Bumps under the skin due to deposition of calcium in scleroderma.
  • Ulcers of finger and toes may be present in scleroderma
  • Insect bite wound may be seen in Chaga's disease with excoriation at the bite site.

HEENT

  • Romana's sign is seen in Chaga's disease (swelling of eyelid at the site of parasite entry)
  • Ophthalmoscopic exam may be abnormal with findings of diabetic retinopathy in diabetics as well as cataract changes.
  • Lower extremities edema in Chaga's disease.
  • Dry mouth and dry eye in scleroderma.

Neck

Lungs

  • Asymmetric chest expansion / Decreased chest expansion
  • Lungs are hyperresonant in scleroderma.
  • Fine/coarse crackles upon auscultation of the lung bases/apices bilaterally seen in scleroderma.

Heart

Heart involvement in Chagas's cardiomyopathy are:

  • Displaced point of maximal impulse (PMI).
  • S3, S4
  • Disturbances of rhythm (arrhythmias) may be noted in scleroderma.

Abdomen


Extremities

  • Clubbing , Cyanosis are features of chronic involvement and fibrosis of lungs in scleroderma.
  • Pitting edema of the lower extremities may be noted in Chaga's cardiomyopathy.

References

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