Gastroparesis physical examination: Difference between revisions

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{{Gastroparesis}}
{{Gastroparesis}}


{{CMG}}; {{AE}} {{MSI}}
{{CMG}}; {{AE}} {{SSH}}; {{MSI}}


==Overview==
==Overview==
Patients with gastroparesis usually appear normal. Physical examination of patients with gastroparesis is usually remarkable for abdominal distension, epigastric or periumbilical tenderness, and no guarding or rigidity.
[[Physical examination]] of patients with gastroparesis is usually remarkable for [[epigastric]] [[distension]] and [[tenderness]]. The presence of other findings on [[physical examination]] depends on the various cause of gastroparesis.  


==Physical Examination==
==Physical Examination==
* Physical examination of patients with [disease name] is usually normal.
*[[Physical examination]] of patients with gastroparesis is usually remarkable for [[epigastric]] [[distension]] and [[tenderness]].<ref name="ParkmanHasler2004">{{cite journal|last1=Parkman|first1=Henry P.|last2=Hasler|first2=William L.|last3=Fisher|first3=Robert S.|title=American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis|journal=Gastroenterology|volume=127|issue=5|year=2004|pages=1592–1622|issn=00165085|doi=10.1053/j.gastro.2004.09.055}}</ref><ref name="pmid25667023">{{cite journal| author=Parkman HP| title=Idiopathic gastroparesis. | journal=Gastroenterol Clin North Am | year= 2015 | volume= 44 | issue= 1 | pages= 59-68 | pmid=25667023 | doi=10.1016/j.gtc.2014.11.015 | pmc=4324534 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25667023  }}</ref><ref name="ParkmanYates2011">{{cite journal|last1=Parkman|first1=Henry P.|last2=Yates|first2=Katherine|last3=Hasler|first3=William L.|last4=Nguyen|first4=Linda|last5=Pasricha|first5=Pankaj J.|last6=Snape|first6=William J.|last7=Farrugia|first7=Gianrico|last8=Koch|first8=Kenneth L.|last9=Abell|first9=Thomas L.|last10=McCallum|first10=Richard W.|last11=Lee|first11=Linda|last12=Unalp–Arida|first12=Aynur|last13=Tonascia|first13=James|last14=Hamilton|first14=Frank|title=Clinical Features of Idiopathic Gastroparesis Vary With Sex, Body Mass, Symptom Onset, Delay in Gastric Emptying, and Gastroparesis Severity|journal=Gastroenterology|volume=140|issue=1|year=2011|pages=101–115.e10|issn=00165085|doi=10.1053/j.gastro.2010.10.015}}</ref><ref name="PasrichaYates2015">{{cite journal|last1=Pasricha|first1=Pankaj J.|last2=Yates|first2=Katherine P.|last3=Nguyen|first3=Linda|last4=Clarke|first4=John|last5=Abell|first5=Thomas L.|last6=Farrugia|first6=Gianrico|last7=Hasler|first7=William L.|last8=Koch|first8=Kenneth L.|last9=Snape|first9=William J.|last10=McCallum|first10=Richard W.|last11=Sarosiek|first11=Irene|last12=Tonascia|first12=James|last13=Miriel|first13=Laura A.|last14=Lee|first14=Linda|last15=Hamilton|first15=Frank|last16=Parkman|first16=Henry P.|title=Outcomes and Factors Associated With Reduced Symptoms in Patients With Gastroparesis|journal=Gastroenterology|volume=149|issue=7|year=2015|pages=1762–1774.e4|issn=00165085|doi=10.1053/j.gastro.2015.08.008}}</ref><ref name="pmid25667022">{{cite journal |vauthors=Koch KL, Calles-Escandón J |title=Diabetic gastroparesis |journal=Gastroenterol. Clin. North Am. |volume=44 |issue=1 |pages=39–57 |year=2015 |pmid=25667022 |doi=10.1016/j.gtc.2014.11.005 |url=}}</ref>
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===
*The presence of other findings on [[physical examination]] depends on the various cause of gastroparesis.
*Patients with [disease name] usually appear [general appearance].  


===Vital Signs===
===Appearance of the patient===
*Patients with gastroparesis usually appear normal


*High-grade / low-grade fever
===Vital signs===
*[[Hypothermia]] / hyperthermia may be present
 
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*Low-grade [[fever]] (in postviral idiopathic gastroparesis)
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Orthostatic hypotension]] (in [[Diabetes mellitus|diabetic]] gastroparesis)
*Tachypnea / bradypnea
*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.
* [[Xeroderma|Dry skin]] (in severe [[dehydration]])
OR
* [[Raynaud's phenomenon]] (in [[Connective tissue disease|connective tissue disorder]])
*[[Cyanosis]]  
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
=== HEENT ===
* HEENT examination of patients with [disease name] is usually normal.
* [[Xerostomia|Dry mouth]] (in severe [[dehydration]])
OR
* Shrunken eyes (in severe [[dehydration]])
* 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===
* Neck examination of patients with [disease name] is usually normal.
*Neck examination of patients with gastroparesis 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===
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
*Fine/coarse [[Rales|crackles]] upon [[auscultation]] of the lung bases (in [[Connective tissue disease|connective tissue disorder]])
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===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
* [[Cardiovascular]] [[examination]] of patients with gastroparesis is usually normal (S1 +S2 + 0)
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 distention]]  
*[[Abdominal distention]]  
*[[Abdominal tenderness]] in the epigastric or periumbilical region  
*[[Abdominal tenderness]] in the [[epigastric]] or periumbilical region  
*Guarding and rigidity is absent.
*Succussion splash
*[[Abdominal guarding|Guarding]] is absent


===Back===
=== Back ===
* Back examination of patients with [disease name] is usually normal.
* Back examination of patients with gastroparesis is usually normal
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
=== Genitourinary ===
* Genitourinary examination of patients with [disease name] is usually normal.
* Genitourinary examination of patients with gastroparesis is usually normal
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
=== Neuromuscular ===
* Neuromuscular examination of patients with [disease name] is usually normal.
* [[Muscles of the abdominal wall|Abdominal muscle]] wall rigidity
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===
=== Extremities ===
* Extremities examination of patients with [disease name] is usually normal.
* Extremities examination of patients with gastroparesis 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 16:02, 20 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]; Madhu Sigdel M.B.B.S.[3]

Overview

Physical examination of patients with gastroparesis is usually remarkable for epigastric distension and tenderness. The presence of other findings on physical examination depends on the various cause of gastroparesis.

Physical Examination

  • The presence of other findings on physical examination depends on the various cause of gastroparesis.

Appearance of the patient

  • Patients with gastroparesis usually appear normal

Vital signs

Skin

HEENT

Neck

  • Neck examination of patients with gastroparesis is usually normal

Lungs

Heart

Abdomen

Back

  • Back examination of patients with gastroparesis is usually normal

Genitourinary

  • Genitourinary examination of patients with gastroparesis is usually normal

Neuromuscular

Extremities

  • Extremities examination of patients with gastroparesis is usually normal

References

  1. ↑ Parkman, Henry P.; Hasler, William L.; Fisher, Robert S. (2004). "American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis". Gastroenterology. 127 (5): 1592–1622. doi:10.1053/j.gastro.2004.09.055. ISSN 0016-5085.
  2. ↑ Parkman HP (2015). "Idiopathic gastroparesis". Gastroenterol Clin North Am. 44 (1): 59–68. doi:10.1016/j.gtc.2014.11.015. PMC 4324534. PMID 25667023.
  3. ↑ Parkman, Henry P.; Yates, Katherine; Hasler, William L.; Nguyen, Linda; Pasricha, Pankaj J.; Snape, William J.; Farrugia, Gianrico; Koch, Kenneth L.; Abell, Thomas L.; McCallum, Richard W.; Lee, Linda; Unalp–Arida, Aynur; Tonascia, James; Hamilton, Frank (2011). "Clinical Features of Idiopathic Gastroparesis Vary With Sex, Body Mass, Symptom Onset, Delay in Gastric Emptying, and Gastroparesis Severity". Gastroenterology. 140 (1): 101–115.e10. doi:10.1053/j.gastro.2010.10.015. ISSN 0016-5085.
  4. ↑ Pasricha, Pankaj J.; Yates, Katherine P.; Nguyen, Linda; Clarke, John; Abell, Thomas L.; Farrugia, Gianrico; Hasler, William L.; Koch, Kenneth L.; Snape, William J.; McCallum, Richard W.; Sarosiek, Irene; Tonascia, James; Miriel, Laura A.; Lee, Linda; Hamilton, Frank; Parkman, Henry P. (2015). "Outcomes and Factors Associated With Reduced Symptoms in Patients With Gastroparesis". Gastroenterology. 149 (7): 1762–1774.e4. doi:10.1053/j.gastro.2015.08.008. ISSN 0016-5085.
  5. ↑ Koch KL, Calles-Escandón J (2015). "Diabetic gastroparesis". Gastroenterol. Clin. North Am. 44 (1): 39–57. doi:10.1016/j.gtc.2014.11.005. PMID 25667022.

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