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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 upper 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 gastroparesis is usually remarkable for:upper abdominal distension, epigastric or periumbilical tenderness, and no guarding and rigidity.
*[[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>
*The presence of other findings on physical examination depends on cause of gastroparesis.


===Appearance of the Patient===
*The presence of other findings on [[physical examination]] depends on the various cause of gastroparesis.
*Patients with gastroparesis usually appear normal.  


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


*Low-grade fever may be present in postviral idiopathic gastroparesis. In minority of cases, patients have a preceeding history of upper respiratory infection or gastrointestinal infection.<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>
===Vital signs===
*Orthostatic hypotension may be present in diabetic gastroparesis.
 
*Low-grade [[fever]] (in postviral idiopathic gastroparesis)
*[[Orthostatic hypotension]] (in [[Diabetes mellitus|diabetic]] gastroparesis)


===Skin===
===Skin===
* Skin examination of patients with severe gastroparesis show signs of dehydration like dry mouth, dry skin , shrunken eyes.
* [[Xeroderma|Dry skin]] (in severe [[dehydration]])
* [[Raynaud's phenomenon]] may be present in gastroparesis related to connective tissue disorder.
* [[Raynaud's phenomenon]] (in [[Connective tissue disease|connective tissue disorder]])
 
=== HEENT ===
* [[Xerostomia|Dry mouth]] (in severe [[dehydration]])
* Shrunken eyes (in severe [[dehydration]])
 
===Neck===
===Neck===
*[[Thyromegaly]] / thyroid nodules tmay be present in hypothyroidism.
*Neck examination of patients with gastroparesis is usually normal
===Lungs===
===Lungs===
*Fine/coarse [[crackles]] upon auscultation of the lung bases is a feature in connective tissue disease (eg. systemic sclerosis) related gastroparesis
*Fine/coarse [[Rales|crackles]] upon [[auscultation]] of the lung bases (in [[Connective tissue disease|connective tissue disorder]])
===Heart===
* [[Cardiovascular]] [[examination]] of patients with gastroparesis is usually normal (S1 +S2 + 0)
 
===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
*succussion splash can be elicited 3 hours or more after food intake, reflecting retention of gastric content.
*[[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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