Primary biliary cirrhosis physical examination: Difference between revisions

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{{Primary biliary cirrhosis}}
{{Primary biliary cirrhosis}}


{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{Anmol}}
 


==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].
Physical examination of patients with primary biliary cirrhosis in early stages of diseases is usually normal. Patients have clinical manifestations as the disease progress. Physical examination of patients with primary biliary cirrhosis is usually remarkable for fatigue and pruritis (worse at night).
 
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 remarkable for:[finding 1], [finding 2], and [finding 3].
*Physical examination of patients with primary biliary cirrhosis in early stages of diseases is usually normal. Patients have clinical manifestations as the disease progress.<ref name="pmid18215315">{{cite journal| author=Kumagi T, Heathcote EJ| title=Primary biliary cirrhosis. | journal=Orphanet J Rare Dis | year= 2008 | volume= 3 | issue=  | pages= 1 | pmid=18215315 | doi=10.1186/1750-1172-3-1 | pmc=2266722 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18215315  }} </ref><ref name="pmid25954476">{{cite journal| author=Purohit T, Cappell MS| title=Primary biliary cirrhosis: Pathophysiology, clinical presentation and therapy. | journal=World J Hepatol | year= 2015 | volume= 7 | issue= 7 | pages= 926-41 | pmid=25954476 | doi=10.4254/wjh.v7.i7.926 | pmc=4419097 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25954476  }} </ref>
*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 primary biliary cirrhosis may appear fatigued.<ref name="pmid20683955">{{cite journal| author=Al-Harthy N, Kumagi T, Coltescu C, Hirschfield GM| title=The specificity of fatigue in primary biliary cirrhosis: evaluation of a large clinic practice. | journal=Hepatology | year= 2010 | volume= 52 | issue= 2 | pages= 562-70 | pmid=20683955 | doi=10.1002/hep.23683 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20683955  }} </ref><ref name="pmid9824355">{{cite journal| author=Cauch-Dudek K, Abbey S, Stewart DE, Heathcote EJ| title=Fatigue in primary biliary cirrhosis. | journal=Gut | year= 1998 | volume= 43 | issue= 5 | pages= 705-10 | pmid=9824355 | doi= | pmc=1727314 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9824355  }} </ref>


===Vital Signs===
===Vital Signs===


*High-grade / low-grade fever
Vital signs of patients with primary biliary cirrhosis are usually normal.
*[[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 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===
*[[Cyanosis]]
*Pruritis, worse at night
*[[Jaundice]]
*Jaundice
* [[Pallor]]
*Diffuse pigmentation due to melanin deposition as a result of cholestasis
* Bruises
*Scratch marks
 
*Xanthelasma in a few patients
<gallery widths=150px>
*xanthomas are observed rarely
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
* Abnormalities of the head/hair may include ___
HEENT examination of patients with primary biliary cirrhosis is usually normal.
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accomodation / non-reactive to neither light nor accomodation
*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===
*[[Jugular venous distension]]
Neck examination of patients with primary biliary cirrhosis is usually normal.
*[[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===
* Asymmetric chest expansion / Decreased chest expansion
Pulmonary examination of patients with primary biliary cirrhosis is usually normal.
*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===
*Chest tenderness upon palpation
Cardiac examination of patients with primary biliary cirrhosis is usually normal.
*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]]
*Splenomegaly due to portal hypertension
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*Hepatomegaly
*[[Rebound tenderness]] (positive Blumberg sign)
*Ascites due to liver failure
*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===
*Point tenderness over __ vertebrae (e.g. L3-L4)
Back examination of patients with primary biliary cirrhosis is usually normal.
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
===Genitourinary===
*A pelvic/adnexal mass may be palpated
Genitourinary examination of patients with primary biliary cirrhosis is usually normal.
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
*Patient is usually oriented to persons, place, and time
*Encephalopathy due to liver failure in late stages
* 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===
*[[Clubbing]]
Extremity examination of patients with primary biliary cirrhosis is usually normal.
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity
 
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 15:22, 5 February 2018

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

Overview

Physical examination of patients with primary biliary cirrhosis in early stages of diseases is usually normal. Patients have clinical manifestations as the disease progress. Physical examination of patients with primary biliary cirrhosis is usually remarkable for fatigue and pruritis (worse at night).

Physical Examination

  • Physical examination of patients with primary biliary cirrhosis in early stages of diseases is usually normal. Patients have clinical manifestations as the disease progress.[1][2]

Appearance of the Patient

  • Patients with primary biliary cirrhosis may appear fatigued.[3][4]

Vital Signs

Vital signs of patients with primary biliary cirrhosis are usually normal.

Skin

  • Pruritis, worse at night
  • Jaundice
  • Diffuse pigmentation due to melanin deposition as a result of cholestasis
  • Scratch marks
  • Xanthelasma in a few patients
  • xanthomas are observed rarely

HEENT

HEENT examination of patients with primary biliary cirrhosis is usually normal.

Neck

Neck examination of patients with primary biliary cirrhosis is usually normal.

Lungs

Pulmonary examination of patients with primary biliary cirrhosis is usually normal.

Heart

Cardiac examination of patients with primary biliary cirrhosis is usually normal.

Abdomen

  • Splenomegaly due to portal hypertension
  • Hepatomegaly
  • Ascites due to liver failure

Back

Back examination of patients with primary biliary cirrhosis is usually normal.

Genitourinary

Genitourinary examination of patients with primary biliary cirrhosis is usually normal.

Neuromuscular

  • Encephalopathy due to liver failure in late stages

Extremities

Extremity examination of patients with primary biliary cirrhosis is usually normal.

References

  1. ↑ Kumagi T, Heathcote EJ (2008). "Primary biliary cirrhosis". Orphanet J Rare Dis. 3: 1. doi:10.1186/1750-1172-3-1. PMC 2266722. PMID 18215315.
  2. ↑ Purohit T, Cappell MS (2015). "Primary biliary cirrhosis: Pathophysiology, clinical presentation and therapy". World J Hepatol. 7 (7): 926–41. doi:10.4254/wjh.v7.i7.926. PMC 4419097. PMID 25954476.
  3. ↑ Al-Harthy N, Kumagi T, Coltescu C, Hirschfield GM (2010). "The specificity of fatigue in primary biliary cirrhosis: evaluation of a large clinic practice". Hepatology. 52 (2): 562–70. doi:10.1002/hep.23683. PMID 20683955.
  4. ↑ Cauch-Dudek K, Abbey S, Stewart DE, Heathcote EJ (1998). "Fatigue in primary biliary cirrhosis". Gut. 43 (5): 705–10. PMC 1727314. PMID 9824355.

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