Pyloric stenosis physical examination: Difference between revisions

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== 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].
[[Palpation]] of the abdomen may reveal a mass in the [[epigastrium]]. This mass consists of the enlarged pylorus smooth muscle and it is called '''olive'''. Palpation of a hypertrophied pylorus is very useful in diagnosis of hypertrophic pyloric stenosis.[[Peristalsis|Peristaltic]] waves may be palpated or may be seen in abdominal exam of patients with infantile pyloric stenosis. [[Hypothermia]] and [[tachycardia]] with regular pulse and [[tachypnea]] may be present. In skin examination [[cyanosis]], poor skin turgur, [[jaundice]] and [[pallor]] may be present.
 
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].
The presence of palpation of an abdominal mass and visible [[peristalsis]] on physical examination is diagnostic of infantile pyloric stenosis.
* The presence of [finding(s)] on physical examination is diagnostic of [disease name].
{| align="right"
* The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
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|}
=== Appearance of the Patient ===
* Patients with [disease name] usually appear [general appearance].
 
=== Vital Signs ===
=== Vital Signs ===
* High-grade / low-grade fever
*[[Hypothermia]] may be present<ref name="pmid3795342">{{cite journal| author=Yagupsky P, Mares AJ, Gorodischer R| title=Pyloric stenosis associated with hypothermia. | journal=J Trop Pediatr | year= 1986 | volume= 32 | issue= 5 | pages= 270 | pmid=3795342 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3795342  }} </ref>
* [[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse may be present due to dehydration
* [[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Tachypnea]] may be present due to dehydration
* [[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]]
*[[Cyanosis]] may be present due to [[dehydration]]
* [[Jaundice]]
* [[Pallor]]
* Bruises


* UploadedImage-01.jpg  Description [http://www.atlasdermatologico.com.br/ (Adapted from Dermatology Atlas)]
* Poor skin turgor may be present due to [[dehydration]]
* UploadedImage-02.jpg  Description [http://www.atlasdermatologico.com.br/ (Adapted from Dermatology Atlas)]
 
* [[Jaundice]] may be present


=== HEENT ===
=== HEENT ===
* Abnormalities of the head/hair may include ___
* Depressed [[fontanelles]] may be present due to [[dehydration]]
* Evidence of trauma
* Decereased tearing may be present due to [[dehydration]]
* 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]]
Physical examination of neck 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
Physical examination of lungs 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
Physical examination of heart 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 S1.2C the .22lub.22.28components M1 and T1.29|S1]]
* [[Heart sounds#Second heart tone S2 the .22dub.22.28components A2 and P2.29|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]]
* [[Palpation]] of the abdomen may reveal a mass in the [[epigastrium]].
* [[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
* This mass consists of the enlarged pylorus smooth muscle and it is called '''olive'''.<ref name="pmid24716658">{{cite journal| author=Peters B, Oomen MW, Bakx R, Benninga MA| title=Advances in infantile hypertrophic pyloric stenosis. | journal=Expert Rev Gastroenterol Hepatol | year= 2014 | volume= 8 | issue= 5 | pages= 533-41 | pmid=24716658 | doi=10.1586/17474124.2014.903799 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24716658  }} </ref>
* [[Rebound tenderness]] (positive Blumberg sign)
* Palpation of a hypertrophied pylorus is very useful in diagnosis of hypertrophic pyloric stenosis.<ref name="pmid3277156">{{cite journal| author=Breaux CW, Georgeson KE, Royal SA, Curnow AJ| title=Changing patterns in the diagnosis of hypertrophic pyloric stenosis. | journal=Pediatrics | year= 1988 | volume= 81 | issue= 2 | pages= 213-7 | pmid=3277156 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3277156  }} </ref>
* A palpable abdominal mass in the right/left upper/lower abdominal quadrant
* [[peristalsis|Peristaltic]] waves may be palpated or may be seen in abdominal exam of patients with infantile pyloric stenosis.<ref name="pmid2039969">{{cite journal| author=Chiou JY, Huang SC, Chuang JH| title=[Clinical experience of infantile hypertrophic pyloric stenosis]. | journal=Changgeng Yi Xue Za Zhi | year= 1991 | volume= 14 | issue= 1 | pages= 39-43 | pmid=2039969 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2039969  }} </ref>
* 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)
Physical examination of back is usually normal.
* Sacral edema
* Costovertebral angle tenderness bilaterally/unilaterally
* Buffalo hump


=== Genitourinary ===
=== Genitourinary ===
* A pelvic/adnexal mass may be palpated
Physical examination of genitourinary system is usually normal.
* Inflamed mucosa
* Clear/(color), foul-smelling/odorless penile/vaginal discharge


=== Neuromuscular ===
=== Neuromuscular ===
* Patient is usually oriented to persons, place, and time
Physical examination of neuromuscular system is usually normal.
* 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]]
Physical examination of extremities is usually normal.
* [[Cyanosis]]
* Pitting/non-pitting [[edema]] of the upper/lower extremities
* Muscle atrophy
* Fasciculations in the upper/lower extremity
 
== References ==
 
==Overview==
:Patients with infantile pyloric stenosis usually appear ill and [[toxic]]. physical examination of patients with infantile pyloric stenosis is usually remarkable for palpation of an abdominal mass in epigastrium.This mass, which consists of the enlarged pylorus, is referred to as the 'olive,'.
 
==Physical examination==
* Physical examination of patients with infantile pyloric stenosis is usually remarkable for: palpation of an abdominal mass, [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].
 
===Vital Signs===
*[[Hypothermia]] may be present
*[[Tachycardia]] may be present
*[[Tachypnea]] may be present
===Skin===
*[[Cyanosis]] may be present
 
* Poor skin turgur
 
===Head===
Depressed [[fontanelles]] may be present
 
===Eyes===
Decereased tearing may be present
 
===Abdomen===
[[Palpation]] of the abdomen may reveal a mass in the [[epigastrium]].  This mass, which consists of the enlarged pylorus, is referred to as the 'olive,' and is sometimes evident after the infant is given formula to drink.  It is an elusive diagnostic skill requiring much patience and experience. There are often palpable (or even visible) [[peristalsis|peristaltic]] waves due to [[stomach]] trying to force its contents past the narrowed pyloric outlet.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Needs content]]
[[Category:Gastroenterology]]
[[Category:Surgery]]


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Latest revision as of 18:32, 11 December 2017

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

Overview

Palpation of the abdomen may reveal a mass in the epigastrium. This mass consists of the enlarged pylorus smooth muscle and it is called olive. Palpation of a hypertrophied pylorus is very useful in diagnosis of hypertrophic pyloric stenosis.Peristaltic waves may be palpated or may be seen in abdominal exam of patients with infantile pyloric stenosis. Hypothermia and tachycardia with regular pulse and tachypnea may be present. In skin examination cyanosis, poor skin turgur, jaundice and pallor may be present.

Physical Examination

The presence of palpation of an abdominal mass and visible peristalsis on physical examination is diagnostic of infantile pyloric stenosis.

JfG0VrSuV2Y|500}}

Vital Signs

Skin

HEENT

Neck

Physical examination of neck is usually normal.

Lungs

Physical examination of lungs is usually normal.

Heart

Physical examination of heart is usually normal.

Abdomen

  • Palpation of the abdomen may reveal a mass in the epigastrium.
  • This mass consists of the enlarged pylorus smooth muscle and it is called olive.[2]
  • Palpation of a hypertrophied pylorus is very useful in diagnosis of hypertrophic pyloric stenosis.[3]
  • Peristaltic waves may be palpated or may be seen in abdominal exam of patients with infantile pyloric stenosis.[4]

Back

Physical examination of back is usually normal.

Genitourinary

Physical examination of genitourinary system is usually normal.

Neuromuscular

Physical examination of neuromuscular system is usually normal.

Extremities

Physical examination of extremities is usually normal.

References

  1. ↑ Yagupsky P, Mares AJ, Gorodischer R (1986). "Pyloric stenosis associated with hypothermia". J Trop Pediatr. 32 (5): 270. PMID 3795342.
  2. ↑ Peters B, Oomen MW, Bakx R, Benninga MA (2014). "Advances in infantile hypertrophic pyloric stenosis". Expert Rev Gastroenterol Hepatol. 8 (5): 533–41. doi:10.1586/17474124.2014.903799. PMID 24716658.
  3. ↑ Breaux CW, Georgeson KE, Royal SA, Curnow AJ (1988). "Changing patterns in the diagnosis of hypertrophic pyloric stenosis". Pediatrics. 81 (2): 213–7. PMID 3277156.
  4. ↑ Chiou JY, Huang SC, Chuang JH (1991). "[Clinical experience of infantile hypertrophic pyloric stenosis]". Changgeng Yi Xue Za Zhi. 14 (1): 39–43. PMID 2039969.

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