Appendix cancer physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Patients with appendix cancer usually appear normal, pale or diaphoretic. If the patient with appendix cancer present with [[acute appendicitis]] which is | Patients with [[Vermiform appendix|appendix]] [[cancer]] usually appear normal, [[Pallor|pale]] or [[Diaphoresis|diaphoretic]]. If the patient with appendix cancer present with [[acute appendicitis]] which is quite common, [[abdominal tenderness]], [[rebound tenderness]], [[Abdominal guarding|abdominal guarding,]] [[Rovsing's sign|Rovsing's sign,]] as well as [[Psoas sign]] might be present. Around 5% of the patients with appendiceal [[Carcinoid Tumor|carcinoid tumors]] might develop [[carcinoid syndrome]]. Common physical examination findings of [[carcinoid syndrome]] include [[dehydration]] due to [[diarrhea]], [[tachycardia]] as well as [[Flushing|facial flushing]], [[Heart murmurs|right heart murmurs]] like [[Tricuspid regurgitation|TR murmur]] is quit common. In patients with [[carcinoid syndrome]], the presence of [[dermatitis]], [[diarrhea]], and [[dementia]] on [[physical examination]] is highly suggestive of [[Pellagra]] disease. | ||
==Physical Examination== | ==Physical Examination== | ||
*Physical examination of patients with appendix cancer is usually normal. | *[[Physical examination]] of patients with [[appendix cancer]] is usually normal.<ref name="WHO">Chapter 5: Tumours of the Appendix - IARC. https://www.iarc.fr/en/publications/pdfs-online/pat-gen/bb2/bb2-chap5.pdf Accessed on January 15, 2019</ref> | ||
*If the patient with appendix cancer present with [[acute appendicitis]] which is | *If the patient with appendix cancer present with [[acute appendicitis]] which is quite common, [[abdominal tenderness]], [[rebound tenderness]], [[Abdominal guarding|abdominal guarding,]] [[Rovsing's sign|Rovsing's sign,]] as well as [[Psoas sign]] might be present. <ref>Hardin, M. Acute Appendicitis: Review and Update. ''Am Fam Physician".1999, Nov 1;60(7):2027-2034''</ref> | ||
*Around 5% of the patients with appendiceal carcinoid tumors might develop carcinoid syndrome. | *Around 5% of the patients with appendiceal [[Carcinoid Tumor|carcinoid]] tumors might develop [[carcinoid syndrome]]. | ||
*Common physical examination findings of carcinoid syndrome include dehydration due to diarrhea, tachycardia as well as facial flushing, right heart murmurs like TR murmur is quit common. | *Common physical examination findings of [[carcinoid syndrome]] include dehydration due to [[diarrhea]], [[tachycardia]] as well as facial [[flushing]], [[Heart murmur|right heart murmurs]] like [[Tricuspid regurgitation|TR]] [[Heart murmur|murmur]] is quit common.<ref name="ss">Signs and symptoms of carcinoid syndrome. National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/patient/gi-carcinoid-treatment-pdq</ref> | ||
*In patients with carcinoid syndrome, the presence of dermatitis, diarrhea, and dementia on physical examination is highly suggestive | *In patients with [[carcinoid syndrome]], the presence of [[dermatitis]], [[diarrhea]], and [[dementia]] on physical examination is highly suggestive of [[Pellagra]] disease.<ref name="pmid14693013">Hegyi J, Schwartz RA, Hegyi V (2004) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14693013 Pellagra: dermatitis, dementia, and diarrhea.] ''Int J Dermatol'' 43 (1):1-5. PMID: [https://pubmed.gov/14693013 14693013]</ref> | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*Patients with appendix cancer usually appear normal but might be pale or diaphoretic, or even present with a facial flushing. | *Patients with appendix cancer usually appear normal but might be pale or [[Diaphoresis|diaphoretic]], or even present with a facial [[flushing]]. | ||
===Vital Signs=== | ===Vital Signs=== | ||
*Fever might be present in patients presenting with appendicitis. | *[[Fever]] might be present in patients presenting with appendicitis. | ||
*[[Tachycardia]] | *[[Tachycardia]] is prevalent in patients with [[carcinoid syndrome]] as well as patients with [[appendicitis]]. | ||
*Tachypnea | *[[Tachypnea]] | ||
*[[Hypertension]] | *[[Hypertension]] | ||
===Skin=== | ===Skin=== | ||
* Skin examination of patients with appendix cancer is usually normal. | * Skin examination of patients with appendix cancer is usually normal. | ||
* In the presence of carcinoid syndrome the following might be present: | * In the presence of [[carcinoid syndrome]] the following might be present: | ||
**[[Flushing]] | **[[Flushing]] | ||
** [[Hirsutism]] | ** [[Hirsutism]] | ||
** [[Pallor]] | ** [[Pallor]] | ||
** [[Dermatitis]] in the presence of [[Pellagra]] | |||
===HEENT=== | ===HEENT=== | ||
* HEENT examination of patients with appendix cancer is usually normal. | * HEENT examination of patients with appendix cancer is usually normal. | ||
* [[Glossitis]] may be suggestive of [[Pellagra]]. | |||
===Neck=== | ===Neck=== | ||
* Neck examination of patients with appendiceal cancer is usually normal. | * [[Neck]] examination of patients with appendiceal cancer is usually normal. | ||
* [[Lymphadenopathy|Cervical lymphadenopathy]] might be present. | * [[Lymphadenopathy|Cervical lymphadenopathy]] might be present. | ||
===Lungs=== | ===Lungs=== | ||
* Pulmonary examination of patients with appendix cancer is usually normal. | * [[Lung|Pulmonary]] examination of patients with [[appendix cancer]] is usually normal. | ||
* [[Wheezing]] : | * [[Wheezing]] : If the patient develop [[carcinoid syndrome]]. | ||
===Heart=== | ===Heart=== | ||
* Cardiovascular examination of patients with appendix cancer is usually normal. | * [[Circulatory system|Cardiovascular]] examination of patients with appendix cancer is usually normal. | ||
* If the patient develop carcinoid syndrome [[Murmur|systolic or diastolic murmur]] might be present | * If the patient develop [[carcinoid syndrome]] [[Murmur|systolic or diastolic murmur]] might be present. | ||
* Right heart murmurs specially TR is prevalent. | * Right [[Heart murmur|heart murmurs]] specially [[Tricuspid regurgitation|TR]] is prevalent. | ||
===Abdomen=== | ===Abdomen=== | ||
* Considering small size of must of appendiceal tumors, abdominal examination of patients with appendix cancer is usually normal. | * Considering small size of must of appendiceal [[Tumor|tumors]], abdominal examination of patients with appendix cancer is usually normal. | ||
* | * But in the cases of complicated tumors such as perforated [[appendicitis]], [[abdominal examination]] may be remarkable for: | ||
*[[Abdominal tenderness]] in the right lower abdominal quadrant | **[[Abdominal tenderness]] in the right lower abdominal quadrant | ||
*[[Rebound tenderness]] | **[[Rebound tenderness]] | ||
*A palpable abdominal mass in the right lower abdominal quadrant | **A palpable [[abdominal mass]] in the right lower abdominal quadrant | ||
*Guarding may be present | **[[Abdominal guarding|Guarding]] may be present | ||
*In cases of late stage metastatic disease [[hepatosplenomegaly]] might be present | *In cases of late stage [[metastatic]] disease [[hepatosplenomegaly]] might be present. | ||
*Additional findings, such as obturator test, | *Additional findings, such as [[obturator]] test, [[Psoas sign|Psoas]] test, McBurney point test are common in [[Appendicitis diagnostic scoring|appendicitis]]. | ||
'''''Palpation''''' | '''''Palpation''''' | ||
* The abdominal wall is very sensitive to mild palpation | * The abdominal wall is very sensitive to mild palpation: | ||
* [[Rebound tenderness]] | ** [[Rebound tenderness]] | ||
* [[Abdominal guarding]] | ** [[Abdominal guarding]] | ||
* [[Rovsing's sign]] | ** [[Rovsing's sign]] | ||
* [[Psoas sign]] | ** [[Psoas sign]] | ||
'''''Rectal examination''''' | '''''Rectal examination''''' | ||
* Tenderness in the [[rectovesical pouch]] | * [[Tenderness]] in the [[rectovesical pouch]] | ||
===Back=== | ===Back=== | ||
* Back examination of patients with appendix cancer is usually normal | * Back examination of patients with appendix cancer is usually normal. | ||
===Genitourinary=== | ===Genitourinary=== | ||
* Genitourinary examination of patients with | * [[Genitourinary tract|Genitourinary]] examination of patients with appendix cancer is usually normal. | ||
*A pelvic | *A pelvic [[Adnexal mass causes|adnexal mass]] may be palpated; in fact a number of appendiceal cancers are misdiagnosed as [[Ovarian cancer|ovarian masses]] vise versa. | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
* Neuromuscular examination of patients with | * Neuromuscular examination of patients with appendix cancer is usually normal. | ||
* [[Dementia]], aggression, and [[mental confusion]] are rare complications of complicated [[carcinoid syndrome]] patients that develop [[Pellagra]]. | |||
* | |||
===Extremities=== | ===Extremities=== | ||
* Extremities examination of patients with appendix cancer is usually normal. | * [[Limb (anatomy)|Extremities]] examination of patients with appendix cancer is usually normal. | ||
* | *Rarely patients with [[Carcinoid syndrome|carcinoid]] syndrome might present with [[Edema|lower limb edema]]. | ||
==References== | ==References== | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category: | [[Category:Surgery]] | ||
[[Category:Medicine]] | |||
[[Category:Emergency medicine]] | |||
[[Category:Oncology]] | |||
[[Category:Up-To-Date]] | |||
Latest revision as of 17:49, 22 February 2019
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Appendix cancer Microchapters |
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Appendix cancer physical examination On the Web |
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American Roentgen Ray Society Images of Appendix cancer physical examination |
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Risk calculators and risk factors for Appendix cancer physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]
Overview
Patients with appendix cancer usually appear normal, pale or diaphoretic. If the patient with appendix cancer present with acute appendicitis which is quite common, abdominal tenderness, rebound tenderness, abdominal guarding, Rovsing's sign, as well as Psoas sign might be present. Around 5% of the patients with appendiceal carcinoid tumors might develop carcinoid syndrome. Common physical examination findings of carcinoid syndrome include dehydration due to diarrhea, tachycardia as well as facial flushing, right heart murmurs like TR murmur is quit common. In patients with carcinoid syndrome, the presence of dermatitis, diarrhea, and dementia on physical examination is highly suggestive of Pellagra disease.
Physical Examination
- Physical examination of patients with appendix cancer is usually normal.[1]
- If the patient with appendix cancer present with acute appendicitis which is quite common, abdominal tenderness, rebound tenderness, abdominal guarding, Rovsing's sign, as well as Psoas sign might be present. [2]
- Around 5% of the patients with appendiceal carcinoid tumors might develop carcinoid syndrome.
- Common physical examination findings of carcinoid syndrome include dehydration due to diarrhea, tachycardia as well as facial flushing, right heart murmurs like TR murmur is quit common.[3]
- In patients with carcinoid syndrome, the presence of dermatitis, diarrhea, and dementia on physical examination is highly suggestive of Pellagra disease.[4]
Appearance of the Patient
- Patients with appendix cancer usually appear normal but might be pale or diaphoretic, or even present with a facial flushing.
Vital Signs
- Fever might be present in patients presenting with appendicitis.
- Tachycardia is prevalent in patients with carcinoid syndrome as well as patients with appendicitis.
- Tachypnea
- Hypertension
Skin
- Skin examination of patients with appendix cancer is usually normal.
- In the presence of carcinoid syndrome the following might be present:
- Flushing
- Hirsutism
- Pallor
- Dermatitis in the presence of Pellagra
HEENT
- HEENT examination of patients with appendix cancer is usually normal.
- Glossitis may be suggestive of Pellagra.
Neck
- Neck examination of patients with appendiceal cancer is usually normal.
- Cervical lymphadenopathy might be present.
Lungs
- Pulmonary examination of patients with appendix cancer is usually normal.
- Wheezing : If the patient develop carcinoid syndrome.
Heart
- Cardiovascular examination of patients with appendix cancer is usually normal.
- If the patient develop carcinoid syndrome systolic or diastolic murmur might be present.
- Right heart murmurs specially TR is prevalent.
Abdomen
- Considering small size of must of appendiceal tumors, abdominal examination of patients with appendix cancer is usually normal.
- But in the cases of complicated tumors such as perforated appendicitis, abdominal examination may be remarkable for:
- Abdominal tenderness in the right lower abdominal quadrant
- Rebound tenderness
- A palpable abdominal mass in the right lower abdominal quadrant
- Guarding may be present
- In cases of late stage metastatic disease hepatosplenomegaly might be present.
- Additional findings, such as obturator test, Psoas test, McBurney point test are common in appendicitis.
Palpation
- The abdominal wall is very sensitive to mild palpation:
Rectal examination
- Tenderness in the rectovesical pouch
Back
- Back examination of patients with appendix cancer is usually normal.
Genitourinary
- Genitourinary examination of patients with appendix cancer is usually normal.
- A pelvic adnexal mass may be palpated; in fact a number of appendiceal cancers are misdiagnosed as ovarian masses vise versa.
Neuromuscular
- Neuromuscular examination of patients with appendix cancer is usually normal.
- Dementia, aggression, and mental confusion are rare complications of complicated carcinoid syndrome patients that develop Pellagra.
Extremities
- Extremities examination of patients with appendix cancer is usually normal.
- Rarely patients with carcinoid syndrome might present with lower limb edema.
References
- ↑ Chapter 5: Tumours of the Appendix - IARC. https://www.iarc.fr/en/publications/pdfs-online/pat-gen/bb2/bb2-chap5.pdf Accessed on January 15, 2019
- ↑ Hardin, M. Acute Appendicitis: Review and Update. Am Fam Physician".1999, Nov 1;60(7):2027-2034
- ↑ Signs and symptoms of carcinoid syndrome. National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/patient/gi-carcinoid-treatment-pdq
- ↑ Hegyi J, Schwartz RA, Hegyi V (2004) Pellagra: dermatitis, dementia, and diarrhea. Int J Dermatol 43 (1):1-5. PMID: 14693013