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==Overview==
==Overview==
[[Physical examination]] of [[patient|patients]] with [[ileus]] is usually remarkable for [[abdominal distension]], [[abdomen|abdominal]] tenderness, and [[Decreased bowel sounds|minimal]] or [[absent bowel sounds]]. [[patient|Patients]] with prolonged [[ileus]] may progress to develop [[peritoneal]] signs such as rigidity, [[guarding]] and [[rebound tenderness]].


==Physical Examination==
==Physical Examination==
*Bowel sounds are minimal or absent, in contrast to early mechanical obstruction, when they are hyperactive.
[[Physical examination]] of [[patient|patients]] with [[ileus]] is usually remarkable for [[abdominal distension]], [[abdominal tenderness]], and [[Decreased bowel sounds|minimal]] or [[absent bowel sounds]] (characteristic finding).<ref name="pmid22866434">{{cite journal |vauthors=Massey RL |title=Return of bowel sounds indicating an end of postoperative ileus: is it time to cease this long-standing nursing tradition? |journal=Medsurg Nurs |volume=21 |issue=3 |pages=146–50 |year=2012 |pmid=22866434 |doi= |url=}}</ref><ref name="pmid24776861">{{cite journal |vauthors=Felder S, Margel D, Murrell Z, Fleshner P |title=Usefulness of bowel sound auscultation: a prospective evaluation |journal=J Surg Educ |volume=71 |issue=5 |pages=768–73 |year=2014 |pmid=24776861 |doi=10.1016/j.jsurg.2014.02.003 |url=}}</ref><ref name="pmid28439845">{{cite journal |vauthors=Rami Reddy SR, Cappell MS |title=A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction |journal=Curr Gastroenterol Rep |volume=19 |issue=6 |pages=28 |year=2017 |pmid=28439845 |doi=10.1007/s11894-017-0566-9 |url=}}</ref><ref name="pmid6849489">{{cite journal |vauthors=Sarr MG, Bulkley GB, Zuidema GD |title=Preoperative recognition of intestinal strangulation obstruction. Prospective evaluation of diagnostic capability |journal=Am. J. Surg. |volume=145 |issue=1 |pages=176–82 |year=1983 |pmid=6849489 |doi= |url=}}</ref><ref name="pmid28818187">{{cite journal |vauthors=Vilz TO, Stoffels B, Strassburg C, Schild HH, Kalff JC |title=Ileus in Adults |journal=Dtsch Arztebl Int |volume=114 |issue=29-30 |pages=508–518 |year=2017 |pmid=28818187 |pmc=5569564 |doi=10.3238/arztebl.2017.0508 |url=}}</ref><ref name="pmid26843914">{{cite journal |vauthors=Nuño-Guzmán CM, Marín-Contreras ME, Figueroa-Sánchez M, Corona JL |title=Gallstone ileus, clinical presentation, diagnostic and treatment approach |journal=World J Gastrointest Surg |volume=8 |issue=1 |pages=65–76 |date=January 2016 |pmid=26843914 |pmc=4724589 |doi=10.4240/wjgs.v8.i1.65 |url=}}</ref><ref name="pmid15269690">{{cite journal |vauthors=Grassi R, Di Mizio R, Pinto A, Romano L, Rotondo A |title=Serial plain abdominal film findings in the assessment of acute abdomen: spastic ileus, hypotonic ileus, mechanical ileus and paralytic ileus |journal=Radiol Med |volume=108 |issue=1-2 |pages=56–70 |date=2004 |pmid=15269690 |doi= |url=}}</ref>
*Decreased or hypoactive bowel sounds
===Appearance of the patient===
*Hypovolemia
*[[patient|Patients]] with [[ileus]] usually appear [[Fatigue (physical)|fatigued]] and in discomfort.  
*Abdominal tenderness
*Abdominal tenderness
*Tympanic on percussion
*Absent or hypoactive bowel sounds
*Absent succussion splash.
 
 


*Physical examination of patients with ileus is usually remarkable for minimal or absent bowel sounds, abdominal distension and tenderness.
===Vital signs===
 
*[[Tachycardia]] with regular [[pulse]]
===Appearance of the Patient===
*[[Low blood pressure]] with normal [[pulse pressure]] (uncommon)
*Patients with ileus usually appear fatigued.
*[[Orthostatic hypotension]]
 
*[[patient|Patients]] who developed [[Complication (medicine)|complications]] such as [[intestine|intestinal]] [[Gastrointestinal perforation|perforation]] or [[peritonitis]] are possibly [[fever|feverish]].
===Vital Signs===
 
*High-grade / low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular 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===
* Skin examination of patients with [disease name] is usually normal.
* [[Skin]] [[Physical examination|examination]] of [[patient|patients]] with [[ileus]] is usually normal.
OR
*[[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.
* HEENT [[Physical examination|examination]] of [[patient|patients]] with [[ileus]] is usually normal.
OR
* 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]] [[Physical examination|examination]] of [[patient|patients]] with [[ileus]] 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.
* [[Lung|Pulmonary]] [[Physical examination|examination]] of [[patient|patients]] with [[ileus]] is usually normal.
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.
* [[Circulatory system|Cardiovascular]] [[Physical examination|examination]] of [[patient|patients]] with [[ileus]] is usually normal.
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 examination of patients with [disease name] is usually normal.
[[abdome|Abdominal]] [[Physical examination|examination]] of [[patient|patients]] with [[ileus]] includes:<ref name="urlIleus and Bowel Obstruction - Holland-Frei Cancer Medicine - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK13786/ |title=Ileus and Bowel Obstruction - Holland-Frei Cancer Medicine - NCBI Bookshelf |format= |work= |accessdate=}}</ref><ref name="pmid20119556">{{cite journal |vauthors=Carroll J, Alavi K |title=Pathogenesis and management of postoperative ileus |journal=Clin Colon Rectal Surg |volume=22 |issue=1 |pages=47–50 |date=February 2009 |pmid=20119556 |pmc=2780226 |doi=10.1055/s-0029-1202886 |url=}}</ref><ref name="pmid18090881">{{cite journal |vauthors=Stewart D, Waxman K |title=Management of postoperative ileus |journal=Am J Ther |volume=14 |issue=6 |pages=561–6 |date=2007 |pmid=18090881 |doi=10.1097/MJT.0b013e31804bdf54 |url=}}</ref><ref name="pmid23055768">{{cite journal |vauthors=Macaluso CR, McNamara RM |title=Evaluation and management of acute abdominal pain in the emergency department |journal=Int J Gen Med |volume=5 |issue= |pages=789–97 |date=2012 |pmid=23055768 |pmc=3468117 |doi=10.2147/IJGM.S25936 |url=}}</ref><ref name="pmid23902744">{{cite journal |vauthors=Coppolino F, Gatta G, Di Grezia G, Reginelli A, Iacobellis F, Vallone G, Giganti M, Genovese E |title=Gastrointestinal perforation: ultrasonographic diagnosis |journal=Crit Ultrasound J |volume=5 Suppl 1 |issue= |pages=S4 |date=July 2013 |pmid=23902744 |pmc=3711723 |doi=10.1186/2036-7902-5-S1-S4 |url=}}</ref><ref name="pmid22866434">{{cite journal |vauthors=Massey RL |title=Return of bowel sounds indicating an end of postoperative ileus: is it time to cease this long-standing nursing tradition? |journal=Medsurg Nurs |volume=21 |issue=3 |pages=146–50 |date=2012 |pmid=22866434 |doi= |url=}}</ref><ref name="pmid19966732">{{cite journal |vauthors=Baid H |title=A critical review of auscultating bowel sounds |journal=Br J Nurs |volume=18 |issue=18 |pages=1125–9 |date=2009 |pmid=19966732 |doi=10.12968/bjon.2009.18.18.44555 |url=}}</ref>
 
OR
*[[Abdominal distention]]  
*[[Abdominal distention]]  
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Abdominal tenderness]] (severe cases)
*[[Rebound tenderness]] (positive Blumberg sign)
*[[Decreased bowel sounds|Hypoactive]] or [[absent bowel sounds]] (characteristic finding)  
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Absent succussion splash
*Guarding may be present
*Tympanic on [[percussion]]
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*[[Peritoneum|Peritoneal]] signs suggests [[intestinal perforation]] such as:
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
**Rigidity
**[[Guarding]]
**[[Rebound tenderness]]


===Back===
===Back===
* Back examination of patients with [disease name] is usually normal.
* [[Human back|Back]] [[Physical examination|examination]] of [[patient|patients]] with [[ileus]] 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 [[Physical examination|examination]] of [[patient|patients]] with [[ileus]] 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.
* [[Neuromuscular junction|Neuromuscular]] [[Physical examination|examination]] of [[patient|patients]] with [[ileus]] is usually normal.
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.
* [[Limb (anatomy)|Extremities]] [[Physical examination|examination]] of [[patient|patients]] with [[ileus]] 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==
{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 18:55, 11 October 2020

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

Overview

Physical examination of patients with ileus is usually remarkable for abdominal distension, abdominal tenderness, and minimal or absent bowel sounds. Patients with prolonged ileus may progress to develop peritoneal signs such as rigidity, guarding and rebound tenderness.

Physical Examination

Physical examination of patients with ileus is usually remarkable for abdominal distension, abdominal tenderness, and minimal or absent bowel sounds (characteristic finding).[1][2][3][4][5][6][7]

Appearance of the patient

Vital signs

Skin

HEENT

Neck

Lungs

Heart

Abdomen

Abdominal examination of patients with ileus includes:[8][9][10][11][12][1][13]

Back

Genitourinary

Neuromuscular

Extremities

References

  1. ↑ 1.0 1.1 Massey RL (2012). "Return of bowel sounds indicating an end of postoperative ileus: is it time to cease this long-standing nursing tradition?". Medsurg Nurs. 21 (3): 146–50. PMID 22866434.
  2. ↑ Felder S, Margel D, Murrell Z, Fleshner P (2014). "Usefulness of bowel sound auscultation: a prospective evaluation". J Surg Educ. 71 (5): 768–73. doi:10.1016/j.jsurg.2014.02.003. PMID 24776861.
  3. ↑ Rami Reddy SR, Cappell MS (2017). "A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction". Curr Gastroenterol Rep. 19 (6): 28. doi:10.1007/s11894-017-0566-9. PMID 28439845.
  4. ↑ Sarr MG, Bulkley GB, Zuidema GD (1983). "Preoperative recognition of intestinal strangulation obstruction. Prospective evaluation of diagnostic capability". Am. J. Surg. 145 (1): 176–82. PMID 6849489.
  5. ↑ Vilz TO, Stoffels B, Strassburg C, Schild HH, Kalff JC (2017). "Ileus in Adults". Dtsch Arztebl Int. 114 (29–30): 508–518. doi:10.3238/arztebl.2017.0508. PMC 5569564. PMID 28818187.
  6. ↑ Nuño-Guzmán CM, Marín-Contreras ME, Figueroa-Sánchez M, Corona JL (January 2016). "Gallstone ileus, clinical presentation, diagnostic and treatment approach". World J Gastrointest Surg. 8 (1): 65–76. doi:10.4240/wjgs.v8.i1.65. PMC 4724589. PMID 26843914.
  7. ↑ Grassi R, Di Mizio R, Pinto A, Romano L, Rotondo A (2004). "Serial plain abdominal film findings in the assessment of acute abdomen: spastic ileus, hypotonic ileus, mechanical ileus and paralytic ileus". Radiol Med. 108 (1–2): 56–70. PMID 15269690.
  8. ↑ "Ileus and Bowel Obstruction - Holland-Frei Cancer Medicine - NCBI Bookshelf".
  9. ↑ Carroll J, Alavi K (February 2009). "Pathogenesis and management of postoperative ileus". Clin Colon Rectal Surg. 22 (1): 47–50. doi:10.1055/s-0029-1202886. PMC 2780226. PMID 20119556.
  10. ↑ Stewart D, Waxman K (2007). "Management of postoperative ileus". Am J Ther. 14 (6): 561–6. doi:10.1097/MJT.0b013e31804bdf54. PMID 18090881.
  11. ↑ Macaluso CR, McNamara RM (2012). "Evaluation and management of acute abdominal pain in the emergency department". Int J Gen Med. 5: 789–97. doi:10.2147/IJGM.S25936. PMC 3468117. PMID 23055768.
  12. ↑ Coppolino F, Gatta G, Di Grezia G, Reginelli A, Iacobellis F, Vallone G, Giganti M, Genovese E (July 2013). "Gastrointestinal perforation: ultrasonographic diagnosis". Crit Ultrasound J. 5 Suppl 1: S4. doi:10.1186/2036-7902-5-S1-S4. PMC 3711723. PMID 23902744.
  13. ↑ Baid H (2009). "A critical review of auscultating bowel sounds". Br J Nurs. 18 (18): 1125–9. doi:10.12968/bjon.2009.18.18.44555. PMID 19966732.

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