Salmonellosis physical examination: Difference between revisions

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==Overview==
==Overview==
Salmonellosis is commonly associated with [[fever]], [[pallor]], [[abdominal distension]] and [[abdominal tenderness|tenderness]]. Depending on the severity of the disease, the appearance of the patient may range from normal, able to communicate, to severely [[dehydrated]] and [[obtundation|obtunded]].


==Physical Examination==
==Physical Examination==
===Appearance of the Patient===
Depending on the severity of salmonellosis, patient's appearance may range from alert and oriented, being able to communicate, to severely [[dehydrated]], [[hypotensive]], with sunken eyes.<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426  }} </ref><ref name="pmid25136336">{{cite journal| author=Gal-Mor O, Boyle EC, Grassl GA| title=Same species, different diseases: how and why typhoidal and non-typhoidal Salmonella enterica serovars differ. | journal=Front Microbiol | year= 2014 | volume= 5 | issue=  | pages= 391 | pmid=25136336 | doi=10.3389/fmicb.2014.00391 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25136336  }} </ref>


===Appearance of the Patient===
Depending on the severity of salmonellosis, patient's appearance may range from alert and oriented, being able to communicate, to severely dehydrated, hypotensive, with sunken eyes and unable to communicate.
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===Vitals===
===Vitals===
====Temperature====
====Temperature====
*A [[fever]] is often present
*A [[fever]] is often present
*[[Hypothermia]] may be present
====Pulse====
====Pulse====
=====Rate=====
=====Rate=====
*[[Tachycardia]] may be present
*[[Tachycardia]] may be present
*[[Bradycardia]] may be present
=====Rhythm=====
*The pulse is regular
*The pules is irregularly irregular
=====Strength=====
=====Strength=====
*The pulse may be weak
*The pulse may be weak
*The pulse may be bounding
*The pulse may be alternating in strength ([[pulsus alternans]])
*A [[paradoxical pulse]] may be present
=====Symmetry=====
*The pulses may be asymmetric
====Blood Pressure====
====Blood Pressure====
*[[Hypotension]] may be present
*[[Hypotension]] may be present
*[[Hypertension]] may be present
*A [[wide pulse pressure]] may be present
*A [[narrow pulse pressure]] may be present
====Respiratory Rate====
====Respiratory Rate====
*[[Tachypnea]] may be present
*[[Tachypnea]] may be present
*[[Bradypnea]] may be present
* [[Kussmaul respirations]] may be present


===Skin===
===Skin===
*[[Cyanosis]] may be present
*[[Pallor]] may be present
*[[Jaundice]] may be present
* A rash may be present
* [[Pallor]] may be present
* Lesions may be present
 
===Head===
* Abnormalities of the head/hair may include ___
* There may be evidence of trauma


===Eyes===
===Eyes===
*Icteric sclera may be present
*[[Mucosa]] may be dehydrated
* [[Nystagmus]] may be present.
* Extra-ocular movements may be abnormal
*Pupils may not react to light
*Ophthalmoscopic exam may be abnormal with findings of ___
 
===Ears===
* Hearing acuity may be reduced
*[[Weber test]] may be positive
*[[Rinne test]] may be positive
* There may be [[exudate]] from the ear canal
* There may be [[tenderness]] on movement of the pinnae
 
===Nose===
* Nares may be inflamed
* There may be [[epistaxis]]
* There may be [[purulent]] exudate from the nares
* There may be [[tenderness]] to percussion of the sinuses
* The nares may be congested
 
===Throat===
* The throat may be erythematous
* There may be [[exudate]] in the throat
* There may be [[petechiae]] seen in the throat
* There may be tonsillar inflammation
 
===Neck===
*[[Jugular venous pressure]] may be elevated
*[[Carotid bruits]] may be present
*[[Lymph nodes]] may be present
*[[Thyromegaly]] may be present
*[[Hepatojugular reflux]] may be present
 
===Lungs===
*[[Pulmonary edema]] and [[rales]] may be present
*[[Wheezing]] may be present
*Consolidation may be present with reduced breath sounds auscultated
*[[Rales]] may be present
*[[Egophony]] may be present
* Chest movement may be assymetric
 
===Heart===
*A [[heave]] may be present
*A [[thrill]] may be present
*A [[friction rub]] may be pressent
 
====Auscultation====
*[[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 [[systolic murmur]] best heard at the base may be present
*A [[systolic murmur]] best heard at the apex may be present
*A [[diastolic murmur]] may be present


===Abdomen===
===Abdomen===
*[[Abdominal distention]] may be present
*[[Abdominal distention]] may be present
*[[Abdominal tenderness]] may be present
*[[Abdominal tenderness]] may be present
*[[Rebound tenderness]] may be present
*An [[abdominal mass]] may be present
*An [[acute abdomen]] may be present
*[[Hepatosplenomegaly]] may be present in immunocompromised patients
*An abdominal mass may be present
*Guarding may be present
*[[Hepatomegaly]] may be present
*[[Splenomegaly]] may be present
*Genitourinary exam if relevant
 
===Extremities===
*[[Clubbing]] may be present
*[[Cyanosis]] may be present
*[[Edema]] may be present


===Neurologic===
===Neurologic===
* Mental status may be altered
*[[Mental status]] may be altered
* Glasgow coma scale is ___
*[[Obtundation]] may be present
* Clonus may be present
* Hyperactive reflexes may be present
* There are deficits in cranial nerves ___
 
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Harrison's:
 
Physical findings included coated tongue (51–56%), splenomegaly (5–6%), and abdominal tenderness (4–5%).
 
Early physical findings of enteric fever include rash ("rose spots"; 30%), hepatosplenomegaly (3–6%), epistaxis, and relative bradycardia at the peak of high fever (<50%). Rose spots (Fig. 153-2; see also Fig. e7-9) make up a faint, salmon-colored, blanching, maculopapular rash located primarily on the trunk and chest. The rash is evident in 30% of patients at the end of the first week and resolves without a trace after 2–5 days. Patients can have two or three crops of lesions, and Salmonella can be cultured from punch biopsies of these lesions. The faintness of the rash makes it difficult to detect in highly pigmented patients.
-->


==References==
==References==
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Latest revision as of 18:41, 18 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2] Jolanta Marszalek, M.D. [3]

Overview

Salmonellosis is commonly associated with fever, pallor, abdominal distension and tenderness. Depending on the severity of the disease, the appearance of the patient may range from normal, able to communicate, to severely dehydrated and obtunded.

Physical Examination

Appearance of the Patient

Depending on the severity of salmonellosis, patient's appearance may range from alert and oriented, being able to communicate, to severely dehydrated, hypotensive, with sunken eyes.[1][2]

Vitals

Temperature

Pulse

Rate
Strength
  • The pulse may be weak

Blood Pressure

Respiratory Rate

Skin

Eyes

Abdomen

Neurologic

References

  1. ↑ Thielman NM, Guerrant RL (2004). "Clinical practice. Acute infectious diarrhea". N Engl J Med. 350 (1): 38–47. doi:10.1056/NEJMcp031534. PMID 14702426.
  2. ↑ Gal-Mor O, Boyle EC, Grassl GA (2014). "Same species, different diseases: how and why typhoidal and non-typhoidal Salmonella enterica serovars differ". Front Microbiol. 5: 391. doi:10.3389/fmicb.2014.00391. PMID 25136336.

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