Diffuse esophageal spasm physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Madhu Sigdel M.B.B.S.[2]
Overview
Patients with primary diffuse esophageal spasm usually appear normal. Physical examination of patients with DES is usually remarkable for findings related to secondary diseases.
Physical Examination
- Physical examination of patients with DES is usually remarkable for presence of features related to secondary diseases.
Appearance of the Patient
- Patients with primary DES usually appear normal.
Vital Signs
- High-grade / low-grade fever in infectious cause of DES
- 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
- Kussmaul respirations
- Weak / bounding pulse
- High / low blood pressure with normal pulse pressure
Skin
- Tight, hardened skin in limited scleroderma
- Red spots or lines in skin of face and hand due to telangiectasia in scleroderma
- Bumps under the skin due to deposition of calcium in scleroderma.
- Ulcers of finger and toes may be present in scleroderma
- Insect bite wound may be seen in Chaga's disease with excoriation at the bite site.
HEENT
- Romana's sign is seen in Chaga's disease (swelling of eyelid at the site of parasite entry)
- Ophthalmoscopic exam may be abnormal with findings of diabetic retinopathy in diabetics as well as cataract changes.
- Lower extremities edema in Chaga's disease.
- Dry mouth and dry eye in scleroderma.
Neck
- Lymphadenopathy (Chaga's disease)
- Thyromegaly / thyroid nodules
Lungs
- Asymmetric chest expansion / Decreased chest expansion
- Lungs are hyperresonant in scleroderma.
- Fine/coarse crackles upon auscultation of the lung bases/apices bilaterally seen in scleroderma.
Heart
Heart involvement in Chagas's cardiomyopathy are:
- Displaced point of maximal impulse (PMI).
- S3, S4
- Disturbances of rhythm (arrhythmias) may be noted in scleroderma.
Abdomen
- Abdominal distention or bloating is noted in Scleroderma, Diabetes.
- Hepatosplenomegaly is feature of Chaga's disease.
Extremities
- Clubbing , Cyanosis are features of chronic involvement and fibrosis of lungs in Scleroderma.
- Pitting edema of the lower extremities may be noted in Chaga's cardiomyopathy.