Hemolytic-uremic syndrome physical examination: Difference between revisions

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__NOTOC__
__NOTOC__
{{HUS}}
{{HUS}}
{{CMG}}; {{AE}}  
{{CMG}}; {{AE}} {{S.G.}}, {{AHS}}


==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].
Common [[physical examination]] findings of [[Hemolytic-uremic syndrome|hemolytic uremic syndrome]] ([[Hemolytic-uremic syndrome|HUS]]) include [[edema]] and [[fluid overload]], [[high blood pressure]] and often sever pallor. [[Gastrointestinal]] findings may include [[abdominal tenderness]], [[distension]] and [[Abdominal guarding|guarding]]. [[Bruise|bruising]], [[purpura]], [[Petechia|petechiae]] or oozing from the site of [[venipuncture]] may be seen sometimes.
 
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 HUS is usually :
[[Physical examination]] of patients with [[Hemolytic-uremic syndrome|HUS]] is usually :<ref>{{Cite journal
| author = [[Marina Noris]], [[Jessica Caprioli]], [[Elena Bresin]], [[Chiara Mossali]], [[Gaia Pianetti]], [[Sara Gamba]], [[Erica Daina]], [[Chiara Fenili]], [[Federica Castelletti]], [[Annalisa Sorosina]], [[Rossella Piras]], [[Roberta Donadelli]], [[Ramona Maranta]], [[Irene van der Meer]], [[Edward M. Conway]], [[Peter F. Zipfel]], [[Timothy H. Goodship]] & [[Giuseppe Remuzzi]]
| title = Relative role of genetic complement abnormalities in sporadic and familial aHUS and their impact on clinical phenotype
| journal = [[Clinical journal of the American Society of Nephrology : CJASN]]
| volume = 5
| issue = 10
| pages = 1844–1859
| year = 2010
| month = October
| doi = 10.2215/CJN.02210310
| pmid = 20595690
}}</ref><ref>{{Cite journal
| author = [[Marina Noris]] & [[Giuseppe Remuzzi]]
| title = Hemolytic uremic syndrome
| journal = [[Journal of the American Society of Nephrology : JASN]]
| volume = 16
| issue = 4
| pages = 1035–1050
| year = 2005
| month = April
| doi = 10.1681/ASN.2004100861
| pmid = 15728781
}}</ref><ref name=":0">{{Cite journal
| author = [[Olivia Boyer]] & [[Patrick Niaudet]]
| title = Hemolytic uremic syndrome: new developments in pathogenesis and treatment
| journal = [[International journal of nephrology]]
| volume = 2011
| pages = 908407
| year = 2011
| month =
| doi = 10.4061/2011/908407
| pmid = 21876803
}}</ref><ref name=":1">{{Cite journal
| author = [[Sylvie Nathanson]], [[Theresa Kwon]], [[Monique Elmaleh]], [[Marina Charbit]], [[Emma Allain Launay]], [[Jerome Harambat]], [[Muriel Brun]], [[Bruno Ranchin]], [[Flavio Bandin]], [[Sylvie Cloarec]], [[Guylhene Bourdat-Michel]], [[Christine Pietrement]], [[Gerard Champion]], [[Tim Ulinski]] & [[Georges Deschenes]]
| title = Acute neurological involvement in diarrhea-associated hemolytic uremic syndrome
| journal = [[Clinical journal of the American Society of Nephrology : CJASN]]
| volume = 5
| issue = 7
| pages = 1218–1228
| year = 2010
| month = July
| doi = 10.2215/CJN.08921209
| pmid = 20498239
}}</ref>


Edema,
*[[Edema]]


Hypertension
*[[Hypertension]]


Fluid overload
*[[Fluid overload]]


Pallor, often severe
*Pallor (often severe)


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].
*Patients with [[HUS]] usually appear [[Pallor|pale]]


===Vital Signs===
===Vital Signs ===


*High-grade / low-grade fever
*[[Fever]] (in some cases)
*[[Hypothermia]] / hyperthermia may be present
*Weak [[pulse]]  
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[High blood pressure]] (with normal [[pulse pressure]])
*[[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===
* Skin examination of patients with [disease name] is usually normal.
* Skin [[examination]] of patients with HUS is usually [[Pale skin color|pale]]. [[Bruise|Bruising]], [[Petechia|petechiae]], [[purpura]] or oozing from site of [[venipuncture]] seen sometimes.
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 examination of patients with [[Hemolytic-uremic syndrome|HUS]] 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 examination of patients with [[Hemolytic-uremic syndrome|HUS]] 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.
* Pulmonary examination of patients with [[Hemolytic-uremic syndrome|HUS]] is usually normal.
OR
*  
* Asymmetric chest expansion OR decreased chest expansion
*Lungs are hyporesonant OR hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR 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.
* Cardiovascular examination of patients with HUS 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.
OR
*[[Abdominal distention]]  
*[[Abdominal distention]]  
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Abdominal tenderness]]
*[[Rebound tenderness]] (positive Blumberg sign)
*[[Abdominal guarding|Guarding]] may be present
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


===Back===
===Back===
* Back examination of patients with [disease name] is usually normal.
* Back examination of patients with [[HUS]] 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 examination of patients with is usually normal
OR
* Hematuria may be present
*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 [[examination]] of patients with [[Hemolytic-uremic syndrome|HUS]] is usually normal.
OR
 
*Patient is usually oriented to persons, place, and time
* Patient is usually oriented to persons, place, and time
* Altered mental status
* [[Altered mental state|Altered mental status]], some patients are in the [[coma]]
* 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.
* Extremities examination of patients with [[Hemolytic-uremic syndrome|HUS]] is usually normal
OR
* [[Pitting edema]] lower [[extremities]]
*[[Clubbing]]  
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

Latest revision as of 00:34, 21 December 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sogand Goudarzi, MD [2], Anila Hussain, MD [3]

Overview

Common physical examination findings of hemolytic uremic syndrome (HUS) include edema and fluid overload, high blood pressure and often sever pallor. Gastrointestinal findings may include abdominal tenderness, distension and guarding. bruising, purpura, petechiae or oozing from the site of venipuncture may be seen sometimes.

Physical Examination

Physical examination of patients with HUS is usually :[1][2][3][4]

  • Pallor (often severe)

Appearance of the Patient

  • Patients with HUS usually appear pale

Vital Signs

Skin

HEENT

  • HEENT examination of patients with HUS is usually normal.

Neck

  • Neck examination of patients with HUS is usually normal.

Lungs

  • Pulmonary examination of patients with HUS is usually normal.

Heart

  • Cardiovascular examination of patients with HUS is usually normal.

Abdomen

Back

  • Back examination of patients with HUS is usually normal.

Genitourinary

  • Genitourinary examination of patients with is usually normal
  • Hematuria may be present

Neuromuscular

Extremities

References

  1. ↑ Marina Noris, Jessica Caprioli, Elena Bresin, Chiara Mossali, Gaia Pianetti, Sara Gamba, Erica Daina, Chiara Fenili, Federica Castelletti, Annalisa Sorosina, Rossella Piras, Roberta Donadelli, Ramona Maranta, Irene van der Meer, Edward M. Conway, Peter F. Zipfel, Timothy H. Goodship & Giuseppe Remuzzi (2010). "Relative role of genetic complement abnormalities in sporadic and familial aHUS and their impact on clinical phenotype". Clinical journal of the American Society of Nephrology : CJASN. 5 (10): 1844–1859. doi:10.2215/CJN.02210310. PMID 20595690. Unknown parameter |month= ignored (help)
  2. ↑ Marina Noris & Giuseppe Remuzzi (2005). "Hemolytic uremic syndrome". Journal of the American Society of Nephrology : JASN. 16 (4): 1035–1050. doi:10.1681/ASN.2004100861. PMID 15728781. Unknown parameter |month= ignored (help)
  3. ↑ Olivia Boyer & Patrick Niaudet (2011). "Hemolytic uremic syndrome: new developments in pathogenesis and treatment". International journal of nephrology. 2011: 908407. doi:10.4061/2011/908407. PMID 21876803.
  4. ↑ Sylvie Nathanson, Theresa Kwon, Monique Elmaleh, Marina Charbit, Emma Allain Launay, Jerome Harambat, Muriel Brun, Bruno Ranchin, Flavio Bandin, Sylvie Cloarec, Guylhene Bourdat-Michel, Christine Pietrement, Gerard Champion, Tim Ulinski & Georges Deschenes (2010). "Acute neurological involvement in diarrhea-associated hemolytic uremic syndrome". Clinical journal of the American Society of Nephrology : CJASN. 5 (7): 1218–1228. doi:10.2215/CJN.08921209. PMID 20498239. Unknown parameter |month= ignored (help)

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