Esophageal stricture physical examination: Difference between revisions

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Revision as of 21:18, 13 November 2017

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

Overview

Patients with esophageal cancer can usually appear normal. Cachexia and pallor are notable in patients with esophageal stricture due to malignant causes.

Physical Examination

Esophageal stricture has many causes. Physical examination due to different causes include:

Appearance of the Patient

Patients with esophageal stricture due to malignant causes usually appear cachectic and pale

Vital Signs

Hypertension spicking specially in patients already with hypertension in gastroesophageal reflux disease^[1]

Skin

Bullous skin eruptions in epidermolysis bullosa dystrophica as a cause of esophageal stricture ^[2]

Epidermolysis bullosa dystrofic dominant. Adapted from Dermatology Atlas.^[3]
Epidermolysis bullosa dystrofic dominant. Adapted from Dermatology Atlas.^[3]

Pallor in malignant causes

HEENT

Esophageal stricture due to gastroesophageal reflux disease:

Hoarse voice
Oropharyngeal erythema
Dental erosions

Neck

Left supraclavicular lymphadenopathy (Virchow node) due to malignant causes of esophageal stricture

Lung

Wheezing may be present

Abdomen

Epigastric tenderness due to gastroesophageal reflux
Hepatomegaly in metastatic esophageal cancer

References

↑ Li ZT, Ji F, Han XW, Wang L, Yue YQ, Wang ZG (2017). "The Role of Gastroesophageal Reflux in Provoking High Blood Pressure Episodes in Patients With Hypertension". J Clin Gastroenterol. doi:10.1097/MCG.0000000000000933. PMID 28961574.
↑ Luedtke P, Levine MS, Rubesin SE, Weinstein DS, Laufer I (2003). "Radiologic diagnosis of benign esophageal strictures: a pattern approach". Radiographics. 23 (4): 897–909. doi:10.1148/rg.234025717. PMID 12853664.
↑ ^3.0 ^3.1 "Dermatology Atlas".

Template:WH Template:WS

[pmid28961574-1] Li ZT, Ji F, Han XW, Wang L, Yue YQ, Wang ZG (2017). "The Role of Gastroesophageal Reflux in Provoking High Blood Pressure Episodes in Patients With Hypertension". J Clin Gastroenterol. doi:10.1097/MCG.0000000000000933. PMID 28961574.

[pmid12853664-2] Luedtke P, Levine MS, Rubesin SE, Weinstein DS, Laufer I (2003). "Radiologic diagnosis of benign esophageal strictures: a pattern approach". Radiographics. 23 (4): 897–909. doi:10.1148/rg.234025717. PMID 12853664.

[Dermatology_Atlas-3] 3.0 ^3.1 "Dermatology Atlas".

[1]

[2]

[3]

@@ Line 7: / Line 7: @@
 Patients with esophageal cancer can usually appear normal. Cachexia and pallor are notable in patients with esophageal stricture due to malignant causes.
-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==
 Esophageal stricture has many causes. Physical examination due to different causes include:
-*Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
-*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
-*The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
 ===Appearance of the Patient===
 *Patients with esophageal stricture due to malignant causes usually appear cachectic and pale
@@ Line 29: / Line 14: @@
 ===Vital Signs===
 * [[Hypertension]] spicking specially in patients already with hypertension in [[gastroesophageal reflux disease]]<ref name="pmid28961574">{{cite journal| author=Li ZT, Ji F, Han XW, Wang L, Yue YQ, Wang ZG| title=The Role of Gastroesophageal Reflux in Provoking High Blood Pressure Episodes in Patients With Hypertension. | journal=J Clin Gastroenterol | year= 2017 | volume=  | issue=  | pages=  | pmid=28961574 | doi=10.1097/MCG.0000000000000933 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28961574  }}</ref>
-*High-grade / low-grade fever
-*[[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
-*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===
@@ Line 63: / Line 39: @@
 * Left supraclavicular lymphadenopathy (Virchow node)  due to malignant causes of esophageal stricture
-*[[Jugular venous distension]]
+===Lung===
-*[[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===
-* Wheezing
-* Bronchitis<ref name="pmid23452632">{{cite journal| author=Hom C, Vaezi MF| title=Extraesophageal manifestations of gastroesophageal reflux disease. | journal=Gastroenterol Clin North Am | year= 2013 | volume= 42 | issue= 1 | pages= 71-91 | pmid=23452632 | doi=10.1016/j.gtc.2012.11.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23452632  }}</ref>
-*
-* 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===
-*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===
 * Epigastric tenderness due to gastroesophageal reflux
+*[[Hepatomegaly]] in metastatic esophageal cancer
-*[[Abdominal distention]]
-*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
-*[[Rebound tenderness]] (positive Blumberg sign)
-*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===
-*Point tenderness over __ vertebrae (e.g. L3-L4)
-*Sacral edema
-*Costovertebral angle tenderness bilaterally/unilaterally
-*Buffalo hump
-===Genitourinary===
-*A pelvic/adnexal mass may be palpated
-*Inflamed mucosa
-*Clear/(color), foul-smelling/odorless penile/vaginal discharge
-===Neuromuscular===
-*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===
-*[[Clubbing]]
-*[[Cyanosis]]
-*Pitting/non-pitting [[edema]] of the upper/lower extremities
-*Muscle atrophy
-*Fasciculations in the upper/lower extremity
 ==References==