Linitis plastica physical examination

Linitis plastica Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Linitis plastica from Other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Staging
Diagnostic study of choice
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Linitis plastica physical examination On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Linitis plastica physical examination All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Linitis plastica physical examination
CDC on Linitis plastica physical examination
Linitis plastica physical examination in the news
Blogs on Linitis plastica physical examination
Directions to Hospitals Treating Linitis plastica
Risk calculators and risk factors for Linitis plastica physical examination

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

Overview

Patients with linitis plastica in the early stages may appear to be normal. When metastasis occurs, the patient usually appears fatigued and cachexic. Physical examination of patients with linitis plastica and metastasis may be remarkable for lymphadenopathy, weight loss, and signs of ascites.

Physical Examination

Physical examination of patients with metastatic linitis plastica is usually remarkable for: lymphadenopaty, ascites, and organomegaly.

Appearance of the Patient

Patients with linitis plastica in the early stages may appear to be normal. When metastasis occurs, the patient usually appears fatigued and cachexic.

Vital Signs

Low-grade fever

Skin

• Jaundice is present with liver metastasis.
• Diffuse seborrheic keratoses (sign of Leser-Trélat)
• Acanthosis nigricans

HEENT

Icteric sclera with liver metastasis

Neck

• Lymphadenopathy may be noted in several regions, in the neck region there may be:
  • Virchow's node (left supraclavicular lymph node)

Lungs

• Massive ascites leads to:
  • Decreased chest expansion
  • Fine crackles upon auscultation of the lung bases bilaterally

Abdomen

• Abdominal distention
• Abdominal tenderness in the left upper quadrant and flanks.
• Hepatomegaly / splenomegaly / hepatosplenomegaly
• Sister Mary Joseph nodule (palpable nodule bulging into the umbilicus)
• Flank fullness
• Shifting dullness (difference in percussion note in the flanks that shifts when the patient is turned on the side)
• If the ascites is massive, a fluid thrill or fluid wave may be present.

Genitourinary

• A pelvic/adnexal mass may be palpated:
  • Krukenberg's tumor (peritoneal spread results in an enlarged ovary)
  • Blumer's shelf (mass in the cul-de-sac on per rectal exam)

Extremities

• Pitting/non-pitting edema of the upper/lower extremities
• Irish node (left axillary node)

References

Template:WikiDoc Sources