Granulomatosis with polyangiitis physical examination: Difference between revisions
Jump to navigation
Jump to search
| (6 intermediate revisions by the same user not shown) | |||
| Line 1: | Line 1: | ||
__NOTOC__ | __NOTOC__ | ||
{{Wegener's granulomatosis}} | {{Wegener's granulomatosis}} | ||
{{CMG}}{{APM}}{{AE}}{{KW}} | {{CMG}}{{APM}}{{AE}}{{ADS}}{{KW}} | ||
==Overview== | ==Overview== | ||
The important physical exam findings are [[Ulcerations]], palpable [[purpura]] and subcutaneous [[nodules]] in the skin; [[conjunctivitis]], [[uveitis]], [[sinusitis]], [[purulent]] exudate from nares,[[saddle nose]] deformity, reduced hearing in the head and neck; [[pleuritic chest pain]] ans signs of [[atelectasis]] in lung examination; and signs of [[mononeuritis multiplex]] on neural exam. | |||
==Physical Examination== | ==Physical Examination== | ||
*Physical examination of patients with Granulomatosis with polyangiitis is usually remarkable for:<ref name="pmid15210387">{{cite journal |vauthors=Seo P, Stone JH |title=The antineutrophil cytoplasmic antibody-associated vasculitides |journal=Am. J. Med. |volume=117 |issue=1 |pages=39–50 |date=July 2004 |pmid=15210387 |doi=10.1016/j.amjmed.2004.02.030 |url=}}</ref><ref name="pmid17106496">{{cite journal |vauthors=Graves N |title=Wegener granulomatosis |journal=Proc (Bayl Univ Med Cent) |volume=19 |issue=4 |pages=342–4 |date=October 2006 |pmid=17106496 |pmc=1618758 |doi= |url=}}</ref> | *Physical examination of patients with Granulomatosis with polyangiitis is usually remarkable for:<ref name="pmid15210387">{{cite journal |vauthors=Seo P, Stone JH |title=The antineutrophil cytoplasmic antibody-associated vasculitides |journal=Am. J. Med. |volume=117 |issue=1 |pages=39–50 |date=July 2004 |pmid=15210387 |doi=10.1016/j.amjmed.2004.02.030 |url=}}</ref><ref name="pmid17106496">{{cite journal |vauthors=Graves N |title=Wegener granulomatosis |journal=Proc (Bayl Univ Med Cent) |volume=19 |issue=4 |pages=342–4 |date=October 2006 |pmid=17106496 |pmc=1618758 |doi= |url=}}</ref> | ||
| Line 29: | Line 27: | ||
* [[Xanthelasma]] | * [[Xanthelasma]] | ||
* [[Purulent]] exudate from the nares | * [[Purulent]] exudate from the nares | ||
* [[Sinusitis]] | * [[Sinusitis]]<ref name="pmid19263410">{{cite journal |vauthors=Cannady SB, Batra PS, Koening C, Lorenz RR, Citardi MJ, Langford C, Hoffman GS |title=Sinonasal Wegener granulomatosis: a single-institution experience with 120 cases |journal=Laryngoscope |volume=119 |issue=4 |pages=757–61 |date=April 2009 |pmid=19263410 |doi=10.1002/lary.20161 |url=}}</ref> | ||
* [[Saddle nose]] deformity | * [[Saddle nose]] deformity | ||
* [[Otitis Media]] | * [[Otitis Media]] | ||
| Line 38: | Line 36: | ||
===Neck=== | ===Neck=== | ||
* Neck examination of patients with granulomatosis with polyangiitis is usually normal | * Neck examination of patients with granulomatosis with polyangiitis is usually normal. | ||
===Lungs=== | ===Lungs=== | ||
Examination may show signs of: | |||
* | *[[Pleuritic pain]] | ||
*[[Atelectasis physical examination|Atelectasis]] | |||
* [[Pleural effusion physical examination|Pleural effusion]] | |||
* [[Pulmonary hypertension physical examination|Pulmonary hypertension]]- bibasilar crackles | |||
* [[Subglottic stenosis]] | |||
*[[ | |||
*[[ | |||
*[[ | |||
* | |||
===Heart=== | ===Heart=== | ||
| Line 58: | Line 50: | ||
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]] | *[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]] | ||
===Abdomen=== | ===Abdomen=== | ||
*[[Abdominal tenderness]] may be present<ref name="pmid15758841">{{cite journal |vauthors=Pagnoux C, Mahr A, Cohen P, Guillevin L |title=Presentation and outcome of gastrointestinal involvement in systemic necrotizing vasculitides: analysis of 62 patients with polyarteritis nodosa, microscopic polyangiitis, Wegener granulomatosis, Churg-Strauss syndrome, or rheumatoid arthritis-associated vasculitis |journal=Medicine (Baltimore) |volume=84 |issue=2 |pages=115–28 |date=March 2005 |pmid=15758841 |doi= |url=}}</ref> | |||
*[[Abdominal tenderness]] in | |||
*Guarding may be present | *Guarding may be present | ||
===Back=== | ===Back=== | ||
* Back examination of patients with | * Back examination of patients with granulomatosis with polyangiitis is usually normal. | ||
===Genitourinary=== | ===Genitourinary=== | ||
*A pelvic/adnexal mass may be palpated | *A pelvic/adnexal mass may be palpated | ||
*Inflamed mucosa | *Inflamed mucosa | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
*Patient is usually oriented to persons, place, and time | *Patient is usually oriented to persons, place, and time | ||
*[[Mononeuritis multiplex]]- Loss of sensory and motor functions | *[[Mononeuritis multiplex]]<ref name="pmid28273992">{{cite journal |vauthors=Anadure R, Narayanan C, Varadraj G, Nandeesh B |title=ANCA Associated Mononeuritis Multiplex with Overlap in Vasculitic Syndromes |journal=J Clin Diagn Res |volume=11 |issue=1 |pages=OD01–OD03 |date=January 2017 |pmid=28273992 |pmc=5324437 |doi=10.7860/JCDR/2017/22252.9149 |url=}}</ref>- Loss of sensory and motor functions | ||
* | *Cranial nerve paralysis | ||
===Extremities=== | ===Extremities=== | ||
* Extremities examination of patients with | * Extremities examination of patients with granulomatosis with polyangiitis is usually normal. | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 17:42, 11 April 2018
|
Granulomatosis with polyangiitis Microchapters |
|
Differentiating Granulomatosis with polyangiitis from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Granulomatosis with polyangiitis physical examination On the Web |
|
American Roentgen Ray Society Images of Granulomatosis with polyangiitis physical examination |
|
FDA on Granulomatosis with polyangiitis physical examination |
|
CDC on Granulomatosis with polyangiitis physical examination |
|
Granulomatosis with polyangiitis physical examination in the news |
|
Blogs on Granulomatosis with polyangiitis physical examination |
|
Directions to Hospitals Treating Granulomatosis with polyangiitis |
|
Risk calculators and risk factors for Granulomatosis with polyangiitis physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Ali Poyan Mehr, M.D. [2]Associate Editor(s)-in-Chief: Amandeep Singh M.D.[3]Krzysztof Wierzbicki M.D. [4]
Overview
The important physical exam findings are Ulcerations, palpable purpura and subcutaneous nodules in the skin; conjunctivitis, uveitis, sinusitis, purulent exudate from nares,saddle nose deformity, reduced hearing in the head and neck; pleuritic chest pain ans signs of atelectasis in lung examination; and signs of mononeuritis multiplex on neural exam.
Physical Examination
- Physical examination of patients with Granulomatosis with polyangiitis is usually remarkable for:[1][2]
Vital Signs
- They usually have normal vital signs until infected.
Skin
The skin findings are seen in 14% of patients:[3]
- Ulcerations
- Palpable purpura
- Subcutaneous nodules
HEENT
- Scleritis
- Keratitis
- Uveitis
- Conjunctivitis
- Proptosis
- Xanthelasma
- Purulent exudate from the nares
- Sinusitis[4]
- Saddle nose deformity
- Otitis Media
- Hearing acuity may be reduced[1]
- Weber test may be abnormal
- Rinne test may be positive
- Gingival hyperplasia or necrotizing gingivitis[5] can be seen
Neck
- Neck examination of patients with granulomatosis with polyangiitis is usually normal.
Lungs
Examination may show signs of:
- Pleuritic pain
- Atelectasis
- Pleural effusion
- Pulmonary hypertension- bibasilar crackles
- Subglottic stenosis
Heart
Abdomen
- Abdominal tenderness may be present[6]
- Guarding may be present
Back
- Back examination of patients with granulomatosis with polyangiitis is usually normal.
Genitourinary
- A pelvic/adnexal mass may be palpated
- Inflamed mucosa
Neuromuscular
- Patient is usually oriented to persons, place, and time
- Mononeuritis multiplex[7]- Loss of sensory and motor functions
- Cranial nerve paralysis
Extremities
- Extremities examination of patients with granulomatosis with polyangiitis is usually normal.
References
- ↑ 1.0 1.1 Seo P, Stone JH (July 2004). "The antineutrophil cytoplasmic antibody-associated vasculitides". Am. J. Med. 117 (1): 39–50. doi:10.1016/j.amjmed.2004.02.030. PMID 15210387.
- ↑ Graves N (October 2006). "Wegener granulomatosis". Proc (Bayl Univ Med Cent). 19 (4): 342–4. PMC 1618758. PMID 17106496.
- ↑ Daoud MS, Gibson LE, DeRemee RA, Specks U, el-Azhary RA, Su WP (October 1994). "Cutaneous Wegener's granulomatosis: clinical, histopathologic, and immunopathologic features of thirty patients". J. Am. Acad. Dermatol. 31 (4): 605–12. PMID 8089286.
- ↑ Cannady SB, Batra PS, Koening C, Lorenz RR, Citardi MJ, Langford C, Hoffman GS (April 2009). "Sinonasal Wegener granulomatosis: a single-institution experience with 120 cases". Laryngoscope. 119 (4): 757–61. doi:10.1002/lary.20161. PMID 19263410.
- ↑ Genuis K, Pewarchuk J (September 2014). "Granulomatosis with polyangiitis (Wegener's) as a necrotizing gingivitis mimic: a case report". J Med Case Rep. 8: 297. doi:10.1186/1752-1947-8-297. PMC 4168997. PMID 25196320.
- ↑ Pagnoux C, Mahr A, Cohen P, Guillevin L (March 2005). "Presentation and outcome of gastrointestinal involvement in systemic necrotizing vasculitides: analysis of 62 patients with polyarteritis nodosa, microscopic polyangiitis, Wegener granulomatosis, Churg-Strauss syndrome, or rheumatoid arthritis-associated vasculitis". Medicine (Baltimore). 84 (2): 115–28. PMID 15758841.
- ↑ Anadure R, Narayanan C, Varadraj G, Nandeesh B (January 2017). "ANCA Associated Mononeuritis Multiplex with Overlap in Vasculitic Syndromes". J Clin Diagn Res. 11 (1): OD01–OD03. doi:10.7860/JCDR/2017/22252.9149. PMC 5324437. PMID 28273992.