Intussusception physical examination: Difference between revisions

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==Overview==
==Overview==
Intussusception is often suspected based on history and physical exam, including observation of [[Dance's sign]]. Per rectal examination is particularly helpful in children as part of the intussusceptum may be felt by the finger.  
Patients with intussusception usually appear in distress . [[Physical examination]] of patients with intussusception is usually remarkable for [[Dance's sign]], sausage shaped palpable mass, and [[abdominal distension]]. On [[rectal examination]] the intussusceptum might be felt. Classical sign of intussusception is currant jelly stools, and may present in a minority of cases at a later stage of the disease. Patient with intussusception usually appear chubby and there may be [[loss of appetite]].  


==Physical Examination ==
==Physical Examination ==
The presence of following findings on physical examination is highly suggestive of Intussusception.  
* Dancer Sign :- Scaphoid right lower abdomen.
The presence of following findings on [[physical examination]] is highly suggestive of intussusception.  
* "Sausage Shaped" palpable mass in the right mid or lower abdomen.
* [[Dance's sign]] - Scaphoid (empty) right lower [[abdomen]].<ref name="pmid7438637">{{cite journal |vauthors=Sty JR, Babbitt DP, Boedecker RA |title=Radionuclide "Dance Sign." |journal=Clin Nucl Med |volume=5 |issue=11 |pages=502–3 |year=1980 |pmid=7438637 |doi= |url=}}</ref>
* "Sausage Shaped" palpable mass in the right mid or lower [[abdomen]].
** This is hard to [[palpate]]. It is best palpated between episodes of [[Spasms|spasm]] especially when the [[infant]] is quiet.
* [[Abdominal distension|Abdominal distention]] is seen when [[intestinal obstruction]] is complete.
* Rigidity and involuntary [[Abdominal guarding|guarding]] (suggests [[peritonitis]] secondary to [[intestinal]] [[gangrene]] and [[infarction]])
Other features  
Other features  
* Episodic Lethargy or altered consciousness  
* Episodic [[lethargy]] or [[Altered sensorium|altered consciousness]], alternating with crying spells 


===Appearance of the Patient===
* Episode lasts 15 to 30 mins
*Patients with [disease name] usually appear [general appearance].


===Vital Signs===
===Appearance of the patient===
*Patient with intussusception are usually chubby and healthy.
*Intussusception is uncommon in [[malnourished]] patients. 
*Patients with intussusception usually appear in distress.


*High-grade / low-grade fever
===Vital signs===
*[[Hypothermia]] / hyperthermia may be present
 
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Hypotensive]] if in [[Shock (medical)|shock]]
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Fever]] and [[leukocytosis]] indicate transmural [[gangrene]] and [[infarction]] (late signs)
*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===
*[[Cyanosis]]
* [[Pallor]] - [[Infant]] can be [[Pale skin|pale]] and [[diaphoretic]]
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
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===HEENT===
* 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 accomodation / non-reactive to neither light nor accomodation
*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===
*[[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===
* 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===
===Abdomen===
*[[Abdominal distention]]  
*[[Dance's sign]] - [[Scaphoid]] (empty) right lower [[abdomen]].
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*"Sausage Shaped" palpable mass in the right mid or lower [[abdomen]].
*[[Rebound tenderness]] (positive Blumberg sign)
** This is hard to [[palpate]]. It is best [[Palpation|palpated]] between episodes of [[Spasms|spasm]] especially when the [[infant]] is quiet.
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*[[Abdominal distention]] :- seen when intestinal obstruction is complete.
*Guarding may be present
*A palpable [[abdominal mass]] in the right/left upper/lower [[abdominal]] quadrant
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*[[Hematochezia]] and currant jelly stools (classic sign)<ref name="pmid15729613">{{cite journal |vauthors=Toso C, Erne M, Lenzlinger PM, Schmid JF, Büchel H, Melcher G, Morel P |title=Intussusception as a cause of bowel obstruction in adults |journal=Swiss Med Wkly |volume=135 |issue=5-6 |pages=87–90 |year=2005 |pmid=15729613 |doi=2005/05/smw-10693 |url=}}</ref><ref name="pmid9148991">{{cite journal |vauthors=Yamamoto LG, Morita SY, Boychuk RB, Inaba AS, Rosen LM, Yee LL, Young LL |title=Stool appearance in intussusception: assessing the value of the term "currant jelly" |journal=Am J Emerg Med |volume=15 |issue=3 |pages=293–8 |year=1997 |pmid=9148991 |doi= |url=}}</ref><ref name="pmid8253498">{{cite journal |vauthors=Mehta MH, Patel RV, Gondalia JS |title=Intraperitoneal red currant jelly in intussusception |journal=Indian J Pediatr |volume=60 |issue=3 |pages=455–7 |year=1993 |pmid=8253498 |doi= |url=}}</ref>
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
*[[Abdominal guarding|Guarding]] -  Rigidity and involuntary [[Abdominal guarding|guarding]] (suggests [[peritonitis]] secondary to [[intestinal]] [[gangrene]] and [[infarction]])  
 
===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===
=== Rectal examination ===
*[[Clubbing]]
* Intussusceptum may be felt by the finger
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

Latest revision as of 16:20, 9 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sargun Singh Walia M.B.B.S.[2]

Overview

Patients with intussusception usually appear in distress . Physical examination of patients with intussusception is usually remarkable for Dance's sign, sausage shaped palpable mass, and abdominal distension. On rectal examination the intussusceptum might be felt. Classical sign of intussusception is currant jelly stools, and may present in a minority of cases at a later stage of the disease. Patient with intussusception usually appear chubby and there may be loss of appetite.

Physical Examination

The presence of following findings on physical examination is highly suggestive of intussusception.

Other features

  • Episode lasts 15 to 30 mins

Appearance of the patient

  • Patient with intussusception are usually chubby and healthy.
  • Intussusception is uncommon in malnourished patients.
  • Patients with intussusception usually appear in distress.

Vital signs

Skin

Abdomen

Rectal examination

  • Intussusceptum may be felt by the finger

References

  1. ↑ Sty JR, Babbitt DP, Boedecker RA (1980). "Radionuclide "Dance Sign."". Clin Nucl Med. 5 (11): 502–3. PMID 7438637.
  2. ↑ Toso C, Erne M, Lenzlinger PM, Schmid JF, Büchel H, Melcher G, Morel P (2005). "Intussusception as a cause of bowel obstruction in adults". Swiss Med Wkly. 135 (5–6): 87–90. doi:2005/05/smw-10693 Check |doi= value (help). PMID 15729613.
  3. ↑ Yamamoto LG, Morita SY, Boychuk RB, Inaba AS, Rosen LM, Yee LL, Young LL (1997). "Stool appearance in intussusception: assessing the value of the term "currant jelly"". Am J Emerg Med. 15 (3): 293–8. PMID 9148991.
  4. ↑ Mehta MH, Patel RV, Gondalia JS (1993). "Intraperitoneal red currant jelly in intussusception". Indian J Pediatr. 60 (3): 455–7. PMID 8253498.

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