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==Physical Examination ==
==Physical Examination ==
The presence of following findings on physical examination is highly suggestive of Intussusception.  
The presence of following findings on physical examination is highly suggestive of Intussusception.  
* Dancer Sign :- Scaphoid right lower abdomen.
* [[Dance's sign]] :- Scaphoid (empty) right lower abdomen.
* "Sausage Shaped" palpable mass in the right mid or lower abdomen.
* "Sausage Shaped" palpable mass in the right mid or lower abdomen.
** This is hard to palpate. It is best palpated between episodes of spasm especially when the infant is quiet.
* Abdominal distention is seen when intestinal obstruction is complete.
* Rigidity and involuntary guarding (suggests peritonitis) - If intestinal gangrene and infarction has occurred.
Other features  
Other features  
* Episodic Lethargy or altered consciousness  
* Episodic Lethargy or altered consciousness, alternating with crying spells 
 
* Episode lasts 15 - 30 mins


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*Patient with intussusception are usually chubby and healthy.
*Intussusception is uncommon in malnourished patients. 
*Patients with intussusception usually appear in distress.  


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


*High-grade / low-grade fever
*Hypotensive if in shock
*[[Hypothermia]] / hyperthermia may be present
*Fever and leukocytosis (late signs) -  indicate transmural gangrene and infarction.
*[[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===
===Skin===
*[[Cyanosis]]
* [[Pallor]] :- Infant can be 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]]
*Dancer 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 palpated between episodes of spasm especially when the infant is quiet.
*[[Abdominal distention]] :- seen when intestinal obstruction is complete.
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*Hematochezia and currant jelly stools (classic sign)
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Guarding -  Rigidity and involuntary guarding (suggests peritonitis) - If intestinal gangrene and infarction has occurred.
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
*Rectal examination :- intussusceptum may be felt by the finger
 
===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===
===Extremities===
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

Revision as of 20:04, 12 December 2017

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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

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.

Physical Examination

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

  • Dance's sign :- Scaphoid (empty) right lower abdomen.
  • "Sausage Shaped" palpable mass in the right mid or lower abdomen.
    • This is hard to palpate. It is best palpated between episodes of spasm especially when the infant is quiet.
  • Abdominal distention is seen when intestinal obstruction is complete.
  • Rigidity and involuntary guarding (suggests peritonitis) - If intestinal gangrene and infarction has occurred.

Other features

  • Episodic Lethargy or altered consciousness, alternating with crying spells
  • Episode lasts 15 - 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

  • Hypotensive if in shock
  • Fever and leukocytosis (late signs) - indicate transmural gangrene and infarction.

Skin

  • Pallor :- Infant can be pale and diaphoretic

Abdomen

  • Dancer Sign :- Scaphoid (empty) right lower abdomen.
  • "Sausage Shaped" palpable mass in the right mid or lower abdomen.
    • This is hard to palpate. It is best palpated between episodes of spasm especially when the infant is quiet.
  • Abdominal distention :- seen when intestinal obstruction is complete.
  • A palpable abdominal mass in the right/left upper/lower abdominal quadrant
  • Hematochezia and currant jelly stools (classic sign)
  • Guarding - Rigidity and involuntary guarding (suggests peritonitis) - If intestinal gangrene and infarction has occurred.
  • Rectal examination :- intussusceptum may be felt by the finger

Extremities

  • Pitting/non-pitting edema of the upper/lower extremities

References

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