Intussusception physical examination: Difference between revisions
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==Overview== | ==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 | 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 | The presence of following findings on [[physical examination]] is highly suggestive of intussusception. | ||
* [[Dance's sign]] | * [[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. | * "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. | ** This is hard to [[palpate]]. It is best palpated between episodes of [[Spasms|spasm]] especially when the [[infant]] is quiet. | ||
* Abdominal distention is seen when intestinal obstruction is complete. | * [[Abdominal distension|Abdominal distention]] is seen when [[intestinal obstruction]] is complete. | ||
* Rigidity and involuntary guarding (suggests peritonitis | * Rigidity and involuntary [[Abdominal guarding|guarding]] (suggests [[peritonitis]] secondary to [[intestinal]] [[gangrene]] and [[infarction]]) | ||
Other features | Other features | ||
* Episodic | * Episodic [[lethargy]] or [[Altered sensorium|altered consciousness]], alternating with crying spells | ||
* Episode lasts 15 | * Episode lasts 15 to 30 mins | ||
===Appearance of the | ===Appearance of the patient=== | ||
*Patient with intussusception are usually chubby and healthy. | *Patient with intussusception are usually chubby and healthy. | ||
*Intussusception is uncommon in malnourished patients. | *Intussusception is uncommon in [[malnourished]] patients. | ||
*Patients with intussusception usually appear in distress. | *Patients with intussusception usually appear in distress. | ||
===Vital | ===Vital signs=== | ||
*Hypotensive if in shock | *[[Hypotensive]] if in [[Shock (medical)|shock]] | ||
*Fever and leukocytosis | *[[Fever]] and [[leukocytosis]] indicate transmural [[gangrene]] and [[infarction]] (late signs) | ||
===Skin=== | ===Skin=== | ||
* [[Pallor]] | * [[Pallor]] - [[Infant]] can be [[Pale skin|pale]] and [[diaphoretic]] | ||
===Abdomen=== | ===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. | ** This is hard to [[palpate]]. It is best [[Palpation|palpated]] between episodes of [[Spasms|spasm]] especially when the [[infant]] is quiet. | ||
*[[Abdominal distention]] :- seen when intestinal obstruction is complete. | *[[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 | ||
*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> | *[[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> | ||
*Guarding - Rigidity and involuntary guarding (suggests peritonitis | *[[Abdominal guarding|Guarding]] - Rigidity and involuntary [[Abdominal guarding|guarding]] (suggests [[peritonitis]] secondary to [[intestinal]] [[gangrene]] and [[infarction]]) | ||
=== Rectal examination === | |||
* Intussusceptum may be felt by the finger | |||
==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.
- Dance's sign - Scaphoid (empty) right lower abdomen.[1]
- "Sausage Shaped" palpable mass in the right mid or lower abdomen.
- Abdominal distention is seen when intestinal obstruction is complete.
- Rigidity and involuntary guarding (suggests peritonitis secondary to intestinal gangrene and infarction)
Other features
- Episodic lethargy or altered consciousness, alternating with crying spells
- 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
- Hypotensive if in shock
- Fever and leukocytosis indicate transmural gangrene and infarction (late signs)
Skin
- Pallor - Infant can be pale and diaphoretic
Abdomen
- Dance's sign - Scaphoid (empty) right lower abdomen.
- "Sausage Shaped" palpable mass in the right mid or lower abdomen.
- 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)[2][3][4]
- Guarding - Rigidity and involuntary guarding (suggests peritonitis secondary to intestinal gangrene and infarction)
Rectal examination
- Intussusceptum may be felt by the finger
References
- ↑ Sty JR, Babbitt DP, Boedecker RA (1980). "Radionuclide "Dance Sign."". Clin Nucl Med. 5 (11): 502–3. PMID 7438637.
- ↑ 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. - ↑ 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.
- ↑ Mehta MH, Patel RV, Gondalia JS (1993). "Intraperitoneal red currant jelly in intussusception". Indian J Pediatr. 60 (3): 455–7. PMID 8253498.