Diagnostic Tests for Overweight
Overweight: Diagnostic Tests
The list of diagnostic tests
mentioned in various sources as
used in the diagnosis of Overweight
includes:
- Body Mass Index (BMI) - BMC 25..<30 is overweight; BMI >= 30 is obesity
- Weight-for-height charts
- Skinfold thickness measurement
- Bioelectrical impedance analysis (BIA)
Overweight Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Overweight:
- Diet & Weight Loss: Home Testing:
- Diabetes: Related Home Testing:
Overweight Diagnosis: Book Excerpts
Tests and diagnosis discussion for Overweight:
Am I at Risk for Type 2 Diabetes: NIDDK (Excerpt)
Body mass index (BMI) is a measure of body weight relative to height.
You can use BMI to see whether you are underweight, normal weight,
overweight, or obese. Use the body mass index table below to find your
BMI.
- Find your height in the left-hand column.
- Move across in the same row to the number closest to your weight.
- The number at the top of that column is your BMI. Check the word
above your BMI to see whether you are normal weight, overweight, or
obese.
Body Mass Index Table
For
a printer-friendly version of this table, use the pdf.*
| |
Normal |
Overweight |
Obese |
| BMI |
19 |
20 |
21 |
22 |
23 |
24 |
25 |
26 |
27 |
28 |
29 |
30 |
31 |
32 |
33 |
34 |
35 |
36 |
Height (inches) |
Body Weight
(pounds) |
| 58 |
91 |
96 |
100 |
105 |
110 |
115 |
119 |
124 |
129 |
134 |
138 |
143 |
148 |
153 |
158 |
162 |
167 |
172 |
| 59 |
94 |
99 |
104 |
109 |
114 |
119 |
124 |
128 |
133 |
138 |
143 |
148 |
153 |
158 |
163 |
168 |
173 |
178 |
| 60 |
97 |
102 |
107 |
112 |
118 |
123 |
128 |
133 |
138 |
143 |
148 |
153 |
158 |
163 |
168 |
174 |
179 |
184 |
| 61 |
100 |
106 |
111 |
116 |
122 |
127 |
132 |
137 |
143 |
148 |
153 |
158 |
164 |
169 |
174 |
180 |
185 |
190 |
| 62 |
104 |
109 |
115 |
120 |
126 |
131 |
136 |
142 |
147 |
153 |
158 |
164 |
169 |
175 |
180 |
186 |
191 |
196 |
| 63 |
107 |
113 |
118 |
124 |
130 |
135 |
141 |
146 |
152 |
158 |
163 |
169 |
175 |
180 |
186 |
191 |
197 |
203 |
| 64 |
110 |
116 |
122 |
128 |
134 |
140 |
145 |
151 |
157 |
163 |
169 |
174 |
180 |
186 |
192 |
197 |
204 |
209 |
| 65 |
114 |
120 |
126 |
132 |
138 |
144 |
150 |
156 |
162 |
168 |
174 |
180 |
186 |
192 |
198 |
204 |
210 |
216 |
| 66 |
118 |
124 |
130 |
136 |
142 |
148 |
155 |
161 |
167 |
173 |
179 |
186 |
192 |
198 |
204 |
210 |
216 |
223 |
| 67 |
121 |
127 |
134 |
140 |
146 |
153 |
159 |
166 |
172 |
178 |
185 |
191 |
198 |
204 |
211 |
217 |
223 |
230 |
| 68 |
125 |
131 |
138 |
144 |
151 |
158 |
164 |
171 |
177 |
184 |
190 |
197 |
203 |
210 |
216 |
223 |
230 |
236 |
| 69 |
128 |
135 |
142 |
149 |
155 |
162 |
169 |
176 |
182 |
189 |
196 |
203 |
209 |
216 |
223 |
230 |
236 |
243 |
| 70 |
132 |
139 |
146 |
153 |
160 |
167 |
174 |
181 |
188 |
195 |
202 |
209 |
216 |
222 |
229 |
236 |
243 |
250 |
| 71 |
136 |
143 |
150 |
157 |
165 |
172 |
179 |
186 |
193 |
200 |
208 |
215 |
222 |
229 |
236 |
243 |
250 |
257 |
| 72 |
140 |
147 |
154 |
162 |
169 |
177 |
184 |
191 |
199 |
206 |
213 |
221 |
228 |
235 |
242 |
250 |
258 |
265 |
| 73 |
144 |
151 |
159 |
166 |
174 |
182 |
189 |
197 |
204 |
212 |
219 |
227 |
235 |
242 |
250 |
257 |
265 |
272 |
| 74 |
148 |
155 |
163 |
171 |
179 |
186 |
194 |
202 |
210 |
218 |
225 |
233 |
241 |
249 |
256 |
264 |
272 |
280 |
| 75 |
152 |
160 |
168 |
176 |
184 |
192 |
200 |
208 |
216 |
224 |
232 |
240 |
248 |
256 |
264 |
272 |
279 |
287 |
| 76 |
156 |
164 |
172 |
180 |
189 |
197 |
205 |
213 |
221 |
230 |
238 |
246 |
254 |
263 |
271 |
279 |
287 |
295 |
| |
Obese |
Extreme Obesity |
| BMI |
37 |
38 |
39 |
40 |
41 |
42 |
43 |
44 |
45 |
46 |
47 |
48 |
49 |
50 |
51 |
52 |
53 |
54 |
Height (inches) |
Body Weight
(pounds) |
| 58 |
177 |
181 |
186 |
191 |
196 |
201 |
205 |
210 |
215 |
220 |
224 |
229 |
234 |
239 |
244 |
248 |
253 |
258 |
| 59 |
183 |
188 |
193 |
198 |
203 |
208 |
212 |
217 |
222 |
227 |
232 |
237 |
242 |
247 |
252 |
257 |
262 |
267 |
| 60 |
189 |
194 |
199 |
204 |
209 |
215 |
220 |
225 |
230 |
235 |
240 |
245 |
250 |
255 |
261 |
266 |
271 |
276 |
| 61 |
195 |
201 |
206 |
211 |
217 |
222 |
227 |
232 |
238 |
243 |
248 |
254 |
259 |
264 |
269 |
275 |
280 |
285 |
| 62 |
202 |
207 |
213 |
218 |
224 |
229 |
235 |
240 |
246 |
251 |
256 |
262 |
267 |
273 |
278 |
284 |
289 |
295 |
| 63 |
208 |
214 |
220 |
225 |
231 |
237 |
242 |
248 |
254 |
259 |
265 |
270 |
278 |
282 |
287 |
293 |
299 |
304 |
| 64 |
215 |
221 |
227 |
232 |
238 |
244 |
250 |
256 |
262 |
267 |
273 |
279 |
285 |
291 |
296 |
302 |
308 |
314 |
| 65 |
222 |
228 |
234 |
240 |
246 |
252 |
258 |
264 |
270 |
276 |
282 |
288 |
294 |
300 |
306 |
312 |
318 |
324 |
| 66 |
229 |
235 |
241 |
247 |
253 |
260 |
266 |
272 |
278 |
284 |
291 |
297 |
303 |
309 |
315 |
322 |
328 |
334 |
| 67 |
236 |
242 |
249 |
255 |
261 |
268 |
274 |
280 |
287 |
293 |
299 |
306 |
312 |
319 |
325 |
331 |
338 |
344 |
| 68 |
243 |
249 |
256 |
262 |
269 |
276 |
282 |
289 |
295 |
302 |
308 |
315 |
322 |
328 |
335 |
341 |
348 |
354 |
| 69 |
250 |
257 |
263 |
270 |
277 |
284 |
291 |
297 |
304 |
311 |
318 |
324 |
331 |
338 |
345 |
351 |
358 |
365 |
| 70 |
257 |
264 |
271 |
278 |
285 |
292 |
299 |
306 |
313 |
320 |
327 |
334 |
341 |
348 |
355 |
362 |
369 |
376 |
| 71 |
265 |
272 |
279 |
286 |
293 |
301 |
308 |
315 |
322 |
329 |
338 |
343 |
351 |
358 |
365 |
372 |
379 |
386 |
| 72 |
272 |
279 |
287 |
294 |
302 |
309 |
316 |
324 |
331 |
338 |
346 |
353 |
361 |
368 |
375 |
383 |
390 |
397 |
| 73 |
280 |
288 |
295 |
302 |
310 |
318 |
325 |
333 |
340 |
348 |
355 |
363 |
371 |
378 |
386 |
393 |
401 |
408 |
| 74 |
287 |
295 |
303 |
311 |
319 |
326 |
334 |
342 |
350 |
358 |
365 |
373 |
381 |
389 |
396 |
404 |
412 |
420 |
| 75 |
295 |
303 |
311 |
319 |
327 |
335 |
343 |
351 |
359 |
367 |
375 |
383 |
391 |
399 |
407 |
415 |
423 |
431 |
| 76 |
304 |
312 |
320 |
328 |
336 |
344 |
353 |
361 |
369 |
377 |
385 |
394 |
402 |
410 |
418 |
426 |
435 |
443 |
Source: Adapted from Clinical Guidelines on the
Identification, Evaluation, and Treatment of Overweight and Obesity in
Adults: The Evidence Report. (Source: excerpt from Am I at Risk for Type 2 Diabetes: NIDDK)
Helping Your Overweight Child: NIDDK (Excerpt)
If you think that your child is overweight, it
is important to talk with your child's doctor. A doctor is the best person
to determine whether your child has a weight problem. Physicians will
measure your child's weight and height to determine if your child's weight
is within a healthy range. A physician will also consider your child's age
and growth patterns to determine whether your child is overweight.
Assessing overweight in children is difficult because children grow in
unpredictable spurts.
For example, it is normal for boys to have a growth spurt in weight and
catch up in height later. It is best to let your child's doctor
determine whether your child will "grow into" a normal weight. If your
doctor finds that your child is overweight, he or she may ask you to make
some changes in your family's eating and activity habits.
(Source: excerpt from Helping Your Overweight Child: NIDDK)
NIDDK _ Statistics Related to Overweight and Obesity: NIDDK (Excerpt)
A number of methods are used to determine if an individual is
overweight or obese. Some of them are based on mathematical calculations
of the relation between height and weight--others are based on
measurements of body fat. These methods are described below.
Body Mass Index
Body Mass Index (BMI) can be used to measure both overweight and
obesity in adults. It is the measurement of choice for many obesity
researchers and other health professionals. BMI is a direct calculation
based on height and weight, and it is not gender-specific. Most health
organizations and published information on overweight and its associated
risk factors use BMI to measure and define overweight and obesity. BMI
does not directly measure percent of body fat, but it provides a more
accurate measure of overweight and obesity than relying on weight alone.
BMI is found by dividing a person's weight in kilograms by height in
meters squared. The mathematical formula is:
weight (kg)/height squared (m2).
To determine BMI using pounds and inches, multiply your weight in
pounds by 704.5,* then divide the result by your height in inches, and
divide that result by your height in inches a second time (Source: excerpt from NIDDK _ Statistics Related to Overweight and Obesity: NIDDK)
NIDDK _ Statistics Related to Overweight and Obesity: NIDDK (Excerpt)
The National Institutes of Health (NIH) identify overweight as a BMI of
25-29.9 kg/m2, and obesity as a BMI of 30 kg/m2 or
greater. However, overweight and obesity are not mutually exclusive, since
obese persons are also overweight.1
Defining overweight as a BMI of 25 or greater is consistent with the
recommendations of the World Health Organization 2
and most other countries.
(Source: excerpt from NIDDK _ Statistics Related to Overweight and Obesity: NIDDK)
NIDDK _ Statistics Related to Overweight and Obesity: NIDDK (Excerpt)
Weight-for-height charts are another measure used to determine if a
person is overweight (although they do not measure body fat). These
charts, which have been used by doctors and other health care workers for
decades, usually give a range of acceptable weights for a person of a
given height. Many versions of weight-for-height charts exist, some
showing different acceptable weight ranges for men and women. Health care
workers often disagree over which is the best chart to use. The 2000
Dietary Guidelines for Americans, published jointly by the U.S.
Departments of Agriculture and Health and Human Services, provide the most
up-to-date weight-for-height
chart. The healthy weight range in this chart corresponds to a BMI
between 18.5 and 25.
(Source: excerpt from NIDDK _ Statistics Related to Overweight and Obesity: NIDDK)
NIDDK _ Statistics Related to Overweight and Obesity: NIDDK (Excerpt)
Measurements of Body Fat
There are a number of ways to measure body fat. Historically, the
standard method is to weigh a person underwater; this procedure is limited
to laboratories with specialized equipment.
Other simpler methods for measuring body fat include skinfold
thickness measurements and bioelectrical impedance analysis
(BIA). Skinfold thicknesses are measures of the subcutaneous (lying just
beneath the skin) fat at specific sites of a person's body, such as the
triceps (the back of the upper arm). Accurate measurements of skinfold
thickness depend on the skill of the examiner and may vary widely when
measured by different examiners.
To measure body fat using BIA, a harmless amount of an electrical
current is sent through the body. The body's ability to conduct an
electrical current reflects the total amount of water in the body.
Generally, a higher percent body water indicates a larger amount of muscle
and lean tissue. Mathematical equations are used to translate the percent
body water measure into an indirect estimate of body fat and lean body
mass. A standard method should be used to measure bioelectrical impedance
because dehydration, recent exercise, skin and room temperature, and
placement of electrodes all can affect test results. To obtain the most
precise reading, the person being tested should fast for at least 4 hours
and lie down for at least several minutes prior to testing. BIA may not be
accurate in severely obese individuals, and it is not useful for tracking
short-term changes in body fat brought about by diet or exercise.
In addition to body weight and height measurements, health
professionals may also rely on a person's waist measurement to determine
the location of excess body fat and the corresponding health risks.
Analogous to BMI, health risks increase as waist circumference increases.
A woman whose waist measures more than 35 inches and a man whose waist
measures more than 40 inches may be at particular risk for developing
health problems. Studies indicate that increased abdominal or upper body
fat is related to the risk of developing heart disease, diabetes, high
blood pressure, gallbladder disease, stroke, and certain cancers, and is
associated with overall mortality (likelihood of death). Body fat
concentrated in the lower body (around the hips, for example) may be less
harmful in terms of mortality and morbidity (likelihood of disease), with
the exception of varicose veins and orthopedic problems (Source: excerpt from NIDDK _ Statistics Related to Overweight and Obesity: NIDDK)
NIDDK _ Statistics Related to Overweight and Obesity: NIDDK (Excerpt)
The definitions or measurement characteristics for overweight and
obesity have varied over time, from study to study, and from one part of
the world to another. The varied definitions affect the prevalence
statistics of studies and make it difficult to compare data from different
studies and from different countries. (Source: excerpt from NIDDK _ Statistics Related to Overweight and Obesity: NIDDK)
Diet: NWHIC (Excerpt)
The words obesity and overweight are generally used interchangeably.
However, according to the Institute of Medicine report, their technical
meanings are not identical. Overweight refers to an excess of body weight
that includes all tissues, such as fat, bone and muscle. Obesity refers
specifically to an excess of body fat. It is possible to be overweight
without being obese, as in the case of a body builder who has a
substantial amount of muscle mass. It is possible to be obese without
being overweight, as in the case of a very sedentary person who is within
the desirable weight range but who nevertheless has an excess of body fat.
However, most overweight people are also obese and vice versa. Men with
more than 25 percent and women with more than 30 percent body fat are
considered obese. The USFDA has released a chart detailing recommended
weights relative to height; women should be in the lower end of their
appropriate weight range, according to the chart. (Source: excerpt from Diet: NWHIC)
Diagnosis of Overweight: medical news summaries:
The following medical news items
are relevant to diagnosis of Overweight:
Diagnostic Tests for Overweight: Online Medical Books
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Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Overweight.
OBESITY, PATHOLOGIC:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine laboratory tests include a CBC, urinalysis, chemistry panel, 2-hr postprandial blood sugar, and thyroid profile. If an insulinoma is strongly suspected, a 24- to 36-hr fast, a 5-hr glucose tolerance test, and tolbutamide tolerance test may be done. If Cushing's syndrome is suspected, a serum cortisol and cortisol suppression test should be done. Pelvic ultrasound will help diagnose polycystic ovaries. Chromosomal analysis will help diagnose Klinefelter's syndrome. Perhaps a psychiatrist should be consulted.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Abdominal distention:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient’s abdominal distention isn’t acute, ask about its onset and duration and associated signs. A patient with localized distention may report a sensation of pressure, fullness, or tenderness in the affected area. A patient with generalized distention may report a bloated feeling, a pounding heart, and difficulty breathing deeply or when lying flat. (See Abdominal distention: Common causes and associated findings.)
The patient may also feel unable to bend at his waist. Make sure to ask about abdominal pain, fever, nausea, vomiting, anorexia, altered bowel habits, and weight gain or loss.
Obtain a medical history, noting GI or biliary disorders that may cause peritonitis or ascites, such as cirrhosis, hepatitis, or inflammatory bowel disease. (See Detecting ascites, page 4.) Also, note chronic constipation. Has the patient recently had abdominal surgery, which can lead to abdominal distention? Ask about recent accidents, even minor ones, such as falling off a stepladder.
Perform a complete physical examination. Don’t restrict the examination to the abdomen because you could miss important clues to the cause of abdominal distention. Next, stand at the foot of the bed and observe the recumbent patient for abdominal asymmetry to determine if distention is localized or generalized. Then assess abdominal contour by stooping at his side. Inspect for tense, taut skin and bulging flanks, which may indicate ascites. Observe the umbilicus. An everted umbilicus may indicate ascites or umbilical hernia. An inverted umbilicus may indicate distention from gas; it’s also common in obesity. Inspect the abdomen for signs of inguinal or femoral hernia and for incisions that may point to adhesions. Both may lead to intestinal obstruction. Then auscultate for bowel sounds, abdominal friction rubs (indicating peritoneal inflammation), and bruits (indicating an aneurysm). Listen for succussion splash — a splashing sound normally heard in the stomach when the patient moves or when palpation disturbs the viscera. However, an abnormally loud splash indicates fluid accumulation, suggesting gastric dilation or obstruction.
Next, percuss and palpate the abdomen to determine if distention results from air, fluid, or both. A tympanic note in the left lower quadrant suggests an air-filled descending or sigmoid colon. A tympanic note throughout a generally distended abdomen suggests an air-filled peritoneal cavity. A dull percussion note throughout a generally distended abdomen suggests a fluid-filled peritoneal cavity. Shifting of dullness laterally with the patient in the decubitus position also indicates a fluid-filled abdominal cavity. A pelvic or intra-abdominal mass causes local dullness upon percussion and should be palpable. Obesity causes a large abdomen without shifting dullness, prominent tympany, or palpable bowel or other masses, with generalized rather then localized dullness.
Palpate the abdomen for tenderness, noting whether it’s localized or generalized. Watch for peritoneal signs and symptoms, such as rebound tenderness, guarding, rigidity, McBurney’s point, obturator sign, and psoas sign. Female patients should undergo a pelvic examination; males, a genital examination. All patients who report abdominal pain should undergo a digital rectal examination with fecal occult blood testing. Finally, measure the patient’s abdominal girth for a baseline value. Mark the flanks with a felt-tipped pen as a reference for subsequent measurements.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Abdominal distention:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient’s abdominal distention isn’t acute, ask about its onset and duration and associated signs. A patient with localized distention may report a sensation of pressure, fullness, or tenderness in the affected area. A patient with generalized distention may report a bloated feeling, a pounding heartbeat, and difficulty breathing deeply or breathing when lying flat. The patient may also feel unable to bend at his waist. Be sure to ask about abdominal pain, fever, nausea, vomiting, anorexia, altered bowel habits, and weight gain or loss.
Obtain a medical history, noting GI or biliary disorders that may cause peritonitis or ascites, such as cirrhosis, hepatitis, or inflammatory bowel disease. (See Detecting ascites.) Also note chronic constipation. Has the patient recently had abdominal surgery, which can lead to abdominal distention? Ask about recent accidents, even minor ones, like falling off a stepladder.
Perform a complete physical examination. Don’t restrict the examination to the abdomen because you could miss important clues to the cause of abdominal distention. Next, stand at the foot of the bed and observe the recumbent patient for abdominal asymmetry to determine if distention is localized or generalized. Then assess abdominal contour by stooping at his side. Inspect for tense, glistening skin and bulging flanks, which may indicate ascites. Observe the umbilicus. An everted umbilicus may indicate ascites or an umbilical hernia. An inverted umbilicus may indicate distention from gas; it’s also common in obese individuals. Inspect the abdomen for signs of an inguinal or femoral hernia and for incisions that may point to adhesions; both may lead to intestinal obstruction. Then auscultate for bowel sounds, abdominal friction rubs (indicating peritoneal inflammation), and bruits (indicating an aneurysm). Listen for a succussion splash—a splashing sound normally heard in the stomach when the patient moves or when palpation disturbs the viscera. An abnormally loud splash indicates fluid accumulation, suggesting gastric dilation or obstruction.
Next, percuss and palpate the abdomen to determine if distention results from air, fluid, or both. A tympanic note in the left lower quadrant suggests an air-filled descending or sigmoid colon. A tympanic note throughout a generally distended abdomen suggests an air-filled peritoneal cavity. A dull percussion note throughout a generally distended abdomen suggests a fluid-filled peritoneal cavity. Shifting of dullness laterally when the patient is in the decubitus position also indicates a fluid-filled abdominal cavity. A pelvic or intra-abdominal mass causes local dullness upon percussion and should be palpable. Obesity causes a large abdomen with generalized rather then localized dullness and without shifting dullness, prominent tympany, or palpable bowel or other masses.
Palpate the abdomen for tenderness, noting whether it’s localized or generalized. Watch for peritoneal signs and symptoms, such as rebound tenderness, guarding, rigidity, McBurney’s point, obturator sign, and psoas sign. Female patients should undergo a pelvic examination; males, a genital examination. All patients who report abdominal pain should undergo a digital rectal examination with fecal occult blood testing. Finally, measure abdominal girth for a baseline value. Mark the flanks with a felt-tipped pen as a reference point for subsequent measurements. (See Abdominal distention: Causes and associated findings, pages 6 and 7.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Obesity:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Body mass index (BMI) 5 mass (kilograms)/height (meters)2. Overweight is
a BMI 25 to 30 kg/m2 and obesity is a BMI .30 kg/m2. A body mass index .30 correlates with increased risk of type 2 diabetes, sleep apnea syndrome, fatty liver, gallstones, gout, degenerative joint disease, and accelerated atherogenesis. Abdominal obesity (waist–hip ratio .0.95 in men and .0.85 in women) with excess visceral (intra-abdominal) fat is associated with elevated trigylceride, insulin and glucose levels, and confers an especially increased incidence of adverse outcomes.
Less than 1% of patients with obesity have an endocrine or other secon-dary cause.
Rapid weight gain is usually due to fluid accumulation, seen with congestive heart failure, renal failure or chronic liver disease. Ascites with the latter can
produce a prominent abdomen, which can be mistaken for obesity by the patient.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Abdominal distention:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Perform a complete physical examination. Don’t restrict the examination to the patient’s abdomen because you could miss important clues to the cause of his abdominal distention. Stand at the foot of the bed and observe the recumbent patient for abdominal asymmetry to determine if distention is localized or generalized. Then assess abdominal contour by stooping at his side. Inspect for tense, glistening skin and bulging flanks, which may indicate ascites. Observe the umbilicus. An everted umbilicus may indicate ascites or umbilical hernia. An inverted umbilicus may indicate distention from gas; it’s also common in obesity. Inspect the abdomen for signs of inguinal or femoral hernia and for incisions that may point to adhesions. Both may lead to intestinal obstruction. Then auscultate for bowel sounds, abdominal friction rubs (indicating peritoneal inflammation), and bruits (indicating an aneurysm). Listen for succussion splash — a splashing sound normally heard in the stomach when the patient moves or when palpation disturbs the viscera. However, an abnormally loud splash indicates fluid accumulation, suggesting gastric dilation or obstruction.
Next, percuss and palpate the abdomen to determine if distention results from air, fluid, or both. A tympanic note in the left lower quadrant suggests an air-filled descending or sigmoid colon. A tympanic note throughout a generally distended abdomen suggests an air-filled peritoneal cavity. A dull percussion note throughout a generally distended abdomen suggests a fluid-filled peritoneal cavity. Shifting of dullness laterally with the patient in the decubitus position also indicates a fluid-filled abdominal cavity. A pelvic or intra-abdominal mass causes local dullness upon percussion and should be palpable. Obesity causes a large abdomen without shifting dullness, prominent tympany, or palpable bowel or other masses, and with generalized, rather then localized, dullness.
Palpate the abdomen for tenderness, noting whether it’s localized or generalized. Watch for peritoneal signs and symptoms, such as rebound tenderness, guarding, rigidity, McBurney’s point, obturator sign, and psoas sign. Female patients should undergo a pelvic examination; males, a genital examination. All patients who report abdominal pain should undergo a digital rectal examination with fecal occult blood testing. Finally, measure abdominal girth for a baseline value. Mark the flanks with a felt-tipped pen as a reference for subsequent measurements.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Obesity:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
If physicalexam and linear growth are normal, combination of genetic influencesand environmental factors is almost always the cause of obesity.If decreased linear growth occurs,glucocorticoid excess, hypothyroidism, and growth hormone deficiencyshould be considered.Many unusual syndromes associated withobesity may be distinguished by their clinical findings and moleculargenetic analysis.
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Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Abdominal distention:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient's abdominal distention isn't acute, ask about its onset and duration and associated signs. A patient with localized distention may report a sensation of pressure, fullness, or tenderness in the affected area. A patient with generalized distention may report a bloated feeling, a pounding heart, and difficulty breathing deeply or when lying flat.
The patient may be unable to bend at the waist. Make sure to ask about abdominal pain, fever, nausea, vomiting, anorexia, altered bowel habits, and weight gain or loss.
Obtain a medical history, noting GI or biliary disorders that may cause peritonitis or ascites, such as cirrhosis, hepatitis, or inflammatory bowel disease. (See Detecting ascites.) When did the patient last have a bowel movement? Note chronic constipation. Has the patient recently had abdominal surgery, which can lead to abdominal distention? Ask about recent accidents, even minor ones such as falling off a stepladder.
Perform a complete physical examination. Don't restrict the examination to the abdomen because you could miss important clues to the cause of abdominal distention. Next, stand at the foot of the bed and observe the recumbent patient for abdominal asymmetry to determine if distention is localized or generalized. Then assess abdominal contour by stooping at his side. Inspect for tense, taut skin and bulging flanks, which may indicate ascites. Observe the umbilicus. An everted umbilicus may indicate ascites or umbilical hernia. An inverted umbilicus may indicate distention from gas; it's also common in obesity and pregnancy. Inspect the abdomen for signs of inguinal or femoral hernia and for healed incisions that may point to adhesions. Both may lead to intestinal obstruction. Auscultate for bowel sounds, abdominal friction rubs (indicating peritoneal inflammation), and bruits (indicating an aneurysm). Listen for succussion splash—a splashing sound normally heard in the stomach when the patient moves or when palpation disturbs the viscera. An abnormally loud splash indicates fluid accumulation, suggesting gastric dilation or obstruction.
Next, percuss and palpate the abdomen to determine if distention results from air, fluid, or both. A tympanic note in the left lower quadrant suggests an air-filled descending or sigmoid colon. A tympanic note throughout a generally distended abdomen suggests an air-filled peritoneal cavity. A dull percussion note throughout a generally distended abdomen suggests a fluid-filled peritoneal cavity. Shifting of dullness laterally with the patient in the decubitus position also indicates a fluid-filled abdominal cavity. A pelvic or intra-abdominal mass causes local dullness upon percussion and should be palpable. Obesity causes a large abdomen without shifting dullness, prominent tympany, or palpable bowel or other masses, with generalized rather then localized dullness.
Palpate the abdomen for tenderness, noting whether it's localized or generalized. Watch for peritoneal signs and symptoms, such as rebound tenderness, guarding, rigidity, McBurney's point, obturator sign, and psoas sign. Female patients should undergo a pelvic examination; males, a genital examination. All patients who report abdominal pain should undergo a digital rectal examination with fecal occult blood testing. Finally, measure the patient's abdominal girth for a baseline value. Mark the flanks with a felt-tipped pen as a reference for subsequent measurements.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
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