Diagnostic Tests for Ulcer
Ulcer Tests: Book Excerpts
Ulcer Diagnosis: Book Excerpts
Diagnosis of Ulcer: medical news summaries:
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Diagnostic Tests for Ulcer: Online Medical Books
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FOOT ULCERATION:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Diminished pulses is a clear indication for Doppler ultrasound studies. Routine tests include a CBC, sedimentation rate, urinalysis, chemistry panel, VDRL test, and glucose tolerance test. An x-ray of the involved foot should be done to rule out osteomyelitis. A bone scan is even more sensitive to osteomyelitis and other disorders of the bone that may be causing the ulcer. A smear should be made of the ulcer material and a culture done also, not just for the common pathogens, but for AFB and fungi. A dark field preparation may be necessary. Skin testing for blastomycosis and other fungi should be done. A nerve conduction velocity study of the lower extremities will be helpful in differentiating neurologic causes. Femoral angiography may be valuable in determining the exact level of the lesion and whether it can be approached surgically.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
LEG ULCERATION:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine studies include a CBC, sedimentation rate, sickle cell preparation, urinalysis, chemistry panel, VDRL test, smear and culture of the material from the ulcer, and x-rays of the involved area. A biopsy may be necessary to establish the diagnosis. Rarely, a dark field examination will be necessary. Arteriography or venography may establish the level of arterial or venous obstruction. A bone scan will help pin down the diagnosis of osteomyelitis.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
VULVAL OR VAGINAL ULCERATIONS:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
The workup includes a CBC, sedimentation rate, urinalysis, and VDRL test. A smear and culture of material from the ulceration should be done. A dark field examination may also be necessary. The Frei test may diagnose lymphogranuloma venereum, but a serologic test for this disorder may also be ordered. Biopsy may be ultimately necessary. It is wise to enlist the help of a urologist or gynecologist in difficult cases.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Dyspepsia:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient complains of dyspepsia, begin by asking him to describe it in detail. How often and when does it occur, specifically in relation to meals? Do drugs or activities relieve or aggravate it? Has he had nausea, vomiting, melena, hematemesis, a cough, or chest pain? Ask if he's taking prescription drugs and if he has recently had surgery. Does he have a history of renal, cardiovascular, or pulmonary disease? Has he noticed a change in the amount or color of his urine?
Ask the patient if he's experiencing an unusual or overwhelming amount of emotional stress. Determine the patient's coping mechanisms and their effectiveness.
Focus the physical examination on the abdomen. Inspect for distention, ascites, scars, obvious hernias, jaundice, uremic frost, and bruising. Then auscultate for bowel sounds and characterize their motility. Palpate and percuss the abdomen, noting tenderness, pain, organ enlargement, or tympany.
Finally, examine other body systems. Ask about behavior changes, and evaluate the patient's level of consciousness. Auscultate for gallops and crackles. Percuss the lungs to detect consolidation. Note peripheral edema and any swelling of the lymph nodes.
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Source: Handbook of Signs & Symptoms (Third Edition), 2006
Breast ulcer:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Begin the history by asking when the patient first noticed the ulcer and if it was preceded by other breast changes, such as nodules, edema, or nipple discharge, deviation, or retraction. Does the ulcer seem to be getting better or worse? Does it cause pain or produce drainage? Has she noticed any change in breast shape? Has she had a skin rash? If she has been treating the ulcer at home, find out how.
Review the patient's personal and family history for factors that increase the risk of breast cancer. Ask, for example, about previous cancer, especially of the breast, and mastectomy. Determine whether the patient's mother or sister has had breast cancer. Ask the patient's age at menarche and menopause because more than 30 years of menstrual activity increases the risk of breast cancer. Also ask about pregnancy because nulliparity or birth of a first child after age 30 also increases the risk of breast cancer.
If the patient recently gave birth, ask if she breast-feeds her infant or has recently weaned him. Ask if she's currently taking an oral antibiotic and if she's diabetic. All these factors predispose the patient to Candidainfections.
Inspect the patient's breast, noting any asymmetry or flattening. Look for a rash, scaling, cracking, or red excoriation on the nipples, areola, and inframammary fold. Check especially for skin changes, such as warmth, erythema, or peau d'orange. Palpate the breast for masses, noting any induration beneath the ulcer. Then carefully palpate for tenderness or nodules around the areola and the axillary lymph nodes.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Dyspepsia:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient complains of dyspepsia, begin by asking him to describe it in detail. How often and when does it occur, specifically in relation to meals? Do any drugs or activities relieve or aggravate it? Has the patient had nausea, vomiting, melena, hematemesis, cough, or chest pain? Ask if he’s taking any prescription drugs and if he has recently had surgery. Does he have a history of renal, cardiovascular, or pulmonary disease? Has he noticed any change in the amount or color of his urine?
Ask the patient if he’s experiencing an unusual or overwhelming amount of emotional stress. Determine the patient’s coping mechanisms and their effectiveness.
Focus the physical examination on the abdomen. Inspect it for distention, ascites, scars, obvious hernias, jaundice, uremic frost, and bruising. Then auscultate it for bowel sounds and characterize their motility. Palpate and percuss the abdomen, noting any tenderness, pain, organ enlargement, or tympany.
Finally, examine other body systems. Ask about behavior changes, and evaluate level of consciousness. Auscultate for gallops and crackles. Percuss the lungs to detect consolidation. Note peripheral edema and any swelling of lymph nodes.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Breast ulcer:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin the history by asking when the patient first noticed the ulcer and if it was preceded by other breast changes, such as nodules, edema, or nipple discharge, deviation, or retraction. Does the ulcer seem to be getting better or worse? Does it cause pain or produce drainage? Has she noticed any change in breast shape? Has she had a rash? If she has been treating the ulcer at home, find out how.
Review the patient’s personal and family history for factors that increase the risk of breast cancer. For example, ask about previous cancer, especially of the breast, and mastectomy. Determine whether the patient’s mother or sister has had breast cancer. Ask the patient’s age at menarche and menopause because more than 30 years of menstrual activity increases the risk of breast cancer. Also ask about pregnancy because nulliparity or a first pregnancy after age 30 also increases the risk of breast cancer.
If the patient recently gave birth, ask if she breast-feeds her infant or has recently weaned him. Ask if she’s currently taking an oral antibiotic and if she’s diabetic. All these factors predispose the patient to candidal infections.
Inspect the patient’s breast, noting any asymmetry or flattening. Look for a rash, scaling, cracking, or red excoriation on the nipples, areola, and inframammary fold. Check especially for skin changes, such as warmth, erythema, or peau d’orange. Palpate the breast for masses, noting any induration beneath the ulcer. Then carefully palpate for tenderness or nodules around the areola and the axillary lymph nodes.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Genital Ulcer:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
A sexually transmitted infection is by far the most likely cause; therefore, a careful sexual history must be taken. Because the patient is often embarrassed or ashamed, cooperation with accurate information can best be gained by first clearly explaining the purpose of the questions. Therapy is usually initiated based upon a clinical diagnosis. Although classic presentations are useful guides, the appearance of ulcers can be atypical (particularly in HIV), overlap, and multiple agents may be acquired simultaneously.
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Source: Field Guide to Bedside Diagnosis, 2007
Leg Ulcer:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Painful necrosis in a cold foot is the result of ischemia. Painless necrosis at a pressure area (MTP heads, heels, toes) is caused by neuropathy.
Ulcerations of the fingertips can be caused by Raynaud syndrome, especially in scleroderma, and by ergots, or bleomycin.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Dyspepsia:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Focus the physical examination on the abdomen. Inspect for distention, ascites, scars, obvious hernias, jaundice, uremic frost, and bruising. Then auscultate for bowel sounds and characterize their motility. Palpate and percuss the abdomen, noting any tenderness, pain, organ enlargement, or tympany.
Finally, examine other body systems. Auscultate for gallops and crackles. Percuss the lungs to detect consolidation. Note peripheral edema and any swelling of lymph nodes.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Dyspepsia:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient complains of dyspepsia, begin by asking him to describe it in detail. How often and when does it occur, specifically in relation to meals? Do drugs or activities relieve or aggravate it? Has he had nausea, vomiting, melena, hematemesis, a cough, or chest pain? Ask if he's taking prescription drugs and if he has recently had surgery. Does he have a history of renal, cardiovascular, or pulmonary disease? Has he noticed a change in the amount or color of his urine?
Ask the patient if he's experiencing an unusual or overwhelming amount of emotional stress. Determine the patient's coping mechanisms and their effectiveness.
Focus the physical examination on the abdomen. Inspect for distention, ascites, scars, obvious hernias, jaundice, uremic frost, and bruising. Then auscultate for bowel sounds and characterize their motility. Palpate and percuss the abdomen, noting tenderness, pain, organ enlargement, or tympany.
Finally, examine other body systems. Ask about behavior changes, and evaluate the patient's level of consciousness. Auscultate for gallops and crackles. Percuss the lungs to detect consolidation. Note peripheral edema and any swelling of the lymph nodes.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Breast ulcer:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin the history by asking when the patient first noticed the ulcer and if it was preceded by other breast changes, such as nodules, edema, or nipple discharge, deviation, or retraction. Does the ulcer seem to be getting better or worse? Does it cause pain or produce drainage? Has she noticed any change in breast shape? Has she had a skin rash? If she has been treating the ulcer at home, find out how.
Review the patient's personal and family history for factors that increase the risk of breast cancer. Ask, for example, about previous cancer, especially of the breast, and mastectomy. Determine whether the patient's mother or sister has had breast cancer. Ask the patient's age at menarche and menopause because more than 30 years of menstrual activity increases the risk of breast cancer. Ask about pregnancy because nulliparity or birth of a first child after age 30 also increases the risk of breast cancer.
If the patient recently gave birth, ask if she breast-feeds her infant or has recently weaned him. Ask if she's currently taking an oral antibiotic and if she's diabetic. All these factors predispose the patient to Candidainfections.
Inspect the patient's breast, noting any asymmetry or flattening. Look for a rash, scaling, cracking, or red excoriation on the nipples, areola, and inframammary fold. Check especially for skin changes, such as warmth, erythema, or peau d'orange. Palpate the breast for masses, noting any induration beneath the ulcer. Then carefully palpate for tenderness or nodules around the areola and the axillary lymph nodes.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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