* * Anonymous Doc

Saturday, July 9, 2011

Secret Words

"Yes, doctor, this patient has pain caused by a large pannus. ETOH, A&O times 2."

And, you, the patient, sit there, not knowing that the doctor has just called you a fat alcoholic who doesn't know what day it is.

I looked up pannus to make sure I was spelling it right-- it's used more out loud than in the notes. And wikipedia tells me it's actually being used incorrectly. We use it to mean a large stomach, in an obese patient. But apparently that's actually panniculus, and pannus is an abnormal layer of fibrovascular tissue. The fact that I'm relying on wikipedia to tell me this is perhaps a little frightening. We use pannus all the time to mean a big fat stomach. And now I'm not really sure why, assuming wikipedia knows what it's talking about. And the entry for panniculus has a whole grading system that we don't use and I've never heard of:

Grade 1
Panniculus barely covers the hairline and mons pubis but not the genitalia.

Grade 2
Extends to cover the genitalia.

Grade 3
Extends to cover the upper thigh

Grade 4
Extends to cover the mid thigh.

Grade 5
Extends to cover the knees or beyond.

Fascinating, I suppose. Wikipedia knows more than I do.


  1. Never seen a grade 5 panniculus,
    I think it would look ridiculus,
    I'd at least hope for hygiene meticulus,

    (Can't think of another near rhyme for the last line. And my pride requires that I mention that the misspellings are intentional and for comic effect.)

  2. wonder what medical school you went to? Pannus is associated with Rheumatoid Arthritis. Interesting though, I've never heard pannus used in the way you've mentioned. First rotation is Monday though, so we shall see.

  3. Panniculus grade 1 is also known as Dunlap's disease ("his belly done laps over his belt"). Bet you didn't learn that in medical school.

  4. I've always heard that if you have a good tool, you build a shed over it?!!?

  5. I'm not a grade one, but I'm fat and I have a belly. It just doesn't hang.

    What's that? Grade .5?

    Maybe this is the advantage of being tall and fat?


  6. Ah, the classic preclinical med student move, assuming they know more than the experienced resident. :) Pannus is indeed used all the time just as Anony Doc said, and I'm fairly certain I'm training in a completely different state as AD so that means it's at least a regional if not national practice.... I similarly have an attending who swears awake, alert and oriented should be awake, alert and orientated to be grammatically correct...but I think that can be chalked up to a difference in British vs American English...

  7. Another point of view-- Nomenclature question: panniculus or pannus? Answer: pannona. Cunningham SC, Klein RV. J Am Coll Surg. 2007 Apr;204(4):726-7.

  8. So I have a BMI of 24.3, and had a large baby many years ago, and I have a pannus (panniculus) grade 1. Are you telling me I'm fat?

  9. The technical name for Grade 2 is 'Thangdo' disease. As in, "My belly pokes out farther than my...." ...well, you get the point...

  10. wow, I can tell what compassionate doctors we have entering the system. I hope and pray I never come across one of you in an emergency room. My guess is you will all have to work for some doc in the box joker outfit because your bedside manor stinks! I hope all of you need a doctor some day and find all they can do is snicker at you and yes we patients do know when you have that "attitude" Maybe you should try another profession perhaps an undertaker?