Celiac disease physical examination: Difference between revisions

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VisualWikitext

Latest revision as of 20:51, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Patients with celiac disease usually appear tired. Common physical examination findings of celiac disease include hepatosplenomegaly, abdominal tenderness with distention and scaly rash on extensor surfaces.

Physical Examination

Appearance

The patient may appear pale and fatigued.^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]

Skin/Mucous Membrane

Dermatitis herpetiformis
Alopecia
Scaly dermatitis
Easy bruisability

HEENT

Heart

Normal heart sounds

Lungs

Normal bilateral vesicular breath sounds

Abdomen

Pale, voluminous and malodorous diarrhoea.
Hepatosplenomegaly
Abdominal pain and cramping
Abdominal distention^[10]
Increased bowel sounds^[11]^[12]

Musculoskeletal

Non-specific bone and/or joint pain
Fractures - Osteopenia
Tetany
Decreased range of motion

Neurological

Peripheral neuropathy(decreased sensations)
Ataxia

Systemic

Extermities

Pallar nails
Edema

Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]
Dermatitis herpetiformis. Adapted from Dermatology Atlas.^[14]

References

↑ Crabbé P, Heremans J (1967). "Selective IgA deficiency with steatorrhea. A new syndrome". Am J Med. 42 (2): 319–26. PMID 4959869.
↑ Collin P, Mäki M, Keyriläinen O, Hällström O, Reunala T, Pasternack A (1992). "Selective IgA deficiency and coeliac disease". Scand J Gastroenterol. 27 (5): 367–71. PMID 1529270.
↑ Marks J, Shuster S, Watson A (1966). "Small-bowel changes in dermatitis herpetiformis". Lancet. 2 (7476): 1280–2. PMID 4163419.
↑ Pengiran Tengah D, Wills A, Holmes G (2002). "Neurological complications of coeliac disease". Postgrad Med J. 78 (921): 393–8. PMID 12151653.
↑ Ferguson A, Hutton M, Maxwell J, Murray D (1970). "Adult coeliac disease in hyposplenic patients". Lancet. 1 (7639): 163–4. PMID 4189238.
↑ Holmes G (2001). "Coeliac disease and Type 1 diabetes mellitus - the case for screening". Diabet Med. 18 (3): 169–77. PMID 11318836.
↑ Collin P, Kaukinen K, Välimäki M, Salmi J (2002). "Endocrinological disorders and celiac disease". Endocr Rev. 23 (4): 464–83. PMID 12202461.
↑ Kingham J, Parker D (1998). "The association between primary biliary cirrhosis and coeliac disease: a study of relative prevalences". Gut. 42 (1): 120–2. PMID 9518232.
↑ Matteoni C, Goldblum J, Wang N, Brzezinski A, Achkar E, Soffer E (2001). "Celiac disease is highly prevalent in lymphocytic colitis". J Clin Gastroenterol. 32 (3): 225–7. PMID 11246349.
↑ Ferguson R, Basu M, Asquith P, Cooke W (1976). "Jejunal mucosal abnormalities in patients with recurrent aphthous ulceration". Br Med J. 1 (6000): 11–13. PMID 1247715.
↑ Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS. "Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis". Gastroenterology. 126 (7): 1721–32. PMID 15188167.
↑ "American Gastroenterological Association medical position statement: Celiac Sprue". Gastroenterology. 120 (6): 1522–5. 2001. PMID 11313323.
↑ Tursi A, Brandimarte G, Giorgetti G (2003). "High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal". Am J Gastroenterol. 98 (4): 839–43. PMID 12738465.
↑ ^14.00 ^14.01 ^14.02 ^14.03 ^14.04 ^14.05 ^14.06 ^14.07 ^14.08 ^14.09 ^14.10 ^14.11 ^14.12 ^14.13 ^14.14 ^14.15 ^14.16 ^14.17 ^14.18 ^14.19 ^14.20 ^14.21 ^14.22 ^14.23 ^14.24 ^14.25 ^14.26 ^14.27 ^14.28 ^14.29 ^14.30 ^14.31 ^14.32 ^14.33 ^14.34 ^14.35 ^14.36 ^14.37 ^14.38 ^14.39 ^14.40 ^14.41 ^14.42 ^14.43 ^14.44 ^14.45 ^14.46 ^14.47 ^14.48 ^14.49 ^14.50 ^14.51 "Dermatology Atlas".

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[1] Crabbé P, Heremans J (1967). "Selective IgA deficiency with steatorrhea. A new syndrome". Am J Med. 42 (2): 319–26. PMID 4959869.

[2] Collin P, Mäki M, Keyriläinen O, Hällström O, Reunala T, Pasternack A (1992). "Selective IgA deficiency and coeliac disease". Scand J Gastroenterol. 27 (5): 367–71. PMID 1529270.

[Marks-3] Marks J, Shuster S, Watson A (1966). "Small-bowel changes in dermatitis herpetiformis". Lancet. 2 (7476): 1280–2. PMID 4163419.

[4] Pengiran Tengah D, Wills A, Holmes G (2002). "Neurological complications of coeliac disease". Postgrad Med J. 78 (921): 393–8. PMID 12151653.

[Ferguson-5] Ferguson A, Hutton M, Maxwell J, Murray D (1970). "Adult coeliac disease in hyposplenic patients". Lancet. 1 (7639): 163–4. PMID 4189238.

[Holmes-6] Holmes G (2001). "Coeliac disease and Type 1 diabetes mellitus - the case for screening". Diabet Med. 18 (3): 169–77. PMID 11318836.

[7] Collin P, Kaukinen K, Välimäki M, Salmi J (2002). "Endocrinological disorders and celiac disease". Endocr Rev. 23 (4): 464–83. PMID 12202461.

[8] Kingham J, Parker D (1998). "The association between primary biliary cirrhosis and coeliac disease: a study of relative prevalences". Gut. 42 (1): 120–2. PMID 9518232.

[9] Matteoni C, Goldblum J, Wang N, Brzezinski A, Achkar E, Soffer E (2001). "Celiac disease is highly prevalent in lymphocytic colitis". J Clin Gastroenterol. 32 (3): 225–7. PMID 11246349.

[10] Ferguson R, Basu M, Asquith P, Cooke W (1976). "Jejunal mucosal abnormalities in patients with recurrent aphthous ulceration". Br Med J. 1 (6000): 11–13. PMID 1247715.

[Spiegel-11] Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS. "Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis". Gastroenterology. 126 (7): 1721–32. PMID 15188167.

[AGA-12] "American Gastroenterological Association medical position statement: Celiac Sprue". Gastroenterology. 120 (6): 1522–5. 2001. PMID 11313323.

[Tursi-13] Tursi A, Brandimarte G, Giorgetti G (2003). "High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal". Am J Gastroenterol. 98 (4): 839–43. PMID 12738465.

[Dermatology_Atlas-14] 14.00 ^14.01 ^14.02 ^14.03 ^14.04 ^14.05 ^14.06 ^14.07 ^14.08 ^14.09 ^14.10 ^14.11 ^14.12 ^14.13 ^14.14 ^14.15 ^14.16 ^14.17 ^14.18 ^14.19 ^14.20 ^14.21 ^14.22 ^14.23 ^14.24 ^14.25 ^14.26 ^14.27 ^14.28 ^14.29 ^14.30 ^14.31 ^14.32 ^14.33 ^14.34 ^14.35 ^14.36 ^14.37 ^14.38 ^14.39 ^14.40 ^14.41 ^14.42 ^14.43 ^14.44 ^14.45 ^14.46 ^14.47 ^14.48 ^14.49 ^14.50 ^14.51 "Dermatology Atlas".

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@@ Line 4: / Line 4: @@
 ==Overview==
-Patients with celiac disease usually appear tired. Common physical examination findings of celiac disease include hepatosplenomegaly, abdominal tenderness with distention and scaly rash on extensor surfaces.
+Patients with celiac disease usually appear [[Fatigue|tired]]. Common [[physical examination]] findings of celiac disease include [[hepatosplenomegaly]], [[abdominal tenderness]] with distention and [[Dermatitis herpetiformis|scaly rash]] on extensor surfaces.
 ==Physical Examination==
 ===Appearance===
-The patient may appear [[pale]] and [[Fatigue|fatigued]].<ref>{{cite journal | author = Crabbé P, Heremans J | title = Selective IgA deficiency with steatorrhea. A new syndrome | journal = Am J Med | volume = 42 | issue = 2 | pages = 319-26 | year = 1967 | id = PMID 4959869}}</ref><ref>{{cite journal | author = Collin P, Mäki M, Keyriläinen O, Hällström O, Reunala T, Pasternack A | title = Selective IgA deficiency and coeliac disease | journal = Scand J Gastroenterol | volume = 27 | issue = 5 | pages = 367-71 | year = 1992|id = PMID 1529270}}</ref><ref name=Marks>{{cite journal | author = Marks J, Shuster S, Watson A | title = Small-bowel changes in dermatitis herpetiformis | journal = Lancet | volume = 2 | issue = 7476 | pages = 1280–2 | year = 1966 | id = PMID 4163419}}</ref><ref>{{cite journal | author = Pengiran Tengah D, Wills A, Holmes G | title = Neurological complications of coeliac disease | journal = Postgrad Med J | volume = 78 | issue = 921 | pages = 393-8 | year = 2002 | url = http://pmj.bmjjournals.com/cgi/content/full/78/921/393 | id = PMID 12151653}}</ref>
+The patient may appear [[pale]] and [[Fatigue|fatigued]].<ref>{{cite journal | author = Crabbé P, Heremans J | title = Selective IgA deficiency with steatorrhea. A new syndrome | journal = Am J Med | volume = 42 | issue = 2 | pages = 319-26 | year = 1967 | id = PMID 4959869}}</ref><ref>{{cite journal | author = Collin P, Mäki M, Keyriläinen O, Hällström O, Reunala T, Pasternack A | title = Selective IgA deficiency and coeliac disease | journal = Scand J Gastroenterol | volume = 27 | issue = 5 | pages = 367-71 | year = 1992|id = PMID 1529270}}</ref><ref name="Marks">{{cite journal | author = Marks J, Shuster S, Watson A | title = Small-bowel changes in dermatitis herpetiformis | journal = Lancet | volume = 2 | issue = 7476 | pages = 1280–2 | year = 1966 | id = PMID 4163419}}</ref><ref>{{cite journal | author = Pengiran Tengah D, Wills A, Holmes G | title = Neurological complications of coeliac disease | journal = Postgrad Med J | volume = 78 | issue = 921 | pages = 393-8 | year = 2002 | url = http://pmj.bmjjournals.com/cgi/content/full/78/921/393 | id = PMID 12151653}}</ref><ref name="Ferguson">{{cite journal | author = Ferguson A, Hutton M, Maxwell J, Murray D | title = Adult coeliac disease in hyposplenic patients | journal = Lancet | volume = 1 | issue = 7639 | pages = 163-4 | year = 1970 | id = PMID 4189238}}</ref><ref name="Holmes">{{cite journal |author=Holmes G |title=Coeliac disease and Type 1 diabetes mellitus - the case for screening |journal=Diabet Med |volume=18 |issue=3 |pages=169-77 |year=2001 |pmid=11318836}}</ref><ref>{{cite journal | author = Collin P, Kaukinen K, Välimäki M, Salmi J | title = Endocrinological disorders and celiac disease | journal = Endocr Rev | volume = 23 | issue = 4 | pages = 464-83 | year = 2002 | url = http://edrv.endojournals.org/cgi/content/full/23/4/464 | id = PMID 12202461}}</ref><ref>{{cite journal | author = Kingham J, Parker D | title = The association between primary biliary cirrhosis and coeliac disease: a study of relative prevalences | journal = Gut | volume = 42 | issue = 1 | pages = 120-2 | year = 1998|id = PMID 9518232}}</ref><ref>{{cite journal | author = Matteoni C, Goldblum J, Wang N, Brzezinski A, Achkar E, Soffer E | title = Celiac disease is highly prevalent in lymphocytic colitis | journal = J Clin Gastroenterol | volume = 32 | issue = 3 | pages = 225-7 | year = 2001 | id = PMID 11246349}}</ref>
-<ref name=Ferguson>{{cite journal | author = Ferguson A, Hutton M, Maxwell J, Murray D | title = Adult coeliac disease in hyposplenic patients | journal = Lancet | volume = 1 | issue = 7639 | pages = 163-4 | year = 1970 | id = PMID 4189238}}</ref><ref name=Holmes>{{cite journal |author=Holmes G |title=Coeliac disease and Type 1 diabetes mellitus - the case for screening |journal=Diabet Med |volume=18 |issue=3 |pages=169-77 |year=2001 |pmid=11318836}}</ref><ref>{{cite journal | author = Collin P, Kaukinen K, Välimäki M, Salmi J | title = Endocrinological disorders and celiac disease | journal = Endocr Rev | volume = 23 | issue = 4 | pages = 464-83 | year = 2002 | url = http://edrv.endojournals.org/cgi/content/full/23/4/464 | id = PMID 12202461}}</ref><!--
---><ref>{{cite journal | author = Kingham J, Parker D | title = The association between primary biliary cirrhosis and coeliac disease: a study of relative prevalences | journal = Gut | volume = 42 | issue = 1 | pages = 120-2 | year = 1998|id = PMID 9518232}}</ref> <!--
---><ref>{{cite journal | author = Matteoni C, Goldblum J, Wang N, Brzezinski A, Achkar E, Soffer E | title = Celiac disease is highly prevalent in lymphocytic colitis | journal = J Clin Gastroenterol | volume = 32 | issue = 3 | pages = 225-7 | year = 2001 | id = PMID 11246349}}</ref>
 ===Skin/Mucous Membrane===
 * [[Dermatitis herpetiformis]]
@@ Line 19: / Line 17: @@
 ===HEENT===
 * [[Aphthous ulcers]]
-* [[Cheliosis]]
+* Chelosis
-*[[stomatitis]]
+* [[Stomatitis]]
 * [[Epistaxis]]
 ===Heart===
-*Normal heart sounds
+*Normal [[heart sounds]]
 ===Lungs===
-*Normal bilateral vesicular breathe sounds
+*Normal bilateral [[Vesicular Breathing|vesicular]] breath sounds
 ===Abdomen===
 *[[steatorrhoea|Pale]], voluminous and malodorous [[diarrhoea]].
-*Hepatosplenomegaly
+*[[Hepatosplenomegaly]]
 *[[Abdominal pain]] and cramping
-*Abdominal distention<ref>{{cite journal | author = Ferguson R, Basu M, Asquith P, Cooke W | title = Jejunal mucosal abnormalities in patients with recurrent aphthous ulceration | journal = Br Med J | volume = 1 | issue = 6000 | pages = 11–13 | year = 1976|id = PMID 1247715}}</ref> .
+*Abdominal distention<ref>{{cite journal | author = Ferguson R, Basu M, Asquith P, Cooke W | title = Jejunal mucosal abnormalities in patients with recurrent aphthous ulceration | journal = Br Med J | volume = 1 | issue = 6000 | pages = 11–13 | year = 1976|id = PMID 1247715}}</ref>
-*Increased bowel sounds<ref name=Spiegel>{{cite journal | author = Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS | year = 2004 | month = Jun | title = Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis | journal = Gastroenterology | volume = 126 | issue = 7 | pages = 1721–32 | id = PMID 15188167}}</ref><ref name=AGA>{{cite journal | author = | title = American Gastroenterological Association medical position statement: Celiac Sprue | journal = Gastroenterology | volume = 120 | issue = 6 | pages = 1522–5 | year = 2001 | id = PMID 11313323 | url = http://www.gastrojournal.org/article/PIIS0016508501701618/fulltext}}</ref>
+*Increased [[bowel]] sounds<ref name="Spiegel">{{cite journal | author = Spiegel BM, DeRosa VP, Gralnek IM, Wang V, Dulai GS | title = Testing for celiac sprue in irritable bowel syndrome with predominant diarrhea: a cost-effectiveness analysis | journal = Gastroenterology | volume = 126 | issue = 7 | pages = 1721–32 | id = PMID 15188167}}</ref><ref name="AGA">{{cite journal | author = | title = American Gastroenterological Association medical position statement: Celiac Sprue | journal = Gastroenterology | volume = 120 | issue = 6 | pages = 1522–5 | year = 2001 | id = PMID 11313323 | url = http://www.gastrojournal.org/article/PIIS0016508501701618/fulltext}}</ref>
 ===Musculoskeletal===
-* Non-specific bone and/or joint pain
+* Non-specific [[bone]] and/or [[joint]] pain
 * [[Fractures]] - [[Osteopenia]]
 * [[Tetany]]
-* Decreased range of motion
+* Decreased [[range of motion]]
 ===Neurological===
 * [[Peripheral neuropathy]](decreased sensations)
+* [[Ataxia]]
 ===Systemic===
 * [[Failure to thrive]]
-*Stunted growth
+*[[Stunted growth]]
-* [[fatigue (physical)|Fatigue]]<ref name=Tursi>{{cite journal | author = Tursi A, Brandimarte G, Giorgetti G | title = High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal | journal = Am J Gastroenterol | volume = 98 | issue = 4 | pages = 839-43 | year = 2003 | id = PMID 12738465}}</ref>
+* [[fatigue (physical)|Fatigue]]<ref name="Tursi">{{cite journal | author = Tursi A, Brandimarte G, Giorgetti G | title = High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal | journal = Am J Gastroenterol | volume = 98 | issue = 4 | pages = 839-43 | year = 2003 | id = PMID 12738465}}</ref>
 ===Extermities===
 *Pallar nails
-*Edema
+*[[Edema]]
+<gallery>
+Image:Dermatitis herpetiformis01.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis02.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis03.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis04.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis05.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis06.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis07.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis08.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis10.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis15.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis26.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis27.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis28.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis29.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis30.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis31.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis32.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis33.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis34.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis09.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis12.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis13.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis14.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis16.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis17.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis18.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis19.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis20.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis22.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis23.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis24.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis25.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis21.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis35.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis36.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis37.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis38.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis39.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis40.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis41.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis42.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis43.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis44.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis45.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis46.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis47.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis48.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis49.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis50.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis51.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis52.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Dermatitis herpetiformis53.jpg|Dermatitis herpetiformis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+</gallery>
 ==References==
 {{reflist|2}}
+{{WH}}
+{{WS}}
 [[Category:Gastroenterology]]
-[[Category:Primary care]]
 [[Category:Rheumatology]]
 [[Category:Autoimmune diseases]]
-[[Category:Gastroenterology]]
 [[Category:Genetic disorders]]
 [[Category:Malnutrition]]
 [[Category:Pediatrics]]
 [[Category:Dermatology]]
-[[Category:Primary care]]
 [[Category:Up-To-Date]]
-{{WH}}
-{{WS}}