Graft-versus-host disease physical examination: Difference between revisions

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==Physical Examination==
==Physical Examination==
*'''Skin'''
'''Skin'''


*erythema<ref name="pmid24914139">{{cite journal| author=Socié G, Ritz J| title=Current issues in chronic graft-versus-host disease. | journal=Blood | year= 2014 | volume= 124 | issue= 3 | pages= 374-84 | pmid=24914139 | doi=10.1182/blood-2014-01-514752 | pmc=4102710 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24914139  }} </ref>  
*erythema<ref name="pmid24914139">{{cite journal| author=Socié G, Ritz J| title=Current issues in chronic graft-versus-host disease. | journal=Blood | year= 2014 | volume= 124 | issue= 3 | pages= 374-84 | pmid=24914139 | doi=10.1182/blood-2014-01-514752 | pmc=4102710 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24914139  }} </ref>  
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*lichen planus-like lesions<ref name="pmid24914139">{{cite journal| author=Socié G, Ritz J| title=Current issues in chronic graft-versus-host disease. | journal=Blood | year= 2014 | volume= 124 | issue= 3 | pages= 374-84 | pmid=24914139 | doi=10.1182/blood-2014-01-514752 | pmc=4102710 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24914139  }} </ref>  
*lichen planus-like lesions<ref name="pmid24914139">{{cite journal| author=Socié G, Ritz J| title=Current issues in chronic graft-versus-host disease. | journal=Blood | year= 2014 | volume= 124 | issue= 3 | pages= 374-84 | pmid=24914139 | doi=10.1182/blood-2014-01-514752 | pmc=4102710 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24914139  }} </ref>  


*'''Liver'''
'''Liver'''


*jaundice<ref name="pmid24914139">{{cite journal| author=Socié G, Ritz J| title=Current issues in chronic graft-versus-host disease. | journal=Blood | year= 2014 | volume= 124 | issue= 3 | pages= 374-84 | pmid=24914139 | doi=10.1182/blood-2014-01-514752 | pmc=4102710 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24914139  }} </ref>
*jaundice<ref name="pmid24914139">{{cite journal| author=Socié G, Ritz J| title=Current issues in chronic graft-versus-host disease. | journal=Blood | year= 2014 | volume= 124 | issue= 3 | pages= 374-84 | pmid=24914139 | doi=10.1182/blood-2014-01-514752 | pmc=4102710 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24914139  }} </ref>
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*signs of cholestatic hepatitis<ref name="pmid24914139">{{cite journal| author=Socié G, Ritz J| title=Current issues in chronic graft-versus-host disease. | journal=Blood | year= 2014 | volume= 124 | issue= 3 | pages= 374-84 | pmid=24914139 | doi=10.1182/blood-2014-01-514752 | pmc=4102710 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24914139  }} </ref>
*signs of cholestatic hepatitis<ref name="pmid24914139">{{cite journal| author=Socié G, Ritz J| title=Current issues in chronic graft-versus-host disease. | journal=Blood | year= 2014 | volume= 124 | issue= 3 | pages= 374-84 | pmid=24914139 | doi=10.1182/blood-2014-01-514752 | pmc=4102710 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24914139  }} </ref>


*'''GI tract'''
'''GI tract'''


*abdominal tenderness
*abdominal tenderness
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*hyperactive or hypoactive bowel sounds
*hyperactive or hypoactive bowel sounds


*'''Lungs'''
'''Lungs'''


Exam findings include decreased breath sounds and crackles (if fluid fills the alveolar space).
*decreased breath sounds  
*crackles (if fluid fills the alveolar space)


Other physical exam findings are based on the particular organ involved. For example, if there is evidence of ocular GvHD, a full ophthalmologic exam should be done.
'''Other organs'''
Other physical exam findings are based on the particular organ involved. For example, if there is evidence of ocular GvHD, a full ophthalmologic exam should be done.<ref name="pmid25655798">{{cite journal| author=Herretes S, Ross DB, Duffort S, Barreras H, Yaohong T, Saeed AM et al.| title=Recruitment of Donor T Cells to the Eyes During Ocular GVHD in Recipients of MHC-Matched Allogeneic Hematopoietic Stem Cell Transplants. | journal=Invest Ophthalmol Vis Sci | year= 2015 | volume= 56 | issue= 4 | pages= 2348-57 | pmid=25655798 | doi=10.1167/iovs.14-15630 | pmc=4406104 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25655798  }} </ref>


==References==
==References==

Revision as of 19:05, 21 June 2017

Graft-versus-host disease

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]

Overview

The physical exam for GvHD focuses on the organ involved, including the skin, liver, and GI tract. The lungs can also be involved in more rare cases.

Physical Examination

Skin

  • erythema[1]
  • maculopapular rash[1]
  • hyperpigmentation[1]
  • lichen planus-like lesions[1]

Liver

  • jaundice[1]
  • pruritis[1]
  • scleral icterus[1]
  • leg swelling[1]
  • tenderness in the right upper quadrant of the abdomen[1]
  • bleeding from coagulopathy[1]
  • signs of cholestatic hepatitis[1]

GI tract

  • abdominal tenderness
  • diarrhea
  • hyperactive or hypoactive bowel sounds

Lungs

  • decreased breath sounds
  • crackles (if fluid fills the alveolar space)

Other organs Other physical exam findings are based on the particular organ involved. For example, if there is evidence of ocular GvHD, a full ophthalmologic exam should be done.[2]

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 Socié G, Ritz J (2014). "Current issues in chronic graft-versus-host disease". Blood. 124 (3): 374–84. doi:10.1182/blood-2014-01-514752. PMC 4102710. PMID 24914139.
  2. ↑ Herretes S, Ross DB, Duffort S, Barreras H, Yaohong T, Saeed AM; et al. (2015). "Recruitment of Donor T Cells to the Eyes During Ocular GVHD in Recipients of MHC-Matched Allogeneic Hematopoietic Stem Cell Transplants". Invest Ophthalmol Vis Sci. 56 (4): 2348–57. doi:10.1167/iovs.14-15630. PMC 4406104. PMID 25655798.

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