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

Jump to navigation Jump to search
No edit summary
m (Bot: Removing from Primary care)
 
(18 intermediate revisions by 2 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Graft-versus-host disease}}
{{Graft-versus-host disease}}
{{CMG}}
{{CMG}} {{shyam}}


==Overview==
==Overview==
The physical exam for GvHD focuses on the organ involved, including the skin, liver, and GI tract.
The physical exam for GvHD focuses on the organ involved, including the skin, liver, and GI tract. Rash and hyperpigmentation are the most common skin exam findings. Jaundice and abdominal tenderness are the most common liver and GI tract exam findings. The lungs or eyes can also be involved in more rare cases. A detailed physical exam is important for an accurate assessment of GvHD diagnosis and for assessment of the severity of the disease.


==Physical Examination==
==Physical Examination==
*Skin: Exam findings include erythema, morbilliform rash, hyperpigmentation.
'''Skin'''


*Liver: Exam findings include jaundice, pruritis, leg swelling, tenderness in the right upper quadrant of the abdomen, bleeding from coagulopathy.
*[[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>
*[[Maculopapular rash]]<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>
*[[Hyperpigmentation]]<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>
*Bullae<ref name="pmid24227989">{{cite journal| author=Nassar A, Tabbara KF, Aljurf M| title=Ocular manifestations of graft-versus-host disease. | journal=Saudi J Ophthalmol | year= 2013 | volume= 27 | issue= 3 | pages= 215-22 | pmid=24227989 | doi=10.1016/j.sjopt.2013.06.007 | pmc=3770225 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24227989  }} </ref>
*Desquamation<ref name="pmid24227989">{{cite journal| author=Nassar A, Tabbara KF, Aljurf M| title=Ocular manifestations of graft-versus-host disease. | journal=Saudi J Ophthalmol | year= 2013 | volume= 27 | issue= 3 | pages= 215-22 | pmid=24227989 | doi=10.1016/j.sjopt.2013.06.007 | pmc=3770225 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24227989  }} </ref>


*GI tract: Exam findings include abdominal tenderness, diarrhea, hyperactive or hypoactive bowel sounds.
'''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>
*[[Pruritis]]<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>
*[[Icterus|Scleral icterus]]<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>
*[[Leg swelling]]<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>
*Tenderness in the [[right upper quadrant]] of the abdomen<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>
*Bleeding from [[coagulopathy]]<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 [[Cholestasis|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'''
*A[[Abdominal tenderness|bdominal tenderness]]
*[[Diarrhea]]
*Hyperactive or hypoactive [[bowel sounds]]
*[[Anorexia]]<ref name="pmid26729898">{{cite journal| author=McDonald GB| title=How I treat acute graft-versus-host disease of the gastrointestinal tract and the liver. | journal=Blood | year= 2016 | volume= 127 | issue= 12 | pages= 1544-50 | pmid=26729898 | doi=10.1182/blood-2015-10-612747 | pmc=4807421 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26729898  }} </ref>
*[[Early satiety]]<ref name="pmid26729898">{{cite journal| author=McDonald GB| title=How I treat acute graft-versus-host disease of the gastrointestinal tract and the liver. | journal=Blood | year= 2016 | volume= 127 | issue= 12 | pages= 1544-50 | pmid=26729898 | doi=10.1182/blood-2015-10-612747 | pmc=4807421 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26729898  }} </ref>
'''Lungs'''
*Decreased [[breath sounds]]
*[[Crackles]] (if fluid fills the [[Alveoli|alveolar space]])
'''Other organs'''
Other physical exam findings are based on the particular organ involved.
*Eye: 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> Ocular GvHD can occur in up to 60% of patients, but the clinical exam findings and severity of disease is variable from patient to patient. Findings in ocular GvHD include:
*[[Retinopathy|Ocular perforation]]
*[[Conjunctivitis|Conjunctival damage]]
*[[Keratopathy]] (corneal damage),
*[[Dry eyes]]
*[[Milphosis]] (Loss of eyelashes)
Multiple layers of the eye can be affected, including the [[Eyelid|lid]], [[Lacrimal gland|lacrimal glands]], and [[choroid]].<ref name="pmid24227989">{{cite journal| author=Nassar A, Tabbara KF, Aljurf M| title=Ocular manifestations of graft-versus-host disease. | journal=Saudi J Ophthalmol | year= 2013 | volume= 27 | issue= 3 | pages= 215-22 | pmid=24227989 | doi=10.1016/j.sjopt.2013.06.007 | pmc=3770225 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24227989  }} </ref> [[Fluorescein (Ophthalmic)|Fluorescein staining]] of the eye can be performed.<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==
Line 20: Line 56:
{{WH}}
{{WH}}


[[Category:Primary care]]
[[Category:Hematology]]
[[Category:Hematology]]
[[Category:Immunology]]
[[Category:Immunology]]

Latest revision as of 21:56, 29 July 2020

Graft-versus-host disease

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Graft-versus-host disease from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

Echocardiograph and Ultrasound

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Graft-versus-host disease physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Graft-versus-host disease physical examination

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Graft-versus-host disease physical examination

CDC on Graft-versus-host disease physical examination

Graft-versus-host disease physical examination in the news

Blogs on Graft-versus-host disease physical examination

Directions to Hospitals Treating Type page name here

Risk calculators and risk factors for Graft-versus-host disease physical examination

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. Rash and hyperpigmentation are the most common skin exam findings. Jaundice and abdominal tenderness are the most common liver and GI tract exam findings. The lungs or eyes can also be involved in more rare cases. A detailed physical exam is important for an accurate assessment of GvHD diagnosis and for assessment of the severity of the disease.

Physical Examination

Skin

Liver

GI tract

Lungs

Other organs

Other physical exam findings are based on the particular organ involved.

  • Eye: If there is evidence of ocular GvHD, a full ophthalmologic exam should be done.[4] Ocular GvHD can occur in up to 60% of patients, but the clinical exam findings and severity of disease is variable from patient to patient. Findings in ocular GvHD include:
  • Ocular perforation
  • Conjunctival damage
  • Keratopathy (corneal damage),
  • Dry eyes
  • Milphosis (Loss of eyelashes)

Multiple layers of the eye can be affected, including the lid, lacrimal glands, and choroid.[2] Fluorescein staining of the eye can be performed.[4]

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. 2.0 2.1 2.2 Nassar A, Tabbara KF, Aljurf M (2013). "Ocular manifestations of graft-versus-host disease". Saudi J Ophthalmol. 27 (3): 215–22. doi:10.1016/j.sjopt.2013.06.007. PMC 3770225. PMID 24227989.
  3. 3.0 3.1 McDonald GB (2016). "How I treat acute graft-versus-host disease of the gastrointestinal tract and the liver". Blood. 127 (12): 1544–50. doi:10.1182/blood-2015-10-612747. PMC 4807421. PMID 26729898.
  4. 4.0 4.1 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.

Template:WS Template:WH