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Is there fever? The presence of fever should suggest infectious mononucleosis, infectious hepatitis, leptospirosis, acute leukemia, lymphoma, malaria, and bacterial endocarditis, among other things.
Is there a rash? The ... DIAGNOSTIC WORKUP
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Is it massive? Massive splenomegaly is characteristic of Gaucher's disease, chronic myeloid leukemia, kala azar, and agnogenic myeloid metaplasia.
Is there jaundice? The presence of jaundice with massive splenomegaly would suggest ... DIAGNOSTIC WORKUP
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The spleen is the largest lymphatic organ of the body. Splenomegaly, or enlargement of the spleen, occurs when the spleen exceeds 12 cm in length, 7 cm in width, or 150 g in mass. Although a normal spleen is not usually palpable, dullness can be... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Clinical history and physical examination is a fundamental diagnostic tool in polyarthritis. Laboratory findings of inflammation include anemia, elevated ESR, CRP, and thrombocytosis. Normal or low platelet count, elevated LDH and uric acid levels raise the possibility of a malignancy.... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Arthritis in a single joint, or monoarthritis, is a difficult diagnostic challenge, because any disorder affecting joints may initially present as monoarthritis. After establishing that the arthritis is truly monoarticular, the most important considerations are septic joint and trauma.... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Neutropenia is based on absolute neutrophil count (ANC), calculated from the percentage of total white blood cell count made up by neutrophils and band forms. Norms are age-dependent and race-dependent. An ANC <1,500 cells/µl is mild neutropenia, <1,000 is moderate, and >>... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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The spleen is the largest lymphoid organ in the body. One of its primary functions is to filter defective and/or foreign cells. Splenomegaly is usually caused by systemic disease and not by primary splenic disease. Splenomegaly is usually caused by infection ... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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... The patient is lying on the table and has a palpable mass in the LUQ. The mass has a hard, smooth surface with a notch on the edge and descends on inspiration. The patient has an enlarged spleen. What can be done about it? What is causing it?
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... Because it occurs with various disorders and in up to 5% of normal adults, splenomegaly — an enlarged spleen — isn’t a diagnostic sign by itself. Usually, however, it points to infection, trauma, or a hepatic, autoimmune,... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Pictures
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... Aging
Rheumatoid arthritis
Systemic lupus erythematosus
Progressive systemic sclerosis
Dermatomyositis, polymyositis
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... Juvenile rheumatoid arthritis
Ankylosing spondylitis
Rheumatoid arthritis (rare)
Systemic diseases
Psoriasis
Behçet
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... Rheumatoid arthritis*
Juvenile rheumatoid arthritis*
Rheumatic fever*
Ankylosing spondylitis*
Collagen-vascular diseases
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... Infection
Bacterial
Viral
Rickettsial
Fungal
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... Osteoarthritis, the most common form of arthritis, is a chronic disease that causes deterioration of the joint cartilage and formation of reactive new bone at the margins and subchondral areas of the joints. This degeneration results from a breakdown of chondrocytes,... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Psoriatic arthritis is a rheumatoid-like joint disease associated with psoriasis of nearby skin and nails. Although the arthritis component of this syndrome may be clinically indistinguishable from rheumatoid arthritis, the rheumatoid nodules are absent, and serologic tests... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... A chronic, systemic, inflammatory disease, rheumatoid arthritis (RA) primarily attacks peripheral joints and surrounding muscles, tendons, ligaments, and blood vessels. Spontaneous remissions and unpredictable exacerbations mark the course of this... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Affecting children younger than age 16, juvenile rheumatoid arthritis (JRA) is an inflammatory disorder of the connective tissues, characterized by joint swelling and pain or tenderness. It may also involve organs such as the skin, heart, lungs, liver, spleen, and... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment
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... Septic, or infectious, arthritis is a medical emergency that occurs when bacterial invasion of a joint causes inflammation of the synovial lining, effusion and pyogenesis, and destruction of bone and cartilage. Septic arthritis can lead to ankylosis... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Hypothyroidism, a state of low serum thyroid hormone, results from hypothalamic, pituitary, or thyroid insufficiency. The disorder can progress to life-threatening myxedema coma.
Causes and incidence
Hypothyroidism results... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Because it occurs with various disorders and in up to 5% of normal adults, splenomegaly—an enlarged spleen—isn’t a diagnostic sign by itself. Usually, however, it points to infection, trauma, or a hepatic, autoimmune, neoplastic, or hematologic disorder.
... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Pictures
... READ EXCERPTS »
... Julie A. Reeves
Neutropenia is not simply a low white blood count (WBC) value. It is defined by the absolute neutrophil count (ANC). The ANC can be calculated as follows: ANC = WBC × (% bands + % neutrophils) × 0.01.
I.
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... Audrey Paulman
The spleen is an encapsulated reticuloendothelial organ in the left upper quadrant of the abdomen with two basic functions: (a) the white pulp makes humoral antibodies, B and T lymphocytes, and plasma cells; and (b) the red pulp... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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... Differential Overview
❑Lyme disease
❑Erythema nodosum
❑Rheumatoid arthritis
❑Systemic lupus erythematosus
❑Psoriatic... Clinical Findings
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... Differential Overview
❑ Injury
❑ Gout
❑ Osteoarthritis
❑ Lyme disease
❑ Gonococcal arthritis ... Diagnostic Approach ... Clinical Findings
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... Differential Overview
❑ Osteoarthritis
❑ Rheumatoid arthritis
❑ Lyme arthritis
❑ Systemic lupus erythematosus
&... Diagnostic Approach ... Clinical Findings ... Pictures
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... Osteoarthritis, also known as hypertrophic osteoarthritis, osteoarthrosis, and degenerative joint disease, is the most common form of arthritis. A chronic disease, it causes deterioration of the joint cartilage and formation of reactive new bone at the... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
... READ EXCERPTS »
... Psoriatic arthritis is a rheumatoid-like joint disease associated with psoriasis of the skin and nails. Although the arthritis component of this syndrome may be clinically indistinguishable from rheumatoid arthritis, the rheumatoid nodules are absent, and serologic tests for... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
... READ EXCERPTS »
... A chronic, systemic inflammatory disease, rheumatoid arthritis (RA) primarily attacks peripheral joints and surrounding muscles, tendons, ligaments, and blood vessels. Partial remissions and unpredictable exacerbations mark the course of this potentially crippling disease. ... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
... READ EXCERPTS »
... Affecting children younger than age 16, juvenile rheumatoid arthritis (JRA), also known as juvenile chronic arthritis, is an immune-mediated inflammatory disorder of the connective tissues characterized by joint swelling and pain or tenderness.... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... A medical emergency, septic (infectious) arthritis is caused by bacterial invasion of a joint, resulting in inflammation of the synovial lining. If the organisms enter the joint cavity, effusion and pyogenesis follow, with eventual destruction of bone and... Causes ... Signs and symptoms ... Treatment ... Special considerations
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... Hypothyroidism, a state of low serum thyroid hormone, results from hypothalamic, pituitary, or thyroid insufficiency. The disorder can progress to life-threatening myxedema coma. Hypothyroidism is more prevalent in women than in men; in the United States, incidence is rising significantly in... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Because it occurs with various disorders and in up to 5% of normal adults, splenomegaly — an enlarged spleen — isn’t a diagnostic sign by itself. Usually, however, it points to infection, trauma, or a hepatic, autoimmune, neoplastic, or hematologic disorder. ... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Because it occurs with various disorders and in up to 5% of normal adults, splenomegaly — an enlarged spleen — isn’t a diagnostic sign by itself. Usually, however, it points to infection, trauma, or a hepatic, autoimmune, neoplastic, or hematologic disorder. ... Emergency Actions ... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Normal spleenmay be palpable 1–2 cm below left costal margin in infantsand children. Pathologically enlarged spleen oftenhas abnormal surface or consistency and is generally associatedwith other findings. ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Because it occurs with various disorders and in up to 5% of normal adults, splenomegaly—an enlarged spleen—isn't a diagnostic sign by itself. Usually, however, it points to infection, trauma, or a hepatic, autoimmune, neoplastic, or... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
...
The patient is lying on the table and has a palpable mass in the left
upper quadrant. The mass has a hard, smooth surface with a notch on the edge
and descends on inspiration. The patient has an enlarged spleen. What can be
done about it?... Pictures
... READ EXCERPTS »
... Author:
Sonya Burroughs, MD
What to Do - Interpret the Data
LD has become the most common vector-borne disease in North America.
The highest prevalence occurs in patients aged 2 to 15 years and 30 to 59
years. In the United States, most LD is... Suggested Readings ... Pictures
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... Author:
Brian Kit, MD
What to Do - Gather Appropriate Data
Scope of the Problem. According to the Centers for Disease Control and
Prevention (CDC), the prevalence of obese children in the United Sates
tripled to 16% from 1980 to 2002. Despite... Definitions ... Health Supervision for Overweight
and Obese Children ... Conclusion ... Suggested Readings
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... Cynthia F. Norris, MD
Neutropenia - BASICS
Neutropenia - description
A decrease in the number of circulating neutrophils (both segmented and band forms), strictly defined as an absolute total neutrophil count (ANC) of <1,500>... Neutropenia - DIAGNOSIS ... Neutropenia - TREATMENT ... Neutropenia - FOLLOW UP ... Neutropenia - bibliography ... Neutropenia - CODES ... Neutropenia - FAQ
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... Sujit S. Iyer, MDRakesh D. Mistry, MD, MSJoel A. Fein, MD, MPH (4th Edition) Septic Arthritis - BASICS Septic Arthritis - description Microbiologic infection and inflammation of the usually sterile joint space. ... Septic Arthritis - DIAGNOSIS ... Septic Arthritis - TREATMENT ... Septic Arthritis - FOLLOW UP ... Septic Arthritis - bibliography ... Septic Arthritis - CODES ... Septic Arthritis - FAQ
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... Matthew J. Ryan, MD Splenomegaly - BASICS Splenomegaly - description A palpable spleen is found in most premature infants and in 30% of term infants. A spleen tip is still palpable in 10% of ... Splenomegaly - DIAGNOSIS ... Splenomegaly - FOLLOW UP ... Splenomegaly - bibliography ... Splenomegaly - CODES ... Splenomegaly - FAQ
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... Epidemiology
Patients undergoing chemotherapy are at considerable risk for serious infection.
The primary cell line affected by aggressive chemotherapy is the neutrophil.
The absolute neutrophil count (ANC) is calculated by multiplying the total
number of white blood... Gram-negative Bacteria in Fever and Neutropenia
... Fungal Pathogens in Fever and Neutropenia
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... Etiology
Children are colonized with a variety of bacteria; a culture of the nasopharynx
of an asymptomatic child could yield any number of bacteria, including
Staphylococcus aureus and Streptococcus pneumoniae. Usually, these... Presentation ... Diagnosis ... Evaluation ... Management ... Selected Readings ... Pictures
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In this segment, Dr. Allan Gibofsky answers viewer you questions about arthritis. Is there a connection between arthritis and fibromyalgia?
For most people, arthritis means simply pain in or around a joint. But there are over 100 different kinds of arthritis, each with its own set of...
