Diagnostic Tests for Mastocytosis
Mastocytosis Tests: Book Excerpts
Mastocytosis Diagnosis: Book Excerpts
Diagnostic Tests for Mastocytosis: Online Medical Books
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Urticaria:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A complete physical is required to rule out infection or other systemic diseases. An urticarial wheal is usually well demarcated. It begins as an erythematous area, which then develops a white center. The size of the wheal can vary from 2 mm to well over 30 cm. The rash is usually pruritic, especially when it occurs on the palms of the hand and the soles of the feet. Most often, the wheal will disappear within 3 to 4 hours of onset. The accompanying angioedema can last for a couple of days. The skin will return to normal once the wheal is gone.
Testing
A. Laboratory tests. Routine tests include (a) complete blood count to look for eosinophilia, neoplastic disorders, and occult infection; (b) thyroid studies (thyroxine and thyroid-stimulating hormone; (c) erythrocyte sedimentation rate to help rule out connective tissue disorders and occult infection, urine analysis with urine culture, chemical profile, stool cultures for parasites, liver function tests, and an antinuclear antibody test. Other tests can include immunoglobulins, prick testing, rheumatoid factor, cryoglobulins, serum complement, and skin biopsy. However, laboratory tests often do not provide answers beyond those obtained in the history (3).
B. Diagnostic imaging. Chest x-ray, sinus, and dental films may help to rule out cancer and infection.
Diagnostic assessment
It is important to rule out underlying conditions such as neoplastic disorders, endocrine disorders, connective tissue diseases, infections, and other disorders. The most significant factors in diagnosing acute urticaria are the history and physical examination. Facts must be obtained concerning food or drug ingestion, insect stings, current infections, or physical triggers such as cold or heat. Most acute urticarial reactions resolve spontaneously, but some continue and become chronic in nature. Of the chronic urticaria, a cause is found in only a few of these patients, with more than 75% of them having an idiopathic disorder (4).
References
1. Beltrani VS. Allergic dermatoses. Med Clin North Am 1998;82(5):1105–1133.
2. Greaves MW, Sabroe RA. ABC of allergies. Allergy and the skin. I—Urticaria. BMJ 1998;316(7138):1147–1150.
3. Kozel MM. The effectiveness of a history-based diagnostic approach in chronic urticaria and angioedema. Arch Dermatol 1998;134(12):1575–1580.
4. Greaves MW. Chronic urticaria [published erratum appears in N Engl J Med 1995;
333(16):1091]. N Engl J Med 1995;332(26):1767–1772.
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Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Urticaria/Angioedema:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Urticaria appears as transient, mutable wheals with red raised serpiginous borders and clear centers, which often coalesce. Urticaria is experienced by 10% to 20% of the population at some time. Angioedema is well-demarcated localized edema.
The appearance may be helpful. Gyrate hives (erythema gyratum) are associated with internal malignancy. Hives without pseudopods suggest allergy. Small lesions with erythematous flares suggest cholinergic urticaria. Urticarial lesions unchanged for 24 hours suggest vasculitis, especially if associated with scaling or purpura.
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Source: Field Guide to Bedside Diagnosis, 2007
Urticaria:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Obtain the patient’s vital signs. Perform a complete cardiopulmonary assessment, noting signs and symptoms of shock or respiratory distress. Finish your examination by assessing for urticaria in other areas because new crops may continue to appear.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Urticaria [Hives]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient isn't in distress, obtain a complete history. Does he have any known allergies? Does the urticaria follow a seasonal pattern? Do certain foods or drugs seem to aggravate it? Is there a relationship to physical exertion? Is the patient routinely exposed to chemicals on the job or at home? Has the patient recently changed or used new skin products or detergents? Obtain a detailed drug history, including prescription and over-the-counter drugs. Note any history of chronic or parasitic infection, skin disease, or a GI disorder.
Next, assess respiratory status. Inspect the chest for sternal retractions and accessory muscle use. Auscultate and percuss the chest. Assess cardiac status. Obtain vital signs and pulse oximetry and begin cardiac monitoring. Assess all skin surfaces.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
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