Arthritis Differential Diagnosis
Arthritis Differential Diagnosis
With today’s average diet, heart burn has become more and more common in the Internist’s medical practice. This is a common differential diagnosis of heart attack, with its symptom presentation of
1. Burning chest pain
2. Palpitations
3. Shortness of breathing and
4. Feeling of doom
Although heartburn has other symptoms that would differentiate it from a heart attack, the feeling of impending doom drives most patients to the emergency room. And some doctors to the Intensive Care Unit. They say it’s better to err on the safe side. But some steps that the patient can do before things get out of control can make the big difference between minor annoyance and a major dramatic emergency.
Acid in the stomach is kept from regurgitating back to the esophagus by a ring of muscle called the GastroEsophageal Junction. This is normally tightly closed so that the food and the acid go forward into the intestines. But factors that
(1) weaken the muscular ring
(2) increase the pressure in the stomach and /or
(3) increase its acidity
force the contents back into the esophagus, sometimes to as far as the throat (leading to dry cough at night while in bed) or even spilling into the lungs (leading to an asthmatic attack).
So what the patient should do would be things that
(1) decrease acid in the stomach (avoid stress, alcohol, carbonated drinks and acidic foods),
(2) decrease pressure inside the stomach (refrain from lying prone, lie down on high back rest, avoid tight clothing and lose weight) and
(3) maintain strength of the muscular ring (avoid vomiting).
It is known that most cases of acid reflux are “self inflicted”, brought about by “overindulgence”, that has become a way of life for modern man. So you see, the trip to the emergency room is really not that necessary, if we know what to do, and we have the will to do it.
A 6 years old female with high ESR since 1 year ago about 100,and recurrent lesions in mouth and tongue?
a girl with wide spread lesions in mouth (herpes?aphtus?)with similar lesions since 1 year ago,accompanied with very high ESR about 100 and 140,no arthritis symptomes,and no obvious weight lost.she had had fever for 1 week ,but no more fever,the lesions arent responsive to acyclovir completely,whats the differential diagnosis?
You may want to research Kawasaki disease.
Kawasaki disease often begins with a high and persistent fever that is not very responsive to normal doses of paracetamol (acetaminophen) or ibuprofen. The fever may persist steadily for up to two weeks and is normally accompanied by irritability. Affected children develop red eyes, red mucous membranes in the mouth, red cracked lips, a “strawberry tongue” and sometimes other symptoms.
Kawasaki disease can only be diagnosed clinically (by medical signs and symptoms), as there exists no specific laboratory test that can tell if someone has it. It is normally difficult to establish the diagnosis, especially early in the course of illness, and frequently children are not diagnosed until they have seen their doctor several times, or visited a number of different health care providers. Many other serious illnesses can cause similar symptoms, and must be considered in the differential diagnosis, including scarlet fever, toxic shock syndrome, and juvenile idiopathic arthritis.
Classically, five days of fever plus four of five diagnostic criteria must be met in order to establish the diagnosis. The criteria are: (1) erythema of the lips or oral cavity or cracking of the lips; (2) rash on the trunk; (3) swelling or erythema of the hands or feet; (4) red eyes (conjunctival injection) (5) swollen lymph node in the neck of at least 15 millimeters.
Many children, especially infants, eventually diagnosed with Kawasaki disease do not exhibit all of the above criteria.
By far, the highest incidence of Kawasaki disease occurs in Japan (175 per 100,000), though its incidence in the United States is increasing. Kawasaki disease is predominantly a disease of young children, with 80% of patients younger than 5 years of age.
Approximately 2000 cases are identified in the United States each year
Leave a Comment