Urticaria (or hives) are a kind of skin rash notable for dark red, raised, itchy bumps. Hives are frequently caused by allergic reactions, however there are many non-allergic causes. For example, most cases of hives lasting less than six weeks (acute urticaria) are the result of an allergic trigger. Chronic urticaria (hives lasting longer than six weeks) are rarely due to an allergy. The majority of patients with chronic hives have an unknown (idiopathic) cause. Perhaps as many as 30-40% of patients with chronic idiopathic urticaria will, in fact, have an autoimmune cause. Acute viral infection is another common cause of acute urticaria (viral exanthem). Less common causes of hives include friction, pressure, temperature extremes, exercise, and sunlight. It may be true that hives are more common in those with fair skin.
Weals (raised areas surrounded by a red base) from urticaria can appear anywhere on the surface of the skin. Whether the trigger is allergic or non-allergic, there is a complex release of inflammatory mediators, including histamine from cutaneous mast cells, resulting in fluid leakage from superficial blood vessels. Weals may be pinpoint in size, or several inches in diameter. Angioedema is a related condition (also from allergic and non-allergic causes), though fluid leakage is from much deeper blood vessels. Individual hives that are painful, last >24 hours, or leave a bruise as they heal are more likely to be a more serious condition called urticaria pigmentosa. Hives caused by stroking the skin (often linear in appearance) is due to a benign condition called dermatographism.
Urticaria also called nettle-rash or hives or wheals in a common language, simply means itching with rash. Medically, urticaria may be defined as skin eruption, which is allergic (or non-allergic) in origin and is characterized by profound itching, red circular or irregularly shaped eruptions on any part of the body. Urticaria is an allergic or non-allergic immunological disease, shown on the skin. Characteristically the skin eruptions are erythematous, raised above the skin level, with intense itching and usually worsened by itching an with slight local warmth. It can be acute or chronic; largely having a tendency to recur frequently for many months or years.
These eruptions can remain on the body for variable period, anywhere between few seconds to even hours. They have tendency to disappear and reappear. They tend to disappear without leaving behind any trace.
Location and duration:
Well, urticaria may appear on any part of the skin. Angioedema is a condition when deep tissues are affected. The typical lesions may last for one minute to half an hour. Some may last even longer. Some patients may get the eruptions once in a while and some may have many times during the day. It may be restricted to a couple of spots in some patients, while some may have wide spread rashes appearing for days or even months together.
There are acute, subacute, chronic and recurring variants as far as the frequency and duration are concerned.
Histopathological view:
Under the microscope, a typical urticarial rash may exhibit perivascular, cellular infiltrate consisting of lymphocytes and eosinophils, is indicative of its allergic behavior. There are findings related to oedema (swelling) and mucosal inflammation.
The Inner War:
The urticaria rash is a symptom of an allergic and immunological event taking place at the dermal level. The exact understanding is illusive to an extent. In brief, urticaria is a hypersensitive reaction due to the histamine release. The histamine release could be from the mast cells when antigens and antibodies (IgM or IgG) combine to activate the immunological reaction. The histamine release could IgE induced. There are certain drugs, pharmacological agents (e.g.: antibiotics, morphine, aspirin, etc.), food articles (proteins, milk products, etc.) Urticaria is a sign of antigen-antibody reaction.
During this process of antibody-antigen reaction, histamine and/or acetyl choline is generated which has the property of causing vessel dilatation (vasodilation) swelling, itching, pain and rash.
Pathophysiology
The skin lesions of urticarial disease are caused by an inflammatory reaction in the skin, causing leakage of capillaries in the dermis, and resulting in an edema which persists until the interstitial fluid is absorbed into the surrounding cells.
Urticaria are caused by the release of histamine and other mediators of inflammation (cytokines) from cells in the skin. This process can be the result of an allergic or non-allergic reaction, differing in the eliciting mechanism of histamine release.
Allergic urticaria
Histamine and other pro-inflammatory substances are released from mast cells in the skin and tissues in response to the binding of allergen-bound IgE antibodies to high affinity cell surface receptors. Basophils and other inflammatory cells are also seen to release histamine and other mediators, and are thought to play an important role, especially in chronic urticarial diseases.
Autoimmune urticaria
In the past decade, it has been noted that many cases of chronic idiopathic urticaria are the result of an autoimmune trigger. For example, roughly one third of patients with chronic urticaria spontaneously develop auto-antibodies directed at the receptor FcεRI located on skin mast cells. Chronic stimulation of this receptor leads to chronic hives. Patients often have other autoimmune conditions such as autoimmune thyroiditis.
Infectious
Hive-like rashes commonly accompany viral illnesses, such as the common cold. They usually appear 3–5 days after the cold has started, and may even appear a few days after the cold has resolved.
Non-allergic urticaria
Mechanisms other than allergen-antibody interactions are known to cause histamine release from mast cells. Many drugs, for example morphine, can induce direct histamine release not involving any immunoglobulin molecule. Also, a diverse group of signaling substances called neuropeptides have been found to be involved in emotionally induced urticaria. Dominantly inherited cutaneous and neurocutaneous porphyrias (porphyria cutanea tarda, hereditary coproporphyria, variegate porphyria and erythropoietic protoporphyria) have been associated with solar urticaria. The occurrence of drug-induced solar urticaria may be associated with porphyrias. This may be caused by IgG binding not IgE.
Stress and chronic idiopathic urticaria
Chronic idiopathic urticaria has been anecdotally linked to stress since the 1940s]. There is a large body of evidence demonstrating an association between this condition and both poor emotional well-beingand reduced health related quality of life]. More recent research has investigated hypotheses about stress as a causal factor in triggering the condition. Evidence has been found for a link between stressful life events (e.g. bereavement, divorce etc...)[ and preliminary evidence has been reported for a link between posttraumatic stress and chronic idiopathic urticaria. Less is known about the individual experiences and characteristics of people who develop chronic idiopathic urticaria following stress. Research into these factors in the relationship between stress and chronic idiopathic urticaria is ongoing by a number of researchers, including an online project currently being undertaken by researchers at the University of Plymouth.
Differential diagnosis
The rash that develops from poison ivy, poison oak, and poison sumac contact is commonly mistaken for urticaria. This rash is caused by contact with urushiol and results in a form of contact dermatitis called Urushiol-induced contact dermatitis. Urushiol is spread by contact, but can be washed off with a strong grease/oil dissolving detergent and cool water and rubbing ointments.
Types
• Acute urticaria usually show up a few minutes after contact with the allergen and can last a few hours to several weeks. Food allergic reactions often fit in this category. The most common food allergies in adults are shellfish and nuts. The most common food allergies in children are shellfish, nuts, peanuts, eggs, wheat, and soy. It is uncommon for patients to have more than 2 true food allergies. A less common cause is exposure to certain bacteria, such as streptococcus or possibly Helicobacter pylori. In these cases, the hives may be exacerbated by other factors, such as those listed under Physical Urticarias below.
• Chronic urticaria refers to hives that persists for 6 weeks or more. There are no visual differences between acute and chronic urticaria. Some of the more severe chronic cases have lasted more than 20 years. A survey indicated that chronic urticaria lasted a year or more in more than 50% of sufferers and 20 years or more in 20% of them. Of course this does mean that in almost half the people it clears up within a year and in 80% it clears up within 20 years or less.
• Drug-induced urticaria has been known to result in severe cardiorespiratory failure. The anti-diabetic sulphonylurea glimepiride (trade name Amaryl), in particular, has been documented to induce allergic reactions manifesting as urticaria. Other cases include dextroamphetamine, aspirin, penicillin, clotrimazole, sulfonamides and anticonvulsants.
• Physical urticarias are often categorized into the following.
o Aquagenic: Reaction to water (exceedingly rare)
o Cholinergic: Reaction to body heat, such as when exercising or after a hot shower
o Cold (Chronic cold urticaria): Reaction to cold, such as ice, cold air or water - worse with sudden change in temperature
o Delayed Pressure: Reaction to standing for long periods, bra-straps, elastic bands on undergarments, belts
o Dermatographic: Reaction when skin is scratched (very common)
o Heat: Reaction to hot food or objects (rare)
o Solar: Reaction to direct sunlight (rare, though more common in those with fair skin)
o Vibration: Reaction to vibration (rare)
o Adrenergic: Reaction to adrenaline / noradrenaline (extremely rare)
Related conditions
Angioedema is similar to urticaria, but in angioedema, the swelling occurs in a lower layer of the dermis than it does in urticaria, as well as in the subcutis. This swelling can occur around the mouth, in the throat, in the abdomen, or in other locations. Urticaria and angioedema sometimes occur together in response to an allergen and is a concern in severe cases as angioedema of the throat can be fatal.
Treatment and management
Chronic urticaria can be difficult to treat. There are no guaranteed treatments or means of controlling attacks, and some sub-populations are treatment resistant, with medications spontaneously losing their effectiveness and requiring new medications to control attacks. It can be difficult to determine appropriate medications since some, such as loratadine, require a day or two to build up to effective levels, and since the condition is intermittent and outbreaks typically clear up without any treatment.
Most treatment plans for urticaria involve being aware of one's triggers, but this can be difficult since there are several different forms of urticaria and people often exhibit more than one type. Also, since symptoms are often idiopathic (unknown reason) there might not be any clear trigger. If one's triggers can be identified then outbreaks can often be managed by limiting one's exposure to these situations.
Histamine antagonists
Drug treatment is typically in the form of antihistamines such as diphenhydramine, hydroxyzine, cetirizine and other H1 receptor antagonists. These are taken on a regular basis to protective effect, lessening or halting attacks. While the disease is obviously physiological in origin, psychological treatments such as stress management can sometimes lessen severity and occurrence. Additionally, methods similar to psychological pain management can be used to shift focus away from the discomfort and itchiness during an attack.
The H2-receptor antagonists such as cimetidine and ranitidine may help control symptoms either prophylactically or by lessening symptoms during an attack. When taken in combination with a H1 antagonist it has been shown to have a synergistic effect which is more effective than either treatment alone.[citation needed] The use of ranitidine (or other H2 antagonist) for urticaria is considered an off-label use, since these drugs are primarily used for the treatment of peptic ulcer disease and gastroesophageal reflux disease.
Jumat, 15 Januari 2010
Appendisitis Acute
A. INTRODUCTION
Appendisitis acute inflammation in the disease is appendiks vermiformis that occur in acute. Appendix umbai or worms to this function is not yet known, but often the cause of complaint. Appendix tube is long, narrow (approximately 6 - 9 cm), the mucus 1-2 ml / day. Mucus that normally be flooded in the lumen and then flowed to sekum. If there are obstacles in the slime flux will facilitate the emergence can apendisitis (inflammation in the Appendix). In Appendix, there are imunoglobulin, substance protective against infection and that there are many in the IG A. In addition there is the Appendix which is the arteria apendikularis end-artery.
B. Etiology
Apendisitis the occurrence of acute infections are generally caused by bacteria. However, there are many factors spark of a disease. Among obstruksi going on Appendix lumen. Obstruksi in Appendix lumen is usually caused due to a heap of hard feces (fekalit), hipeplasia network limfoid, hookworm disease, parasites, foreign substances in the body, the primary cancer and striktur. However, the most frequent cause is obstruksi lumen Appendix fekalit and hiperplasia network limfoid.
C. PATOGENESIS
The occurrence of acute apendisitis because bacteria in general. However, there are many factors that spark occurrence. Alerts patogenetik primary because of the alleged pile of hard feces (fekalit). Sumbatan from the lumen Appendix mukus prevent expenditure will result in swelling, infection and ulserasi. Appendix tumor is also considered to have at least mucnulnya apendisitis. Research found that last ulserasi mukosa due to parasites such as Hystolitica E, is the first step of a apendisitis in more than half the cases, even more often than sumbatan lumen. Low-fiber foods also has raised the possibility apendisitis. Hard feces that will ultimately cause constipation which increases the pressure inside the sekum that will facilitate the occurrence of the disease. Apendisitis can attack anyone, any age and gender on all
Painful APPENDICITIS
Pain from visera often simultaneously localized in two areas because the surface of the body through painful dijalarkan aches and pain over viseral direct parietal.
Mechanism:
1. Impulse aches that come from the appendix through fiber-fiber sympathetic nerve pain viseral and will next go to medulla spinalis at approximately thorakal X to XI thorakal and transferred to the regions around umbilikus (cause cramps and feeling stiff)
2. Starting in the peritoneum parietal inflame the appendix attached to the abdomen wall. This causes sharp pain in the peritoneum of teriritasi in the bottom right quadrant abdomen.
D. A Clinical
There are some early symptoms of the typical pain that is felt to be equivocal (dull pain) in the area around the navel. Often accompanied by the feeling of nausea, vomiting and even sometimes, and then the pain will move to the right under the belly with the signs of the typical apendisitis acute pain at the point Mc Burney. Stomach pain will be pain when movement occurs, such as cough, breathing in, sneezing, and untouched areas of pain. Pain that increases when there is movement, because of friction between the visera so excited cause peritonium stimulus. Besides pain, other symptoms of acute apendisitis degree of fever is low, mules, constipation or diarrhea, stomach swell, and the inability gas issue. Symptoms are usually accompany acute apendisitis the presence of these symptoms is not very important in apendisitis and increase the likelihood that the absence of these symptoms will not reduce the likelihood apendisitis.
In the case of acute apendisitis the classic, early symptoms include:
Pain or not feeling comfortable around umbilikus (dull pain). Several hours later the pain will move to the stomach right down there is painful and may press the point Mc Burney. Pain has been increasing, so that when people are running will feel the pain that will cause the body posture on the couch while running. The pain is felt depends on the location of Appendix also, whether in the pelvis or paste in the bladder so that the frequency of urine to be increased. Stomach pain will also be felt by people when moving, breathing in, walking, coughing, and mengejan. Pain when coughing can occur because of the increased pressure of intra-abdomen.
Vomiting, nausea, and no appetite.
In general, any inflammation that occurs in the channel system will cause a feeling of indigestion and nausea, vomiting. Although in this case apendisitis, not sure why you found the mechanism to stimulate the incidence of vomiting.
Mild fever (37.5 ° C - 38.5 ° C) and feel very tired
The process of inflammation that occurs will cause the occurrence of fever, especially if the bacteria is kausanya. Inflamasi going on all the walls Appendix layer. Fever appears if inflammation is not immediately get the right treatment.
Diarrhea or constipation
Inflammation in the Appendix can stimulate the increase of intestinal peristaltic so can cause diarrhea. Infection from the bacteria will be treated as foreign substances by intestinal mukosa so will automatically try to remove the intestinal bacteria through increased peristaltic. In addition, apendisitis can also occur because of the hard feses (fekolit). In the circumstances this can occur even constipation.
In some circumstances, quite difficult apendisitis diagnosed so that they can cause more serious complications.
E. Reviewing DIBUTUHKAN
Vetting fisis
Ø Inspection: on apendisitis often found the existence of acute abdominal swelling, so that the inspection found distensi normal stomach.
Ø Palpasi: apendisitis will suffer the suspicion arose when doctors do palpasi stomach and right thigh kebahagian. At the bottom of the right abdomen when pressed will often feel pain and pressure when released will also feel pain (Blumberg sign). Stomach pain right bottom is the key to the diagnosis of acute apendisitis.
Ø Sometimes doctors will perform colok rectal examination to determine the location of Appendix difficult if the location is known. If done at colok rectum and feels the pain sufferer is likely Appendix didaerah pelvis.
v Checking support
Supplementary examination can be done with the examination and laboratory examination Radiology. Laboratory examination is done in the usual patient suspected of acute apendisitis is a complete examination and blood test reaktive protein (CRP). Complete blood examination in the most number of patients usually found leukosit above 10,000 and neutrofil above 75%. While the review found the number of serum CRP is increased in the 6-12 hours after inflamasi jaringan.Pemeriksaan Radiology usual on the patient suspected of, among other apendisitisakut is Ultrasonografi, CT-scan. On examination ultrasonogarafi found on the aft section of the Appendix occurs inflamasi. Are on the CT-scan examination found that the armed apendicalith and with the expansion of the Appendix inflamasi and the widening of saekum.
F. Diagnosis
Apendisitis acute diagnosis must be done carefully and thoroughly. Error diagnosis occurs more frequently in women than men. This is because women often arise in the pain that resembles apendisitis acute, ranging from genital tool (due process ovulasi, menstruasi), pelvic inflammation in the uterus or other diseases. This often causes a terlambatnya diagnosis so that more than half the new patients can be diagnosed after perforation.
To reduce the error diagnosis, while in the hospital made observations on each of 1-2 hours. From the results of the laboratory examination, obtained an increase in white blood cell that exceeds the normal.
G. Medicine
When the diagnosis is certain, the therapy with the most appropriate action operatif. There are two techniques commonly used operations:
Open surgery: one slice will be made (about 5 cm) at the bottom right of the belly. Slice will be larger if apendisitis already experienced perforation.
Laparoskopi: cutlet made about two to four units. One near navel, the other include stomach. Laparoskopi shaped like a fine thread denagn camera that will be inserted through the slice. The camera will record in the stomach and then ditampakkan on the monitor. The resulting picture will help detract from the operation and the equipment needed for operations will be entered through the slice in place. Appendix elevation, blood vessel, and part of the Appendix leads to the large intestine will be tied.
Appendisitis acute inflammation in the disease is appendiks vermiformis that occur in acute. Appendix umbai or worms to this function is not yet known, but often the cause of complaint. Appendix tube is long, narrow (approximately 6 - 9 cm), the mucus 1-2 ml / day. Mucus that normally be flooded in the lumen and then flowed to sekum. If there are obstacles in the slime flux will facilitate the emergence can apendisitis (inflammation in the Appendix). In Appendix, there are imunoglobulin, substance protective against infection and that there are many in the IG A. In addition there is the Appendix which is the arteria apendikularis end-artery.
B. Etiology
Apendisitis the occurrence of acute infections are generally caused by bacteria. However, there are many factors spark of a disease. Among obstruksi going on Appendix lumen. Obstruksi in Appendix lumen is usually caused due to a heap of hard feces (fekalit), hipeplasia network limfoid, hookworm disease, parasites, foreign substances in the body, the primary cancer and striktur. However, the most frequent cause is obstruksi lumen Appendix fekalit and hiperplasia network limfoid.
C. PATOGENESIS
The occurrence of acute apendisitis because bacteria in general. However, there are many factors that spark occurrence. Alerts patogenetik primary because of the alleged pile of hard feces (fekalit). Sumbatan from the lumen Appendix mukus prevent expenditure will result in swelling, infection and ulserasi. Appendix tumor is also considered to have at least mucnulnya apendisitis. Research found that last ulserasi mukosa due to parasites such as Hystolitica E, is the first step of a apendisitis in more than half the cases, even more often than sumbatan lumen. Low-fiber foods also has raised the possibility apendisitis. Hard feces that will ultimately cause constipation which increases the pressure inside the sekum that will facilitate the occurrence of the disease. Apendisitis can attack anyone, any age and gender on all
Painful APPENDICITIS
Pain from visera often simultaneously localized in two areas because the surface of the body through painful dijalarkan aches and pain over viseral direct parietal.
Mechanism:
1. Impulse aches that come from the appendix through fiber-fiber sympathetic nerve pain viseral and will next go to medulla spinalis at approximately thorakal X to XI thorakal and transferred to the regions around umbilikus (cause cramps and feeling stiff)
2. Starting in the peritoneum parietal inflame the appendix attached to the abdomen wall. This causes sharp pain in the peritoneum of teriritasi in the bottom right quadrant abdomen.
D. A Clinical
There are some early symptoms of the typical pain that is felt to be equivocal (dull pain) in the area around the navel. Often accompanied by the feeling of nausea, vomiting and even sometimes, and then the pain will move to the right under the belly with the signs of the typical apendisitis acute pain at the point Mc Burney. Stomach pain will be pain when movement occurs, such as cough, breathing in, sneezing, and untouched areas of pain. Pain that increases when there is movement, because of friction between the visera so excited cause peritonium stimulus. Besides pain, other symptoms of acute apendisitis degree of fever is low, mules, constipation or diarrhea, stomach swell, and the inability gas issue. Symptoms are usually accompany acute apendisitis the presence of these symptoms is not very important in apendisitis and increase the likelihood that the absence of these symptoms will not reduce the likelihood apendisitis.
In the case of acute apendisitis the classic, early symptoms include:
Pain or not feeling comfortable around umbilikus (dull pain). Several hours later the pain will move to the stomach right down there is painful and may press the point Mc Burney. Pain has been increasing, so that when people are running will feel the pain that will cause the body posture on the couch while running. The pain is felt depends on the location of Appendix also, whether in the pelvis or paste in the bladder so that the frequency of urine to be increased. Stomach pain will also be felt by people when moving, breathing in, walking, coughing, and mengejan. Pain when coughing can occur because of the increased pressure of intra-abdomen.
Vomiting, nausea, and no appetite.
In general, any inflammation that occurs in the channel system will cause a feeling of indigestion and nausea, vomiting. Although in this case apendisitis, not sure why you found the mechanism to stimulate the incidence of vomiting.
Mild fever (37.5 ° C - 38.5 ° C) and feel very tired
The process of inflammation that occurs will cause the occurrence of fever, especially if the bacteria is kausanya. Inflamasi going on all the walls Appendix layer. Fever appears if inflammation is not immediately get the right treatment.
Diarrhea or constipation
Inflammation in the Appendix can stimulate the increase of intestinal peristaltic so can cause diarrhea. Infection from the bacteria will be treated as foreign substances by intestinal mukosa so will automatically try to remove the intestinal bacteria through increased peristaltic. In addition, apendisitis can also occur because of the hard feses (fekolit). In the circumstances this can occur even constipation.
In some circumstances, quite difficult apendisitis diagnosed so that they can cause more serious complications.
E. Reviewing DIBUTUHKAN
Vetting fisis
Ø Inspection: on apendisitis often found the existence of acute abdominal swelling, so that the inspection found distensi normal stomach.
Ø Palpasi: apendisitis will suffer the suspicion arose when doctors do palpasi stomach and right thigh kebahagian. At the bottom of the right abdomen when pressed will often feel pain and pressure when released will also feel pain (Blumberg sign). Stomach pain right bottom is the key to the diagnosis of acute apendisitis.
Ø Sometimes doctors will perform colok rectal examination to determine the location of Appendix difficult if the location is known. If done at colok rectum and feels the pain sufferer is likely Appendix didaerah pelvis.
v Checking support
Supplementary examination can be done with the examination and laboratory examination Radiology. Laboratory examination is done in the usual patient suspected of acute apendisitis is a complete examination and blood test reaktive protein (CRP). Complete blood examination in the most number of patients usually found leukosit above 10,000 and neutrofil above 75%. While the review found the number of serum CRP is increased in the 6-12 hours after inflamasi jaringan.Pemeriksaan Radiology usual on the patient suspected of, among other apendisitisakut is Ultrasonografi, CT-scan. On examination ultrasonogarafi found on the aft section of the Appendix occurs inflamasi. Are on the CT-scan examination found that the armed apendicalith and with the expansion of the Appendix inflamasi and the widening of saekum.
F. Diagnosis
Apendisitis acute diagnosis must be done carefully and thoroughly. Error diagnosis occurs more frequently in women than men. This is because women often arise in the pain that resembles apendisitis acute, ranging from genital tool (due process ovulasi, menstruasi), pelvic inflammation in the uterus or other diseases. This often causes a terlambatnya diagnosis so that more than half the new patients can be diagnosed after perforation.
To reduce the error diagnosis, while in the hospital made observations on each of 1-2 hours. From the results of the laboratory examination, obtained an increase in white blood cell that exceeds the normal.
G. Medicine
When the diagnosis is certain, the therapy with the most appropriate action operatif. There are two techniques commonly used operations:
Open surgery: one slice will be made (about 5 cm) at the bottom right of the belly. Slice will be larger if apendisitis already experienced perforation.
Laparoskopi: cutlet made about two to four units. One near navel, the other include stomach. Laparoskopi shaped like a fine thread denagn camera that will be inserted through the slice. The camera will record in the stomach and then ditampakkan on the monitor. The resulting picture will help detract from the operation and the equipment needed for operations will be entered through the slice in place. Appendix elevation, blood vessel, and part of the Appendix leads to the large intestine will be tied.
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