Symptomatology
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Transcript of Symptomatology
Symptomatology in clinical practice
Dr. B. K. Iyer
Cardicare
Symptomatology terms
SymptomatologySymptomatology
Symptomatology is the clinical picture of all the patient's
symptoms and signs
Any deviation from health that can only
be perceived or felt by the patient
When a symptom has a
physical manifestation that can be detected by
others
Set of symptoms &
signs associated with & characteristic
of any one particular disease.
SymptomSymptom
SignSignSyndromeSyndrome
Symptomatology types
SymptomatologySymptomatology
AcuteAcute
SubacuteSubacuteChronicChronic
Symptomatology outcomesSudden worsening in
the severity of the symptoms / signs
OutcomeOutcome
Abnormal condition or
complication due to the original disease and remains after
original disease has resolved
Temporary improvement in the symptoms and signs of a disease without the underlying disease being cured
Return of the original
symptoms and signs of the
disease
ExacerbationExacerbation
SequelaSequela
RemissionRemission
RelapseRelapse
Symptomatology association
To fully understand
the symptoms, history is vital and thereafter
only a physical
examination
CurrentCurrent
Past Past medical / medical / surgicalsurgical
FamilyFamilySocialSocial
Drug Drug allergyallergy
HistoryHistory
A diagnosis is a
determination as to the
cause of the patient's
symptoms and signs
Symptomatology - significance
Attention to symptomatology is very important when it comes to -
HIV
Fever
Pain abdomen
Symptomatology - significance
Why so?
In HIV, misleading symptomatology is seen Due to diminished immunity Due to multiple opportunistic infections
Fever symptomatology of may be misleading Due to multiple causes Due to probability of rapid condition worsening
Misleading symptomatology in PUO
Check yourself up and tick the right answer:
The commonest cause of PUO is:1. A rare disease presenting in atypical way.
2. A common disease presenting typically.
3. A rare disease presenting typically.
4. A common disease presenting in atypical way.
Misleading symptomatology in PUO
The right answer:
The commonest cause of PUO is:4. A common disease presenting in atypical
way.Categories of Illness Causing PUO
Infections 30 - 40 %
Malignancies 20 – 25 %
Collagen Vascular Disease 10 – 20 %
Miscellaneous 15 – 20 %
Undiagnosed 10 – 15 %
Changes in terminology in PUO
Old Definition: Fever higher than 38.3oC on several occasions. Duration of fever – 3 weeks Uncertain diagnosis after 1 week of study in
hospital New definition:
Eliminated the in-hospital evaluation requirements → 3 outpatient visits, or 3 days in hospital. … Ambulatory as well as in hospital.
Classification in PUO
Classical PUO Nosocomial PUO
Immune related
Diseases to remember after initial inconclusive investigation reports:• DVT/PE, C diff, drugs
•Neutropenic PUO•HIV-Associated•Transplant
1) Neoplasm2) Sero-ve Collagen Vascular
Disease3) Increasing Tuberculosis4) Elderly with Endocarditis5) HIV with or without infection or
malignancy6) Implanted prosthetic devices7) Travel … New Exposure
Aetiologies of PUO
Infection: 3 major causes
1. Abscess .. especially occult ..
2. Intracellular organisms. (salmonella mycobacterium, brucella)
3. Intravascular … SBE
Sero –ve collagen vascula diseases, need to recognize the syndrome otherwise no diagnosis
1) Still’s disease(young / adult)2) Giant cell arteritis3) Polymyalgia Rheumatica4) Behcet’s Disease5) Relapsing polychondritis
15% of PUO
Remember not to forget travel, animal exposure.
Symptomatology changes in PUO
Failure to have quick response → does not mean wrong diagnosis: Endocarditis Pelvic Inflammatory Disease Typhoid Fever
Antimicrobial Therapy is expected to suppress, but not cure an infectious process such as abscess → may have false feeling of response.
Clues to aetiologies of PUO
Hyperthyroidism1. Occasionally cause
PUO → most frequently diagnosed clinically.
2. Often accompanied by weight loss.
Any drug can cause fever
Clues to aetiologies of PUO
Localizing Symptoms may indicate the source of fever
Back Pain TB Spondylitis / Bone Metastasis
Headache Chronic Meningitis/GCA
RUQ Pain Liver Abscess
LUQ Pain Splenic Abscess
Oral & Genital Ulcer Behcet’s Disease
Jaw Claudication Temporal Arteritis
Subtle changes in behavior Granulomatous Meningitis
Diagnostic delay has adverse effect in:
Intra Abdominal Infection
Miliary Tuberculosis
Recurrent Pulmonary Emboli
Disseminated Fungal Infection
Temporal Arteritis
Arnow PM. Fever of Unknown Origin. Lancet, 1997; 350:575-580
PUO in HIV patients
PUO in HIV patients
Diagnostic approach to PUO
Minimal Diagnostic tests for PUO
History+Physical exam. CBC & Diff Blood Cultures x 3 Chemistry Microscopy as needed LFTs
USG and Urine culture Chest X-ray Hepatitis serologies (if
abnormal LFTs)
Other Basic Tests for PUO
ESR/CRP ANA Rheumatoid Factor HIV testing IgM Mantoux
Invasive Procedures in PUO
Lumbar Puncture Biopsy
Liver Temporal Artery Bone Marrow Lymph Node
Surgical Exploration of the Abdomen
Imaging in PUO
CT Abdomen Chest
Nuclear Imaging Lower Extremity Dopplers Echocardiography
Clues to diagnostic tests of PUO
ESR & CRP is elevated in: Bacterial Infection Neoplasm Immunological-mediated
inflammatory states Tissue infarction
Bone marrow1) Granuloma±Tubercle Bacilli→TB
2) Aplastic Cells → Leukemia
3) Leishmania Bodies → Kala-Azar
4) Atypical Cells → Lymphoma
5) Atypical Plasma Cells M.myeloma
Arnow PM. Fever of Unknown Origin. Lancet, 1997; 350:575-580