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o ANAEMIA

The box shows the symptoms and signs that will help to indicate the dinicai $everity of anaemia.

ANAEMIA

Search for symptoms and signs łntfccating the cause of anaemia

Non-specific symptoms

•    Tlredness

•    Lightheadedness

•    Breathlessness

•    AnWe-swelling

•    Worsening of any previous coewsting disease such as angina

Non-specific signs

•    Mucous membranę palior

•    Tachypnoea

•    Raised jugular venous pressure

•    Flowmurmurs

•    Ankie oedema

•    Posturai hypotension

•    Tachycardia

Abnormalities in the blood are caused not only by primary diseases of the blood and lymphoreticular systems but also by diseases affecting other systems of the body. The dinicai assessment of patients with haematological abnormalities must include a generał history and examinahon as well as a search for symptoms and signs of abnormalities of red cells, white cells, piatelets, bleeding and clotting systems. lymph nodes and lymphoreticular tissues.

0 LYMPHADENOPATHY

Lymphadenopathy can be caused by benign or malignant disease. The clinical points to ciarify are shown in the box.

LYMPHAOENOPATHY

BLEEDING

Bleeding can be due to congenital or acquired abnormahties in different components of the clotting system. The hlstory and exammation will help to ciarify the severity and underiymg cause of the Weeding problem.

Supradavicular

Axiilary

Epitrochlear

Inguinal

Femoral

History

Speed of onset. ratę of eniargement Painful or painless Associated symptoms: weight lass. night sweats. itch

Examination

Sit es: locaiised. generaiised Size(cm)

Characler hard. soft. rubbery Fixed. mobile

Search area that node drains for abnormalities (e g. tooth abscess) Other generał examlnation (eg. joints. rashes. dubbing)

Popliteal

fossa

Pre-auricular

Parotid

Submandibular

Submentai

Antenor cervical Posterior cenńcal Supraciavicular

BLEEDING

o EXAMINATION OF THE SPLEEN

History

•    Site ol bieed

•    Duration ot bieed

•    Precipitating causes indtiding previous surgery

•    Family history

•    Drugs

•    Other medical conditions

• Move hand up from right iliac fossa. towards left upper guadrant on expiration.

Examination

There are twe major patterns of bleeding

1.    Abnormal piatelets

Abnormai function (eg. aspirin) or reduced numbers (eg. leiAaemia)

•    Skin: petechiae. bruises

•    Gum and mucous membranę bleeding

•    Fundal haemorrhages

2.    Abnormal coagulation cascade (e.g haemophliia)

•    Bleeding Into joints (haemarthrosis)

•    Bleeding into soft tissues

•    Keep hand stiil and ask patient to take a deep breath through the mouth to feel spleen edge being dispiaced downwards.

•    Race your left hand around patienfs lower nbs and approach costal margin to puli spleen forward.

•    To help palpate smali spleens. roli patient on to the right side and examine as before.

CHARACTERISTICS OF THE SPLEEN

•    Notch

•    Supcrficial

•    Oull to percussion

•    Cannoł get between ribs and spleen

•    Moves wel with respiration

© Elsevier. Boon et al.: Davidson's Principles and Practice of Medicine 20e - www.studentconsult.com