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Terms in this set (29)
separate sensory modality than pain.
Pruritus originating in CNS is referred to as____ neurogenic and is mediated by_____,_______,_____
1) glucagon releasing peptide in lamina 1 of dorsal horn of SC,
2) Substance P (NK-1 receptors)
3) opioid peptides.
Pruritis transmitted in epidermis by ____ and ______
Delta neuron terminals
Dematologic causes of Pruritus w/ no or little skin findings.
1) Xerosis-dry skin
2) Dermatographia- gentle skin stroking with finger or tongue blade to elicit redness, itching, or wheal formation
3) Scabies: excoriated vesicles in fingers webs, elbows, wrists, breasts. Look for mites, ova.
4) Exposures: diagnosis based on history of exposure to fiber glass or other agents
5) Dermatits herpetiformis: small erosions or vesicles on elbows and upper back
1) skin (free nerve endings)
2) C-Nerve sensory fibers, Delta neuron terminals
3) spinal cord
4) dorsolateral spinothalamic tract
pruritis originating in the skin from non-specializd receptor units. Mediated by histamine.
Dermatitic vs. Non-dermatitic pruritis (pruritis w/ skin eruptions)
dermatitic- causes scratching (eczema, pityriasis rosea, neurodermatitis, contact dermatitis, seboreheic dermatitis, psoriasis.
Non-dermatitic- does not cause scratching- (uticaria-> scratching makes itch/pain worse)
Causes of neurologic pruritis
Neuro injury-Head trauma/surgery/CNS infection, TIA/Stroke, MS; associated with dizzyness.
Psychiatric- Stree, chronic excoration, delusions parasitosis
Internal causes of pruritis
ID- Renal failure/Dialysis, Liver Disease-> Hepatitis, biliary cirrhosis, liver failure, prurigo Gravidarum
Internal Malignancies- Lymphomas, P. Vera, Leukemia, Carcinoma
Drugs that can induce pruritis
Opiod analgesics- itching= common side effect
Drug reactions- itching w/ or w/o rash
Drugs to treat pruritis
1) anti-histamines (benadryl, hydroxyzine, doxepin)
2) mu-opiod antagonist (naltrexone)
3) kappa agonist (butorphanol)
4) central and peripheral itch pathway inhibitor (gabapentin)
5) Other: topicals (steriods, menthol, camphor)
% of adults suffering from chronic itch
chronic inflammatory skin condition that invovles a complex interaction between environmental and genetic factors.
1) most common chronic skin disease in children (5-20%)
2) First manifestation of allergies (atopy) in children
Acute Urticaria (2 types)
1) lesions last 1-2 hours, caused by prompt mast cell degranulation. Biopsy reveals little or no cellular infiltrate
2) lesions last as long a 36 hours. Food and drug reactions, delayed pressure uticaria, chronic uticaria, uticarial vasculitis.
Prominent cellular infiltrate.
non-necrotizing perivascular mononuclear-cell infiltrate (CD4 T-cells and monocytes) with accumulation of eosinophils, neutrophils, and mast cells
cause of chronic urticaria in patients with vasculitis
pathogenesis of hive formation appears to involve immune complexes, complement activation, anaphylatoxin formation, histamine release, and neutrophil accumulation, activation, and degranulation.
Non-specific stimuli leading to urticaria ( what?, examples)
mast cells degranulate in the absence of a defined allergen.
ex. radiocontrast (changes osmolarity)
Opiates and vancomycin
mechanism by which ACE inhibitors cause urticaria
1) ACE inhibits Bradykinin. Bradykinin causes vasodialation of vessels in skin
2) most common cause of angioedema seen in ER. Tongue, throat, laryngeal swelling can be severe.
Physical urticarias may be induced by....
change in temp, pressure, stroking, vibration, light
Idiopathic cold urticaria
rapid onset if pruritus, erythema, and swelling after exposure to cold.
- ice cube test may be performed for diagnosis....
Cholinergic or generalized heat urticaria
onset of small (1mm) punctate wheals surrounded by prominent erythematous flare associated with exercise, hot showers, sweating, anxiety.
- uncommon cholinergic problems may be associated-> lacrimation, salivation, diarrhea
Exercise induced anaphylaxis
15-20mm hives, pruritis, urticaria, angioedema, wheezing, hypotension....
- a subtype associated with exercise within 5 hrs of eating a food that individual is allergic too...
ability to induce urticaria by rubbing/scratching skin. (write on skin)
4-6 hours after pressure has been applied
Swelling secondary to pressure w/ normal appearing skin.
Hammering, walking, sitting...
-brief exposure causes development of utricaria w/in 1-3 minutes. pruritis appears first->edema in light exposed areas-> surrounded by erythema
- lesion disappears w/in 1-3 hours
small wheals develop after contact with water, regardless of temperature.
chronic autoimmune urticaria and angioedema
common disorder of unknown origin, subjects don't need to have a lot of allergies.
-hives w/ palpable borders
-IgE within normal limits.
acute attacks of urticaria and angioedema can be treated with...
-w/ history of anapylaxis, epipen is carried.
treatment for chronic urticaria
balance between drug efficacy and toxicity/side effects,
non drowsy antihistamines tried first...
THIS SET IS OFTEN IN FOLDERS WITH...
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