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Physical inspection - the Eosinophilia

Table of contents
Clinical displays of an eosinophilia and related diseases
Anamnesis of an eosinophilia
Physical inspection
Diagnostic testings at an eosinophilia
Diagnostic approach

General survey

The general survey is an obligatory element of any high-quality physical inspection. At the kakhetichny, pale patient cancer can be the cause of an eosinophilia. To the contrary, with allergic signs no additional researches for an explanation of a moderate eosinophilia are required from the active, vigorous child. Attentive survey in this case allows to avoid expensive inspection. Nevertheless, as the eosinophilia is connected with extremely large number of various diseases, usually the careful analysis on all bodies and systems is necessary for definition of a source of proliferation of eosinophils.

Inspection of bodies and systems

Neurologic inspection. The eosinophilia is not connected with peripheral neuropathies or degenerative neurologic diseases. It will also hardly be observed at acute neuroinfections, for example, meningitis or encephalitis. When the system eosinophilia is observed in combination with an eosinophilia of formations of TsNS or cerebrospinal fluid, it is necessary to think of unusual diseases. Certain types of viral meningitis, for example, a lymphocytic choriomeningitis, can proceed with existence of an eosinophilia in formations of TsNS and in blood. However rigidity of a nape and symptoms of a meningism in combination with an eosinophilia can not comprise diagnostic characters of infectious meningitis as the eosinophilia in cerebrospinal fluid is observed at the disseminated glioblastoma and other new growths of TsNS. In one of reviews only in 94 of 10 000 quantitative cytologic researches of cerebrospinal fluid the eosinophilia was found; the vast majority of cases belonged to infectious or inflammatory diseases. Eosinophils can really possess a neurotoxicity. The fact that eosinophils cause damage of TsNS fabrics was definitely proved in experiments on animals and confirmed at people. This eosinophilic neurotoxicity was called Gordon's phenomenon. It is possible that at patients with ES or eosinophilic a leukosis such manifestations as weakness, a hemiplegia and lacks of coordination, are caused by an eosinophilic infiltration of TsNS.

Inspection of eyes. As the inflammation of a retina and an iris of the eye can be complications of ES, at patients with risk of this disease careful ophthalmologic inspection is of great importance.
Inspection of heart. Cordial pathological symptoms in combination with an eosinophilia are observed at ES. Symptoms of congestive heart failure, including a gepatosplenomegaliya, tachycardia, cordial noise and a pathological pulsation of precordial area concern to them. Existence of cardiopulmonary symptoms helps to distinguish ES from eosinophilic myeloproliferative syndromes. Most of authors agree in opinion that cardiopulmonary symptoms prevail at ES while for the malignant new growths proceeding with an eosinophilia they are uncharacteristic.
Less expressed symptoms of damage of heart and lungs are observed also at other eosinophilic diseases. The fibroplastic parietal endocarditis of Leffler can be a specific example. At the last along with an eosinophilia in blood the eosinophilic infiltration of heart, lungs, a nervous system and skin is observed.

Inspection of lungs. Pulmonary infiltrates and an eosinophilia are often observed together. ES, certainly, represents an example of such coexistence. Cardinal signs at the so-called pulmonary infiltrates proceeding with an eosinophilia are their migrating character. At Leffler's syndrome representing an example of this pathology during auscultation dry and wet rattles in lungs are listened. Pathological cordial symptoms usually are absent. Therefore, the isolated wet rattles, the dry and whistling rattles in lungs can mean availability of pulmonary infiltrates with an eosinophilia at Leffler's syndrome, but not ES.

The parasitic invasion represents the frequent reason of diseases of lungs. For example, patients with a filariasis often arrive with paroxysms of cough and stidor breath. Observed pulmonary symptoms are similar to an attack of bronchial asthma.

Inspection of bodies of a digestive tract. It is necessary to make a careful palpation and auscultation of a stomach for differential diagnosis of the diseases of intestines accompanied with an eosinophilia. For example, strengthening of intestinal noise, an abdominal murmur and morbidity at a palpation in paraumbilical area is characteristic of patients with eosinophilic a gastroenteritis. On the other hand, patients with a gepatosplenomegaliya can suffer from ES. If the splenomegaly is observed in combination with massive educations in an abdominal cavity, for example, myeloblastomas or hloroma, the reason it the leukosis (OLL or OEL) is. The isolated gepatosplenomegaliya and a lymphadenopathy with an eosinophilia testify to Hodzhkin's illness. Rectal research is shown to all patients with pathological gastrointestinal symptoms. Existence of a bloody diarrhea testifies to the gastrointestinal tract disease caused by helminths. Test on the occult blood and the bacteriological analysis a calla, received during rectal research, are obligatory.

Dermatological inspection. A number of the diseases proceeding with an eosinophilia has skin manifestations. The erythematic creeping rash caused by migration of larvae in a derma is the frequent reason of an itch at children. Characteristic places of a larval invasion are a foot of legs, buttocks, hands, palms and a back.

Consolidations of skin at ES remind a scleroderma. Skin has a characteristic appearance of whitish consolidations with impressions.
Inspection of a musculoskeletal system. Inspection of muscular groups is necessary as well as careful poll of rather muscular pains, weakness or other possible symptoms. Noninflammatory muscular pseudoneoplasms at an eosinophilic miositis are easily palpated; existence of an erythema and local morbidity on a surface of a muscle testifies to trichinosis or cysticercosis. The eosinophilia and the changes of skin reminding a scleroderma over muscles are practically diagnostic characters of an eosinophilic fasciitis. Weakness and lacks of coordination in distal and proximal parts of extremities with signs of an inflammation of joints or without them periodically appear at patients with ES.

Inspection of lymphatic system. The expressed lymphadenopathy at which the increased lymph nodes are palpated in combination with an eosinophilia meets seldom. Increase in axillary, supraclavicular and inguinal lymph nodes in combination with a gepatosplenomegaliya has to send the clinical physician to search for malignant new growths of lymphatic system. The localized lymphadenopathy on one extremity is characteristic of a local gelmintny invasion, for example, of trichinosis or cysticercosis more. One of rare diseases which display can be big, slowly progressing papular and nodular educations in the head and a neck is the angiolymphoid hyperplasia with an eosinophilia. The amount of defeat usually increases by slow distribution and is limited to area of the head and neck.

Inspection of urinogenital system. In most cases on the basis of inspection of urinogenital system it is not possible to diagnose the diseases which are followed by an eosinophilia. Statement of the final diagnosis requires performance of an intravenous piyelografiya or tsistoskopiya. Nevertheless, an eosinophilia in combination with signs of irritation of an urethra and morbidity of a bladder point to eosinophilic cystitis. In a prodromal stage of ES at women ulcerations mucous vaginas and crotches, and at men — in the field of an urethra opening are observed. They should be distinguished from the parasitic invasions affecting a bladder, for example, of an invasion of Shistosoma haematobium at which as a result of the blossoming granulematozny and inflammatory damages of both ureters and a bladder there can be ureteral occlusion.

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