3. Cancer Radiotherapy: Mucosa, Teeth, Salivary gland, Jaw bone (osteoradionecrosis)
Define: an allergic swelling of an entire anatomic part: lips, 1) tongue, foot, and hand. Also may affect the respiratory and GI tract! factors other than allergic reactions are known to predispose to induce this condition!
autosomal dominant = c-1 esterase deficiency. Causes edema and swelling!
Clinical features of angioedema?
-patient presents with?
-how long does it last?
-when does this condition begin?
-tx? What about breathing?
What is the best Tx?
-Rapid diffuse tissue swelling involving the lips, chin, and sometimes the eyes and tongue.
-Swelling last for 24-72 hours and sometimes for several days!
-Both sexes equally!
-Depends on the severity of condition! From elimination of stimulus to use of oral-antihistamines! If swelling interferes with breathing, try epi injections, intravenous steroids and/or anti-histamines, intubation or tracheotomy
-Prophylaxis is the best tx through avoidance of precipitating substances and events, admin of preoperative plasma (hereditary angioedema) or steroids!.
-Reaction starts within? Reactions within what time frame of admin are most severe?
-Clinical features? Which involvement is rare, but if it happens what are the features?
-The released mediators will lead to what?
-As symptoms progress, what will happen, leading to what?
-Must be able to distinguish between what?
--For a reaction to a needle, what should you look for?
-What is less common? Give a few examples!
-Drugs are capable of inducing immediate allergic reactions; MOST COMMON=penicillin, streptomycin, sulfonamides, aspirin, and barbiturates.
-30 min after drug is introduced into body! Reaction within 60 min of admin of drug are likely to be severe!
-Patient will present with a rash, itching, angio-edema, and erythema. If GI tract involvement occures (rare), vomiting, abdominal cramp and diarrhea are present!
-Bronchospasm, thus causing dyspnea and wheezing!
-Vasopermiability and vasodilatation will lead to loss of intravascular fluid and hypotension. Failure to recognize and treat may lead to death from asphyxia or shock.
-allergic reaction to a local anesthetic and the psychological reaction to a needle.
-Patient may act in a manner, resembling in some ways an allergic reaction. For this reason, always look for rash, itching, and edema before rendering it as an allergic reaction.
-Oral manifestations are less common! May include erythema, ulceration, desquamation, necrosis of epithelium and/or lip and tongue swelling.
-Eliminate stimulus, if severe (edema, hypotention, dyspnea, bronchospasm); monitor the blood pressure and respiration; administer epinephrine 1mg sub-cutaneously repeated every 3-5min to effect; establish IV access, IV promethazine 50mg, IV hydrocortisone 100mg; establish airway; and seek assistance. Administration of SQ epinephrine is safe and effective.
what is the crucial step and must be done at the first indication of a severe hypersensitivity reaction.