Morning Report

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Graft Versus Host Disease - Presentation Intestinal manifestations • Cramping abd pain with diarrhea. • Severity determined by volume of diarrhea, which can exceed 10 liters per day • Frequently begins as watery diarrhea, can become bloody. Not unusual to require transfusions. • Ileus can become problematic if narcotic Upper GI manifestation • One study characterized GVHD in the upper GI as anorexia. dyspepsia, food intolerance, nausea and vomiting (biopsy+) • Upper GI sxs are more responsive to immunotherapy than lower GI sxs
Graft Versus Host Disease - Diagnosis • Can be made clinically if common presenting sxs are present • Histology is helpful if confirmation is needed o Typically, GVHD shows intracryptal apoptosis in 90% of biopsies. Most reliable indicator on path. • Biomarkers including IL-2, IL-8, TNF receptor-1 can aid in dx at the onset of sxs and provide prognostic information independent of severity • Graded 1-4, 1 being mild, and 4 being life threatening. Shidom et al. 2003 BMC Gastro enterol;3;5
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Page 11 and 12: Physical Exam Temp 36.5, HR 142, BP
Page 13 and 14: Acute Diarrhea - Differential Infec
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Page 17 and 18: Management, further workup? Acute D
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Page 21: Graft Versus Host Disease - Present
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Page 29: Repeat Colonoscopy Diffuse moderate
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Page 34: Take Home Points • Understand the

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