Heme and Lymph Flashcards
non blanchable, hemorrhagic skin lesions that result from leakage of RBCs into skin
purpura
macular purpura
non palpable/ non-inflammatory
petechiae if under 3 mm
ecchymosis if over 5 mm
purpura + thrombocytopenia and abnormal coagulation studies
septicemia HUS Leukemia ITP coagulpathies (hemophilia)
SHLIC
are purpura palpable in thrombocytopenic purpuric disorders
no
purpura + normal platelet count and coagulation studies
henosch-schoenlein purpura (HSP or IgA vasculitis)
common in children with HSP but not in adults
intussesception
tetrad for HSP is
palpable purpura without thrombocytopenia and coagulopathy
\+ 1 or more of the following -acute arthralgia and or arthritis acute abdominal pain renal disease IgA depostion on biopsy
immune mediated vasculitis that may be triggered by a variety of antigens including various infections and immunizations
IgA vasculitis (IgA nephropathy)
considerations for diagnosis of HSP:
may follow ____ infection and present with generalized what
strep
arthralgias/myalgias, rash, palpable purpura (especially on LE and buttocks) abdominal pain, and renal insufficiency
PAM RARI
acute hemorrhagic edema of infancy
called what else what age extent of disease presents with biopsy
leukocytoclastic vasculitis
children btwn ages of 4 months to two years
self limited disease, resolves in 1-3 weeks
fever, purpura, ecchymosis, inflammatory edema of limbs (FEPI)
biopsy demonstrates leukocytoclastic vasculitis with occasional IgA deposition
hypersensitivity vasculitis
from what
symptoms
histopath
inflammation of the small vessels that occurs after exposure to:
drugs, infection, or without known tigger
fever, urticaria, LAD, arthralgias (no GN)
histopathology: leukocytoclastic vasculitis primarily of postcap venules, but IgA deposition is absent
other small vessel vasculitieds: primary vasculitieds
granulomatosis with polyangiitis (wegner)
microscopic polyangiitis
eosinophilic granulomatosis with polyangiitis (churg strauss syndrome)
secondary vascular inflammation
SLE
RA
infectious disease (hepatitis)
uncommon in children
pt doing insanity workout with arthralgias, abdominal pain, renal insufficiency, cpk elevation
rhabdomyolysis
until pt develops the classical purpura of HSP could have DDx of
arthritis and arthralgia
rheumatic fever vs HSP
evidence of recent gropu A beta hemolytic strep infection
+ clincial course of Jones criteria: rash diff, erythema marginatum, nodules and carditis
possible history of recent strep + clinical course of HSP tetrad then
HSP
septic and toxic synovitis aka transient synovitis
joint symptoms similar to those seen in pts with HSP
only one or two joints, unlike polyarthritis seen in HSP
-affected joints are warm and erythematous in septic arthritis, unlike hsp
reactive arthritis trigger
variety of GU or GI pathogens like b-hemolytic strep
differentiating acute abdominal emergency from HSP before purpura develops
rash of HSP usually precedes GI manifestations and seldom lags b more than few days
managment of HSP
vast majorit of pts recover spontaneously thus care is primarily supportive
what do you need to assess in HSP
renal status, overall fluid/electrolyte status
in severe cases, corticosteroids have been used (only when absolutley need them)
what is impiric to give in HSP
IV hydration (saline/D5/LR)
other drugs for HSP
pain managment (possible NSAIDs)
anti-emetics for N/V
PPI for acute gastritis/PUD from NSAID or steroids
acute abdominal series (xray) or US to screen for intussusception
lab tests to consider with HSP
IgA levels, higher level associated with renal involvement
routine blood test: CBC, CMP, urinalysis
-confirmation of normal platelet cont and coag studies (PTT) necessary
hypocomplementemia
skin biopsy
kidney biopsy
hypocomplementemia in HSP
(typically normal in HSP)
- more likely in children with recent strep
- levels normalize within 3 months
skin biopsy in HSP
sample small BV of superficial dermis
H&E stain demonstrate leukocytoclastic vasculitis in postcappilalary venules with IgA deposition***
kidney biopsy in HSP
IgA depostion in the mesangium on immunofluorescence microscopy identical to that in IgA nephropathy
light microscopy changes on kidney biopsy in HSP
range from isolated mesangial proliferation to severe cresentic GN
ANA, anti ds DNA, anca, RF in HSP are what
negative
why importnat to monitor urine analysis in HSP
always will be blood in UA, but if there is protein, need to worry about if kidney disease will become chronic
proteinuria in hsp is indicator of long term kidney disease
imaging to consider in HSP
plain abdominal radiography
-can see intussusception and dilated loops of bowel
abdominal US
can detect intussusception
doppler flow studies and/or radionuclide scans
-in boys with scrotal symptoms, can distinguish scrotal pain caused by HSP vs testicular torsion
abdominal US, for a child if intussusception is considered then what first
US rather than contrast enema
contrast enema neither detect nor help reduce ileoileal intussusception
what kind of intussusception in HSP (more than 1/2 of cases)
ileoileal intussusception
adult clinical findings in HSP
palpable purpura, arthritis, GI symptoms. 1/3 of pts have renal impairment
OMT in HSP
only after recovery
check what for OMT after recvoery
T10-L1 for kidney
upper and lower GI (T5-9 and T10-L2)
whole body lymphatic treatment
right lymphatic duct drains
what drains rest of body
right head and neck, right UE, all lung lobes except upper left
thoracic duct
sequence
thoracic inlet–> thoracic area–> abdominal area–>UE or LE–> UE or LE–> head and neck–> thoracic inlet
TTALHT
