HSP Flashcards
Urgent Findings that need intervention
- AMS - significant change from baseline mental status (lack of perfusion to brain, not protecting airway)
- Respiratory Distress/Depression - tachypnea, grunting, slow shallow breathing –> all suggests compromise of oxygenation and ventilation
- Mottled Skin/Cyanosis - inadequate tissue perfusion or oxygenation –> NEED TO FIX
Mechanism of petechiae and purpura
Trauma Platelet deficiency/dysfunction Coagulation abnormalities Vascular fragility (vasculitis) Combo
Get the patient’s perspective
What do you think is going on?
What concerns you most?
What do you think happened?
DDx for bruising and leg pain
Coag disorder Henoch-schonlein purpura idiopathic thrombocytopenic purpura leukemia viral infection
Coagulation disorder
may present with petechiae or small bruising, hemarthrosis, minor trauma, family history
Henoch-Schonlein Purpura presentation
often as otherwise healthy child with leg bruises and pain walking
50% of cases have URI preceding bruising
ITP
asymptomatic petechiae –> URI preceding
Leukemia
consititutional symptoms of fever, malaise, weight loss
- bone pain from infiltration of bone marrow with leukemic cells and bruising from thrombocytopenia
Viral Infection
enterovirus can cause petechiae rash and sometimes pain with walking
Examining lymph nodes
Size --> >2 cm = concern Location Tenderness Texture Mobility - hard and non-mobile = concern Distribution --> diffuse = concern
Hepatomegaly
although palpating liver can be normal –> if you feel it, you need to investigate it further
- can be from inflammation, infiltration, accumulation of storage material, congestion, or obstruction
- can percuss to hear difference or feel by palpation
Causes of arthralgia or arthritis in kids
Trauma, septic arthritis, transient synovitis, reactive arthritis
Lyme disease, rheumatic fever, lupus, HSP
DDx for rash and leg pain
- HSP - rash unique for tendency for lower extremities and buttocks (periarticular vasculitis) –> no splenomegaly
- ITP - no splenomegaly
- Leukemia - bone pain, splenomegaly, lymphadenopathy
Splenomegaly
Infection - EBV, CMV, Sepsis, endocarditis
Hemolysis - sickle cell
Malignancy - leukemia, lymphoma
Lupus, venous congestion, CHF
Examining the spleen
lie supine or in lateral position –> palpate anteriorly and posteriorly
Labs for HSP
- CBC with smear - need platelet count for ITP vs HSP
- BUN and Cr - determine extent of renal involvement
- UA - hematuria/proteinuria
HSP
self-limited IgA mediated small vasculitis that involves skin, GI, renal, joints
- most commonly diagnosed vasculitis in kids
HALLMARK = non-thrombocytopenic purpura
1/3 have renal involvement
- early steroids MAY prevent GI and renal involvement
ITP diagnosis
binding of antiplatelet antibody to platelet surface –> removal and destruction of platelets in spleen and liver
*smear shows immature giant platelets cells
HSP prognosis
symptoms usually last a month and self-resolve without treatment
- resample urine to monitor kidney function and BP
- re-evaluate if things get worse
Intussusception
telescoping of proximal bowel into distal bowel –> bowel compression and ischemia
- most common cause of bowel obstruction in kids 6 months - 6 years
- paroxysmal abdominal pain, currant jelly stools, sausage felt in abdomen
Tx = air or barium enema, US
Complications of HSP
- GI Bleeding - 50% have this, from same inflammation that caused vasculitis, stool guaiac test to confirm –> short course of steroids
- Kidney - 1/3 of kids have kidney problems –> hematuria and self-resolving
Recurrence of HSP
30% - weeks to months after 1st episode
- same symptoms
