week 8 interactive session Flashcards
Kawasaki Disease Arteritis
Affects coronary arteries
coronary aneurisms are caused by vascular infiltration of neutrophils, transitioning to large mononuclear cells=weakening and dilation of vessel walls
Kawasaki Disease Arteritis s/s
CRASH and Burn
Conjunctivitis
Rash (polymorphic)
Cervical adenopathy (swollen lymph nodes) bigger than 1.5cm
Strawberry tongue
Hands and feet edema (periungual desquamation) peeling after 2 weeks
Burn/fever
Kawasaki Disease Arteritis diagnosis
4/5 clincal s/4/5 clinical symptoms and a fever for 5 days or more
Incomplete Kawasaki’s disease is 2 or 3 symptoms + fever for 5 days or more, or 7 day fever with an unknown reason
Incomplete Kawasaki Disease
Follow American Heart Association
Assess lab tests for CRP and ESR
If CRP is greater than 3 and ESR is greater than 40, assess more labs
These labs include albumin, anemia, platelets, ALT, WBC, and urine WBC (3=treatment)
Irritability and difficult to console
The CVS, RESP, GI, GU and MSK can also be affected
Incomplete Kawasaki Disease potential complications
Most concerning-coronary artery aneurysm
Incomplete Kawasaki Disease H->T assessment
Appearance (irritable or difficult to console?)
Skin assessment (rash presence) and describe (NEVER VESICULAR), is there edema to hands and feet?
HEENT (conjunctival infection?, tongue with red papillae?, cracked lips, swollen oropharynx?, lymphadenopathy-is it unilateral and bigger than 1.5cm?
Incomplete Kawasaki Disease management
Echocardiogram to look for coronary aneurysm
Also dilation, pericardial effusion, decreased left ventricular valve function and valvular regurgitation
Incomplete Kawasaki Disease lab findings
Aid in diagnosis
Elevated WBC
Elevated platelets
Elevated ESR and CRP
Elevated ALT
Leukocytes
Organisms
Low hemoglobin
Low albumin
Incomplete Kawasaki Disease
Intravenous immunoglobulin (IVIG) - 1 time dose in first ten days
Aspirin- moderate high dose 2-3 days, then low dose for 4-6 weeks after
Those who get IVIG then get another fever after with no explanation can have refractory Kawasaki disease, can be retreated with IVIG
Define Kawasaki Disease
Kawasaki Disease is systemic vasculitis of children. The etiology is unknown but it is thought that it is the immune response to an infectious trigger. The cause of the systemic vasculitis is the vascular infiltration of neutrophils that transition to larger mononuclear cells, causing dilation and weakening of vessel walls. This disease primarily affects coronary arteries.
Who is most affected by Kawasaki (age group, culture and sex)?
Those with Asian ancestors are primarily affected. Boys are also predominantly more affected than females with a 1.3-1 ratio. Also, 3/4 of those affected are below age 5, however it can manifest in those above age 5.
What is the cause of Kawasaki’s Disease?
The true cause is unknown, however it is suspected that it is an immune response to an unknown infectious agent. The cause of the symptoms is related to systemic vasculitis, where the blood vessel walls weaken and dilate, as the blood vessels then become inflamed and swell.
What causes the coronary aneurysms associated with Kawasaki’s Disease?
Due to the weakened vessel wall, as blood passes through this section of the artery, the blood pressure can cause it to bulge outwards like a balloon (known as an aneurysim).
How does Kawasaki’s Disease Present?
Kawasaki disease can present in children differently, and some general symptoms that may or may not be related to Kawasaki’s Disease include irritability and difficulty being consoled. Some more specific findings fall under the CRASH and Burn pneumonic. Conjunctivitis is a common symptom associated with Kawasaki’s disease, and is seen bilaterally. Rash is another common sign, seen on the trunk and genital area, this rash is typically polymorphic (NEVER vesicular). Cervical Adenopathy is another sign (lymph node swelling), this is seen unilaterally and is related to Kawasaki’s if it is greater than 1.5cm large. Strawberry tongue is another clinical finding, and involves red papillae on the tongue and oropharyngeal erythema. H stands for hand and feet edema, which can progress to peringual desquamation after 2 weeks of onset. Finally, a fever is the last clinical symptom, which involves a fever for longer 5 days or longer.
What physical exam would I perform? for kawasakis
The physical exam would begin with a general appearance assessment, and I would be looking for irritability, and difficulty being consoled. The next part of the exam would be integumentary exam and I would assess for polymorphic rash on trunk or genital areas as well as assessing hands and feet for edema or peringuinal desquamation. Next exam is HEENT, involving unilateral cervical adenopathy bigger than 1.5cm. I would then also assess the tongue for red papillae as well as oropharyngeal swelling. Finally, I would assess GI, GU, RESP, CVS for other symptoms that are not directly linked to Kawasaki’s.
