Gullain Barre Flashcards

1
Q

Define guillain barre

A

A group of acute immune mediated polyneuropathies that generate an acquired weakness often following infection that may be complicated by respiratory failure or autonomic dysfunction

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2
Q

Define polyneuropathy

A

Polyneuropathy is damage or disease affecting peripheral nerves (peripheral neuropathy) in roughly the same areas on both sides of the body, featuring weakness, numbness, and burning pain

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3
Q

Define autonomic dysfunction

A

Autonomic dysfunction is a condition in which the autonomic nervous system (ANS) does not work properly

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4
Q

Why can gullain barre be difficult to diagnose?

A

Its very rare
Sometimes patients have variant symptoms
Sometimes paralysis moves in opposite direction it traditionally does

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4
Q

What is the leading subtype of gullain barre?

A

Acute inflammatory demyelinating polyneuropathy (AIDP)

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5
Q

What is meant by the term molecular mimicry in regards to gullain barre?

A

Antigens occasionally resemble proteins on host cells resulting in host antibodies attacking the host cells

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6
Q

What is the precursor infection that triggers most cases of GBS?

A

Campylobacter jenuni

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7
Q

What cells are attacked by the immune system in acute inflammatory demyelinating poly neuropathy?

A

Schwann cells

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8
Q

What do schwann cells do?

A

Produce myelin sheath around the axons that allow for the rapid conduction of nerve impulses

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9
Q

Why does the patient experience muscular weakness in GBS?

A

Muscles are fine, but the electrical impulses that are being sent are not reaching the muscles so they are unusable

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10
Q

What is the classic pattern of weakness displayed in GBS?

A

Weakness presents in an ascending pattern
Lower extremity weakness may present first
Ground to brain

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11
Q

What symptoms of GBS are concerning in regards to respiratory therapy?

A

Loss of ability to manage oral secretions
Weak cough, secretion accumulation
Respiratory muscle paralysis
Inability to protect airway (dysphagia)

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12
Q

What symptoms or history could lead you to suspect GBS?

A

Acute onset of mostly symmetrical muscle weakness
Absence of deep tendon reflexes
Symptoms progress over days to 4 weeks
Symptoms preceded by an infection

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13
Q

What are the diagnostic criteria required to diagnose GBS?

A

Progressive weakness of arms and/or legs ranging from minimal weakness in legs to total paralysis of all four limbs including trunk, bulbar and facial muscles
Decreased deep tendon reflexes in weak limbs

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14
Q

What supportive features would aid in a clinical diagnosis of GBS?

A

Symptom progression over days to 4 weeks
Relatively symmetric bilateral symptoms
Pain in trunk or limbs
Cranial nerve symptoms or signs
Mild sensory disfunction
No fever at onset
Elevated protein count in CSF
Recovery staring 2-4 weeks after progression halts

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15
Q

What might a patient with GBS present with at the bedside?

A

Variable respiratory rate based on degree of muscular paralysis
Possibly apnea
Cyanosis

16
Q

What would the lungs of a patient with GBS potentially sound like?

A

Diminished
Crackles

17
Q

What concerns might a patient with GBS raise?

A

Paresthesias (tingling, burning, electrical sensations)
Dysesthesias (upleasant sense of touch)
Pain
Numbness
Ascending muscle weakness

18
Q

What problems would the autonomic nervous system dysfunctions cause?

A

Cardiac arythmias
Urinary retention
Alternating hypertension/hypotension
Ileus
Loss of sweating

19
Q

What would the volumes and flows of a patient with GBS look like?

A

Decreased volumes and flows

20
Q

What kind of lung pathology would a PFT reveal about a patient with GBS?

A

Restrictive

21
Q

What testing would be performed on patients suspected of GBS to monitor their condition?

A

NIF
VC

22
Q

What would the ABG of a patient with GBS look like?

A

Acute respiratory acidosis

23
Q

Why would a spinal tap be administered to a patient with GBS?

A

Get tapped, loser
Check for elevated protein levels in CSF
Rule out competing diagnosis such as lyme or lymphoma

24
Q

What would the CXR of a patient with GBS look like?

A

Normal
Maybe some atelectasis

25
Q

What is the role of a respiratory therapist in treating GBS?

A

Oxygen therapy
Airway clearance
Lung expansion
Mechanical ventilation

26
Q

When is mechanical ventilation indicated for GBS patients?

A

RR > 30
SpO2 < 92
FVC < 20
NIF < –30
Acute hypercapnia

27
Q

Why is NIV not safe for patients with GBS?

A

Cant protect airway from secretions

28
Q

What are the two disease modifying therapies available to GBS patients?

A

Intravenous immune globulin (IVIG)
Plasma exchange (PLEX)

29
Q

Describe IVIG therapy

A

Patient is infused with healthy antibodies to replace damaged ones?

30
Q

Describe PLEX therapy

A

Remove blood from the body and then separate the plasma out to remove the damaged antibodies
Blood is returned with added plasma or albumin

31
Q

Why are steroids not used to treat GBS?

A

Studies show it doesnt work

32
Q

What will most GBS patients need to full recover?

A

Physical therapy
Rehabilitation