Flashcards in 21- bruising Deck (13):
causes of petechiae/purpura
Platelet deficiency or dysfunction (e.g. immune-mediated thrombocytopenia, bone marrow infiltration or suppression, malignancy)
Coagulation abnormalities (e.g. hereditary or acquired clotting-factor deficiencies)
Vascular fragility (e.g., immune-mediated vasculitis)
Combinations of the above (e.g., infection causing coagulation abnormalities, vascular fragility, platelet consumption)
Henoch-Schönlein purpura (HSP)
HSP is a self-limited, IgA-mediated, small vessel vasculitis that typically involves the skin, GI tract, joints, and kidneys.
Often presents in an otherwise well appearing child with bruising and leg pain (due to arthritis). Petechiae primarily on legs
In roughly 50% of cases, a URI precedes the diagnosis of HSP.
diffuse adenopathy occurs when...
generalized infection, malignancy, storage diseases, and chronic inflammatory disease.
inflammation (e.g., viral hepatitis),
infiltration (e.g., leukemia/lymphoma), accumulation of storage products (e.g., glycogen-storage disease),
congestion (e.g., congestive heart failure) or obstruction (e.g., biliary atresia).
causes of arthritis in child
Reactive arthritis (e.g., post-streptococcal arthritis)
Juvenile idiopathic arthritis
Systemic lupus erythematosus
arthritis vs arthralgia
Arthralgia refers to pain in or around the joint without signs of synovitis
arthritis is used in the presence of true synovitis, defined as either joint swelling or joint pain with limitation of motion on exam.
labs to test for HSP
BUN, Cr- for renal function
CBC with differential- platelet count (if low--> ITP)
causes of splenomegaly
infection (EBV, CMV, bacteria, endocard)
hemolysis- sickle cell
storage- gaucher dz
lupus, juvenile idiopathic arthritis
years you can get intusscecption
6 mo-6 yrs
most under 2
The recurrence rate for HSP is about 30%. Symptoms may return weeks to many months after the first episode.
Like the initial episode, a recurrence may start with abdominal pain, rather than rash, so it is important to keep HSP in mind if a patient has significant abdominal pain in the future.
If a recurrence does occur, it is important to recheck the urine to evaluate for renal involvement.
supportive- NSAIDS for joint pain
resolves within 4-6 weeks
boys > girls
2-17 yrs, mostly 4-6