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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.


hepatomegaly causes

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

Septic arthritis
Transient synovitis
Reactive arthritis (e.g., post-streptococcal arthritis)
Lyme disease
Rheumatic fever
Juvenile idiopathic arthritis
Systemic lupus erythematosus
Henoch-Schönlein Purpura


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

malignancy- leukemia/lymphoma

storage- gaucher dz

lupus, juvenile idiopathic arthritis

portal HTN


years you can get intusscecption

6 mo-6 yrs

most under 2


HSP recurrence

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.


HSP treatment

supportive- NSAIDS for joint pain

resolves within 4-6 weeks


HSP epidemiology

boys > girls

2-17 yrs, mostly 4-6


evaluation of a skin lesion

Type (shape, color, consistency, size)

Arrangement (confluent, scattered, symm)


Pattern of distribution (sun-ex, flexural)

Progression over time