Henoch Schonlein Purpura Flashcards Preview

Pediatrics > Henoch Schonlein Purpura > Flashcards

Flashcards in Henoch Schonlein Purpura Deck (19):
1

What is HSP

acute immunoglobulin A (IgA)–mediated disorder generalized vasculitis involving the small vessels of the skin, the gastrointestinal (GI) tract, the kidneys, the joints, and, rarely, the lungs and the central nervous system (CNS).

2

Pathophysiology and cause

IgA aggregates or IgA complexes with complement deposited in target organs, resulting in elaboration of inflammatory mediators

The cause is unknown but there may be a recent history of an upper respiratory tract infection.

3

Classical presentation

HSP typically presents with the triad of

purpuric rash on the extensor surfaces of limbs (mainly lower) and buttocks,
joint pain/swelling and
abdominal pain.

4

Assessment

Rash
Joint pain
Abdominal pain
Renal disease
SC edema
Pulmonary and CNS complications

5

If child unwell or rash atypical, what to consider

Consider meningicocemia, thrombocytopenia or other rare vasculitic disease

6

When does the joint pain usually resolve

Usually in 24-48 hours

7

When does the uncomplicated abdominal pain usually resolve

Usually 72 hours

8

What are possible GIT complications (5)

Hematemesis
Pancreatitis
Intussusception
Perforation
Bloody stools

9

How common is hematuria, how often persistent/recurrent

Hematuria in 90%, 5% persistent/recurrent

10

Less common renal complications

Proteinuria
Nephrotic syndrome
Renal failure
Hypertension
Renal insufficiency

11

Rare complications

Pulmonary and CNS complications

12

Investigations

Urinalysis
FBE, PLT count
UEC
Blood culture
Consider coags? ->rule out differentials

13

Management

Get senior help due to rash
Document BP
Consider surgical consult if abdominal features are prominent (?testicular torsion)
Consider steroids in some cases
Rest and analgesia

14

When to consider steroids

More than mild joint or abdominal pain. Consider prednisolone 1mg/kg while symptoms persist.

15

Indications for admission (3)

Abdominal complication->arrange early surgical consultatioin
Renal complication->nephritis, nephrotic syndrome
Symptomatic management for severe joint/abdominal/edema

16

Follow up

See GP
Blood pressure measurement
Urinalysis

17

When does the rash go away, when is it made worse

Last clinical manifestation to remit
Usually worse when + activity

18

Advice to parents

->No specific treatment
->Rest and analgesia
->HSP usually gets better on its own without causing lasting problems.
->About half of people who have had HSP once will get it again.
->A few people will have kidney damage because of HSP. This may occur in the first week or so of illness, but there may be a delay of weeks or months before it appears.
->Your child's doctor will want to test urine samples and blood pressure several times after the HSP goes away to check for kidney problems. These checks should go on for at least six months and some doctors recommend a blood pressure and urine check every year for life.

19

When to return

Return to your doctor or the hospital if your child has increasing stomach pains or swelling, blood in the stools or urine, or if you are worried for any other reason.

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