revma Flashcards
(13 cards)
Punktformede blødninger på to til tre millimeter som oppstår i hud og slimhinner. Rødheten på hud er “non-blanching”.
“A pinpoint, nonraised, perfectly round, purplish red spot caused by interdermal or submucous hemorrhage.”
Hva heter det?
Petekkier er en sikker tegn på mangel av blodpalter, evt. defekt i funksjon av blodplater, eller økt kapillærskjørhet.
Diff: Meningokokksepsis, immunologisk trombocytopenisk purpura,
Traumatic bruise: mention situation that require lab for checking platelet count ang couagulation status.
Bruising resulting in ecchymosis is of course seen in everyone following soft tissue injury. When the bruising is excessive compared to the injury sustained, it is wise to check platelet count and coagulation status. If there are bite marks or the story is implausible, consider whether the injury may be non-accidental.
What do you see in the image
Senile purpura describes the purple patches and persistent brown marks that arise from minor shear force in aging skin. It is due to loss of skin collagen, and is particularly prevalent on the arms and lower legs, especially those taking oral or inhaled corticosteroids. It is accompanied by other signs of skin fragility, such as stellate pseudoscars, atrophy and delayed wound healing
What do you see in the image?
Many different laser and intense light sources are used to treat facial telangiectasia; each type has advantages relating to wavelength, pulse duration, spot size and cutaneous cooling. Purpura and swelling often arise from short-pulsed 577-585 nm dye laser treatment.
A sick child with the rash (see image)
Petechiae due to meningococcal infection. Purpura in a sick patient may indicate a medical emergency. The cutaneous signs of meningococcal infection range from petechiae to purpura fulminans. They are due to dermal intravascular thrombosis caused by the endotoxin and mediated by cytokines.
The rash (see image) accompanying fever, localised well demarcated erythema, oedema and blistering
Erysipelas. Purpura accompanying fever, localised well demarcated erythema, oedema and blistering may be due to streptococcal erysipelas or cellulitis. It indicates severe infection; deep vascular damage may lead to gangrene. Purpura is the result of direct vessel wall invasion by the infective organisms.
A person with Raynaud, after excessive cold exposure, presents with a painful, red/purple, oedematous bullae. What is this called.
Chilblains (frostknute) affect exposed sites (most often fingers and/or toes) and are induced by cold damp conditions. They present as itchy or painful, red or purple, oedematous plaques that may blister, and subsequently scab or ulcerate. They may persist for weeks or months. Excessive cold exposure may lead to tissue necrosis (frostbite). Recent onset of chilblains (perniosis) might indicate systemic lupus, especially if accompanied by nail fold telangiectases, Raynaud phenomenon and photosensitivity. SSA/Ro autoantibodies are often positive. Also consider anorexia nervosa, cryoproteinaemia and antiphospholipid syndrome.
Plutselig sterke smerter og hvit-blå misfarging i stortå (see bildet) etter å ha gjort PCI (inngang via a. femoris).
Hva heter det?
Blodpropp forårsaket av kolesterol-plakk som har løsnet fra blodårevegg.
Symptomer
Plutselig sterke smerter og hvit-blå misfarging i huden, oftest i en tå (Blue toe syndrome). Kan utvikle seg til nekroser. Ligner andre former for arteriell blodpropp. Hele 75% utløses under eller like etter kirurgisk inngrep som omfatter blodårer, ved angiografi (radiografisk blodåre-fremstilling) eller kateter-undersøkelser av pulsårer. Misfarging i form av livedo retikularis også vanlig.
Undersøkelse:
De fleste har kjent, stor risiko for aterosklerose (ved høy alder, storrøkere, diabetes). Diagnose stilles sikkert ved vevsprøve (biopsi) av området med nedsatt blodsirkulasjon
Behandling
Smertestillende. Forebyggende med statiner (kolesterolsenkende medikamenter)
Hva er dette?
Kajennepepper (Cayenne pepper) misfarging, som ses ved kapilarittis av Schamberg’s disease or progressive pigmented purpura is characterised by crops of asymptomatic reddish brown ‘cayenne pepper’ spots and patches. They may arise on any part of the body, most often the lower legs. Close inspection reveals tiny petechial haemorrhages and haemosiderin deposition.
This eruption occurs in a young child that is mildly unwell. There are large bruise-like lesions, limb oedema and fever.
Acute haemorrhagic oedema of infancy(Finkelstein’s syndrome). a rare type of cutaneous small vessel vasculitis with a characteristic presentation in infants. It consists of a clinical triad of: Large bruise-like lesions (purpura/ekymose) Swelling (ødem) og feber. It is benign, self-limited, and without sequelae
50 år gammel kvinne, sicca-symptomer (xerostomi og xerooftalmi og dyspareuni), utvikler følgende utslett (se bildet). Hva er dette?
Hudvaskulitt (palpabel purpura) hos en Sjøgren pasient. Acute hypersensitivity vasculitis. Leucocytoclastic vasculitis often presents as palpable purpura. Other signs include tissue necrosis, haemorrhagic bullae and ulcers. Immune complexes may be detected on direct immunofluorescence of skin biopsy, or antineutrophilic cytoplasmic antibodies (ANCA+) on serology. Classification depends on the size of the vessel involved, and the type of inflammatory cells seen on histology. Hypersensitivity vasculitis may be due to infections (e.g. streptococcus, hepatitis B), drugs, connective tissue disease or malignancy. In this case it was associated with Sjogren syndrome.
Flassing fra fingertuppene (kerotlysis exfoliativa) opptrer oftest hos personer som har plagsom økt svetteproduksjon i håndflatene (hyperhidrosis palmaris), særlig om sommeren. Det ses da luft-fylte blemmer palmart i fingre og håndflatene.
Det sies at flassingen er pga svikt i stukturen som er en mekansik forbindelse mellom naboceller som binder disse sammen. Struktren er synlig med elektronmikroskop, som ved øverste bildet og punkt b i nederste bildet. Hva heter sturkturen?
Desmosom. Desmos gr. bånd, soma gr. legeme.
