Diferencia entre revisiones de «Henoch-Schonlein purpura»

Revisión del 23:37 22 jun 2011

Background

Usually affects 2-11yr
5% of cases are a/w intussusception (abd vasculitis)
Renal involvement is feared complication
95% recover completely

Diagnosis

Triad:
- Purpuric rash (lower extremity, buttock)
- Acute abdominal pain (Diffuse, colicky)
  - Develops after onset of rash
- Arthritis
  - Migratory, usually involves knees/ankles

DDx

Meningococcemia
Erythema nodosum
Intussusception
Rheumatic fever
Polyarteritis nodosa
SLE
RA
Drug reaction

Work-Up

UA
1. If +hematuria obtain chemistry

Treatment

Supportive
NSAIDs for pain

Disposition

Outpt management for most w/ rheum f/u

Source

Rosen's, Tintinalli

Authors:

@@ Línea 1: / Línea 1: @@
 ==Background==
--HSP, aka anaphylactoid purpura
+*Usually affects 2-11yr
+*5% of cases are a/w intussusception (abd vasculitis)
--systemic vasculitis associated with abdominal pain and rash
+*Renal involvement is feared complication
+*95% recover completely
--usually age 4-11, may occur in adults
--commonly occurs in springtime after viral URI
 ==Diagnosis==
--clinical diagnosis based on presence of abdominal pain, classic rash, microscopic hematuria, arthralgias in otherwise well appearing child
+*Triad:
+**Purpuric rash (lower extremity, buttock)
+**Acute abdominal pain (Diffuse, colicky)
+***Develops after onset of rash
+**Arthritis
+***Migratory, usually involves knees/ankles
--symptoms: abdominal pain, nausea, vomiting, diarrhea, rash, mild arthralgias
+==DDx==
+#Meningococcemia
--rash: palpable purpura on buttocks and lower extremities
+#Erythema nodosum
+#Intussusception
--intussusception: ileoileal more common than ileocolic inpatients with HSP
+#Rheumatic fever
+#Polyarteritis nodosa
+#SLE
+#RA
+#Drug reaction
 ==Work-Up==
-#CBC, Chem7
 #UA
-#Blood cx
+##If +hematuria obtain chemistry
-#ESR
-#consider CT abdomen (ileoileal intussusception difficult to detect by US)
-==DDx==
-#meningococcemia (febrile, ill appearing)
-#erythema nodosum
 ==Treatment==
-*dz self limited: 94% recover completely
+*Supportive
-*consider corticosteroids for severe disease (abdominal pain, hematuria, arthralgias)
+*NSAIDs for pain
-**prednisone 1mg/kg/day
 ==Disposition==
-*most patients managed safely as outpatient
+*Outpt management for most w/ rheum f/u
-*consider admission for:
-**uncertain diagnosis to exclude possibility of meningococcemia
-**severe abdominal pain and vomiting
 ==Source==
-Adapted from Rosens 7th edition
+Rosen's, Tintinalli
 [[Category:Peds]]