Emergency Strategy - How to treat Henoch - Schonlein purpura
Emergency Strategy - How to treat Henoch- Schonlein purpura
Children who suffer from Henoch - Schonlein purpura are admitted to the hospital if there is an evidence of abdominal pain severe in nature, gastrointestinal bleeding, significant central nervous system disturbance, symptoms and signs of renal failure and intussusception.
The treatment initially focus on establishing the airway, breathing and circulation. Patient may suffer from shock or dehydration due to gastrointestinal bleeding. In this case consider establishing IV lines, giving IV fluid and packed red blood cells. Patient may also complain of pain of the joints( arthralgia). In this case consider ibuprofen/NSAIDS. In severe life threatening cases consider polyclonal immunoglobulin therapy. Prednisolone may also consider in severe cases which involve the central nervous system involvement , arthritis, severe pain in the abdomen, renal disorder or painful subcutaneous edema. However, not everyone required prednisolone.
The patient will later discharge if there is normal function of the renal system., normal platelet count and free from abdominal pain. Urinalysis and full blood count is rechecked in any follow up with the consultant.
Henoch - Schonlein purpura sufferer typically presented with fever, malaise and past history or recent /recurrent history of respiratory tract infection. Commonly the child may present with eruption of purpuric rash. The purpuric rash initially present as papule which are rounded pink in shape that blanch. All the Henoch - schonlein purpura cases may manifest with purpuric rash. However, purpuric rash may be the only presenting symptoms for children less than 3 months old. WIthin 24 hours, the pink rounded papule may progress into palpable purpura 2-3 cm circular in shape. The purpura is discrete in nature or confluent. Within 6 weeks, the rash may recur. The rash may involve the lower back and rarely affecting the face. The rash initially begin in the buttock or legs and the purpuric rash is symmetrical in distribution.
Patient may also complain of arthritis. The arthritis mostly affect the ankles and knees. The arthritis is presented as migratory pain of the periarticular. Gastrointestinal bleeding is common. It may be severe or occult loss of blood. 4 weeks before purpuric rash eruption, patient may complain of abdominal tenderness. The abdominal pain is severe, swelling of the testicles and asymptomatic hematuria are commonly associated with renal symptoms. Focal neurological deficit, seizures and headache are common neurological condition.
Patient typically may suffer from hypotension and fever. Carefully the patient hemodynamically status is assessed ( capillary refill time, pulses). Patient abdomen is observed for any evidence of abdominal distention, masses which are palpable or any tenderness of the abdomen. It is important to be able to elicit between purpura, macule, petechia as well as blanching and non blanching lesions. Level of consciousness is assessed and observed for any evidence of neurological deficit.
The common differential diagnosis for Henoch Schonlein purpura are acute glomerulonephritis, acute rheumatic fever, systemic lupus erythematosus,juvenile rheumatoid arthritis, polyarteritis nodosa, testicular torsion, orchitis, incarcerated hernia, drugs/toxin intake, infectious mononucleosis, viral exanthem, meningococcemia, staphylococcal or streptococcal bacterial infection ( sepsis), bacterial endocarditis, Rocky Mountain Spotted fever, erythema nodosum, vasculitis, trauma /child abuse, thrombocytopenia and functional disorder of the platelet, gastroenteritis, Meckel diverticulum, inflammatory bowel disease, appendicitis and intussusception.
The investigations require are full blood count ( elevated white blood cell), culutres to exclude infection, urinalysis( glomerulonephritis may present with proteinuria, look for evidence of hematuria), creatinine , electrolytes and blood urea nitrogen. Creatinine and blood urea nitrogen may be elevated if serious renal complication occur.Lumbar puncture may also required. Imaging technique such as head CT scan is perform to exclude any abnormality of the central nervous system finding. If the patient present with gastrointestinal bleeding or abdominal pain consider abdominal radiography. Barium enema, abdominal ultrasound and CT scan are also considered. If the patient develop testicular pain or testicular swelling consider ultrasound of the testicle to rule out underlying disorders.
What is Henoch - Schonlein purpura? Henoch - Schonlein purpura is part of vasculitis disorders. Henoch Schonlein purpura is associated with drugs ( erythromycin, sulfonamides, aspirin, tetracycline and penicillin), infection ( mycoplasma infection, Group A streptococci infection and viral infection such as Epstein Barr virus or Varicella virus infection) and allergic reaction ( milk, chocolate, insect bites and wheat). It present in young adult and school age children. Usually present during spring or winter time. More common in male. Henoch Schonlein purpura is associated with raised serum IgA with deposition of IgA of the glomerular mesangial and circulating IgA complex.
The common complication of Henoch Schonlein purpura are chronic renal failure, proliferative glomerulonephritis, intracranial hemorrhage and intussusception.
References
1.Gedalia, Abraham. “Henoch-Schönlein Purpura.” Current Rheumatology Reports 6, no. 3 (June 1, 2004): 195–202. doi:10.1007/s11926-004-0068-2.
2.Wl, Robson, and Leung Ak. “Henoch-Schonlein Purpura.” Advances in Pediatrics 41 (December 1993): 163–194.
3.Tizard, E. J., and M. J. J. Hamilton-Ayres. “Henoch–Schönlein Purpura.” Archives of Disease in Childhood - Education & Practice Edition 93, no. 1 (February 1, 2008): 1–8. doi:10.1136/adc.2004.066035.
Children who suffer from Henoch - Schonlein purpura are admitted to the hospital if there is an evidence of abdominal pain severe in nature, gastrointestinal bleeding, significant central nervous system disturbance, symptoms and signs of renal failure and intussusception.
The treatment initially focus on establishing the airway, breathing and circulation. Patient may suffer from shock or dehydration due to gastrointestinal bleeding. In this case consider establishing IV lines, giving IV fluid and packed red blood cells. Patient may also complain of pain of the joints( arthralgia). In this case consider ibuprofen/NSAIDS. In severe life threatening cases consider polyclonal immunoglobulin therapy. Prednisolone may also consider in severe cases which involve the central nervous system involvement , arthritis, severe pain in the abdomen, renal disorder or painful subcutaneous edema. However, not everyone required prednisolone.
The patient will later discharge if there is normal function of the renal system., normal platelet count and free from abdominal pain. Urinalysis and full blood count is rechecked in any follow up with the consultant.
Henoch - Schonlein purpura sufferer typically presented with fever, malaise and past history or recent /recurrent history of respiratory tract infection. Commonly the child may present with eruption of purpuric rash. The purpuric rash initially present as papule which are rounded pink in shape that blanch. All the Henoch - schonlein purpura cases may manifest with purpuric rash. However, purpuric rash may be the only presenting symptoms for children less than 3 months old. WIthin 24 hours, the pink rounded papule may progress into palpable purpura 2-3 cm circular in shape. The purpura is discrete in nature or confluent. Within 6 weeks, the rash may recur. The rash may involve the lower back and rarely affecting the face. The rash initially begin in the buttock or legs and the purpuric rash is symmetrical in distribution.
Patient may also complain of arthritis. The arthritis mostly affect the ankles and knees. The arthritis is presented as migratory pain of the periarticular. Gastrointestinal bleeding is common. It may be severe or occult loss of blood. 4 weeks before purpuric rash eruption, patient may complain of abdominal tenderness. The abdominal pain is severe, swelling of the testicles and asymptomatic hematuria are commonly associated with renal symptoms. Focal neurological deficit, seizures and headache are common neurological condition.
Patient typically may suffer from hypotension and fever. Carefully the patient hemodynamically status is assessed ( capillary refill time, pulses). Patient abdomen is observed for any evidence of abdominal distention, masses which are palpable or any tenderness of the abdomen. It is important to be able to elicit between purpura, macule, petechia as well as blanching and non blanching lesions. Level of consciousness is assessed and observed for any evidence of neurological deficit.
The common differential diagnosis for Henoch Schonlein purpura are acute glomerulonephritis, acute rheumatic fever, systemic lupus erythematosus,juvenile rheumatoid arthritis, polyarteritis nodosa, testicular torsion, orchitis, incarcerated hernia, drugs/toxin intake, infectious mononucleosis, viral exanthem, meningococcemia, staphylococcal or streptococcal bacterial infection ( sepsis), bacterial endocarditis, Rocky Mountain Spotted fever, erythema nodosum, vasculitis, trauma /child abuse, thrombocytopenia and functional disorder of the platelet, gastroenteritis, Meckel diverticulum, inflammatory bowel disease, appendicitis and intussusception.
The investigations require are full blood count ( elevated white blood cell), culutres to exclude infection, urinalysis( glomerulonephritis may present with proteinuria, look for evidence of hematuria), creatinine , electrolytes and blood urea nitrogen. Creatinine and blood urea nitrogen may be elevated if serious renal complication occur.Lumbar puncture may also required. Imaging technique such as head CT scan is perform to exclude any abnormality of the central nervous system finding. If the patient present with gastrointestinal bleeding or abdominal pain consider abdominal radiography. Barium enema, abdominal ultrasound and CT scan are also considered. If the patient develop testicular pain or testicular swelling consider ultrasound of the testicle to rule out underlying disorders.
What is Henoch - Schonlein purpura? Henoch - Schonlein purpura is part of vasculitis disorders. Henoch Schonlein purpura is associated with drugs ( erythromycin, sulfonamides, aspirin, tetracycline and penicillin), infection ( mycoplasma infection, Group A streptococci infection and viral infection such as Epstein Barr virus or Varicella virus infection) and allergic reaction ( milk, chocolate, insect bites and wheat). It present in young adult and school age children. Usually present during spring or winter time. More common in male. Henoch Schonlein purpura is associated with raised serum IgA with deposition of IgA of the glomerular mesangial and circulating IgA complex.
The common complication of Henoch Schonlein purpura are chronic renal failure, proliferative glomerulonephritis, intracranial hemorrhage and intussusception.
References
1.Gedalia, Abraham. “Henoch-Schönlein Purpura.” Current Rheumatology Reports 6, no. 3 (June 1, 2004): 195–202. doi:10.1007/s11926-004-0068-2.
2.Wl, Robson, and Leung Ak. “Henoch-Schonlein Purpura.” Advances in Pediatrics 41 (December 1993): 163–194.
3.Tizard, E. J., and M. J. J. Hamilton-Ayres. “Henoch–Schönlein Purpura.” Archives of Disease in Childhood - Education & Practice Edition 93, no. 1 (February 1, 2008): 1–8. doi:10.1136/adc.2004.066035.
