Hemorrhagic vasculitis

Hemorrhagic vasculitisHEMORRHAGIC VASCULITIS (anafylaktiske purpura, purpura nervosa, disease Seleina's disease). The etiology is not entirely clear. The causal significance of acute and chronic infections, toxic-allergic factors (eggs, fish, milk, vaccinations, certain medications, helminths). The pathogenesis is complex. Attached is the formation of toxic substances that affect blood vessel walls, increasing their permeability. A role divert immune complex lesions of the vascular wall (discovery in the skin and blood vessels of immunoglobulins a, M, G, fibrinogen, C-complement), and immunodeficiency-like state (deficit C2-complement). The clinical picture. The illness often begins suddenly, rarely after a short prodromal period (posapyvanie, headache, malaise), usually after infection (flu, sore throat and others). An important symptom is skin lesions in the form of papular-hemorrhagic, sometimes bullous rash. Skin rashes symmetric, localized mainly on the legs around the joints, although there may be on the trunk, buttocks, face (cheeks, nose, ears, hands, characterized by distal location. After the disappearance of the rash on the skin pigmentation. Frequent itching, paresthesias. Often along with purpura in children include swelling of the hands, feet, legs type of swelling Kvinke. Body temperature in most patients is increased up to subfebrile figures. Hematuria indicates the accession of hemorrhagic nephritis. A frequent symptom in purple-abdominal pain, possible vomiting blood, black stools. Marked pain and swelling. The laboratory investigations are marked neutrophilic leukocytosis with a left shift, eosinophilia; albumin-globulin index reduced the stronger, the more severe the disease, the number of prothrombin decreased, increased capillary permeability. More sick children of preschool age. The disease duration from 2-3 weeks to several years. There are acute (up to 30-40 days), subacute (within 2 months or more), chronic (clinical symptoms persist up to 1.5 - 5 years or more) and relapsing course (relapses up to 3-4 times more for 3-5 years or more), and 3 degrees of activity: grade I (lowest) and II degree to which exudative component is expressed clearly, and grade III (rich exudative-hemorrhagic rash often with vesicular necrotic cells; polyarthritis; changing its localization recurrent angioneurotic edema; severe abdominal syndrome with hematemesis and bloody stool; defeat of kidneys, blood vessels, liver, retina, nerve, cardiovascular system). Must be differentiated from disease Verligofa and hemophilia. Treatment. It is important to stay in bed, not only in the acute period of the disease, but in 1-2 weeks after the disappearance of the rash. In those cases, when a connection is established with the infection, use broad-spectrum antibiotics. To hyposensitization prescribe diphenhydramine, suprastin and other antihistamines. As an anti-inflammatory prescribed drugs salicylates, amidopyrine, analgin. Carbolenum used as a means of adsorbing gistaminopodobnykh substances in the intestine. To reduce the permeability of the vascular wall using 10% solution of chloride of calcium, vitamin C, rutin. In severe cases, abdominal, renal and cerebral syndromes good effects of hormone therapy (prednisolone), in very severe cases using heparin. The prognosis is generally favorable, but becomes serious when the development of the abdominal, renal, or cerebral syndrome..



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