Hospital pediatrics. Systemic vasculitis in children. Clinic, diagnosis, treatment (lecture notes)

Lecture notes, cheat sheets
Free library / Directory / Lecture notes, cheat sheets

Hospital pediatrics. Systemic vasculitis in children. Clinic, diagnosis, treatment (lecture notes)

Lecture notes, cheat sheets

Table of contents (expand)

LECTURE No. 7. Systemic vasculitis in children. Clinic, diagnosis, treatment

Systemic vasculitis is a heterogeneous group of diseases with primary inflammatory and necrotic changes in the vascular wall.

Etiology of systemic vasculitis: viruses (cytomegaloviruses, hepatitis virus), bacteria (streptococci, staphylococci, salmonella), parasitic diseases (roundworm, filariotosis). Classification of vasculitis.

1. Primary vasculitis with the formation of granulomas (giant cell arteritis, Takayasu arteritis, Wegener's granulomatosis, Churg-Strauss syndrome) and without the formation of granulomas (polyarteritis nodosa, Kawasaki disease, microscopic polyangitis).

2. Secondary vasculitis in rheumatic diseases (aortitis in rheumatoid arthritis, rheumatoid vasculitis, vasculitis in rheumatic diseases), in infections (aortitis in syphilis, hepatitis B, HIV infection).

1. Microscopic polyangiitis

Microscopic polyangiitis (microscopic polyarteritis) is a necrotizing vasculitis with a small number or absence of immune deposits, predominantly affecting small vessels.

Clinic. The clinical picture is dominated by symptoms of glomerulonephritis and pulmonary capillaritis.

Signs: early development of renal failure due to the presence of extracapillary glomerulonephritis (urinalysis shows hematuria, moderate proteinuria). No arterial hypertension. Pulmonary syndrome: damage to the upper respiratory tract - necrotic damage to the nasal mucosa (necrotizing rhinitis), not leading to destructive processes that deform the nose; in the lower respiratory tract - pronounced pulmonary hemorrhagic processes (hemorrhagic capillaritis, pulmonary hemorrhage).

2. Churg-Strauss syndrome

Churg-Strauss syndrome is a granulomatous inflammation involving the respiratory tract associated with asthma and eosinophilia, and a necrotizing vasculitis affecting small and medium-sized vessels.

Clinic. Bronchial asthma for several years. Increased levels of eosinophils in the peripheral blood and their migration into tissues (chronic eosinophilic infiltration of the lungs). Severe attacks of asthma + signs of systemic vasculitis (fever, myalgia, arthralgia, weight loss). Damage to the central nervous system (peripheral neuropathy, hemorrhagic stroke). Kidney damage. Damage to the gastrointestinal tract (ischemia and perforation of the wall of the stomach or intestines). Skin lesions (painful purpura mainly on the lower extremities).

Diagnosis criteria. Asthma, eosinophilia > 10%, changes in the paranasal sinuses, sinusitis, mono- or polyneuropathy, variable (volatile) pulmonary infiltrates, extravascular tissue eosinophilia. Laboratory criteria: hypereosinophilia, increased immunoglobulin E, C-reactive protein, accelerated ESR.

Treatment. Glucocorticoids, cytostatics, plasmapheresis.

3. Wegener's granulomatosis

Wegener's granulomatosis is a granulomatous inflammation of the respiratory tract, necrotizing vasculitis of small and medium-sized vessels, usually combined with necrotizing glomerulonephritis.

There are 3 forms: localized, transitional, generalized. Laboratory criteria: accelerated ESR, leukocytosis, hypergammaglobulinemia.

Criteria for diagnosis. The criteria for diagnosis are as follows.

1. Ulcerative-necrotic lesion of the upper respiratory tract.

2. Progressive areas of necrosis of ENT organs with cartilage destruction.

3. Involvement of the eye orbit.

4. A large number of eosinophils, granulomas in the biopsy specimen of the nasal mucosa, septum, and palate.

Treatment. Glucocorticoids, cytostatics, NSAIDs, antiaggregants, anticoagulants.

4. Behçet's disease

Behçet's disease is a vasculitis that affects small and medium-sized arteries and is manifested by the clinical triad of recurrent aphthous stomatitis, ulcerative necrotic changes in the genital organs and eye damage.

Diagnostic criteria. Recurrent oral ulcer (at least 3 times during the year): minor aphthae, major aphthae, herpetiform rash. Also 2 of the following signs: recurrent genital ulcers, eye lesions (anterior posterior uveitis). Skin lesions (erythema nodosum, pseudofolliculitis, papulopustular inflammation, acneiform nodules). Formation of pustules at injection sites.

5. Polyarteritis nodosa

Polyarteritis nodosa is a necrotizing inflammation of medium and small caliber arteries without the formation of granulomas.

Clinic.

clinical options.

1. Thromboangiitis (juvenile) - damage to the vessels of the skin.

2. Visceral (classic):

1) damage to the vessels of the lungs;

2) damage to the vessels of the gastrointestinal tract;

3) damage to the vessels of the kidneys;

4) damage to the vessels of the heart.

Diagnostic criteria. Loss of body weight by more than 4 kg, livedo reticularis on the skin, myalgia, weakness, decreased blood pressure (especially diastolic), arteriographic changes in blood vessels (aneurysm, occlusion). Biopsy - necrotizing vasculitis.

Treatment. Glucocorticoids, cytostatics, symptomatic therapy (angioprotectors, antihypertensives, anticoagulants). Hemorrhagic vasculitis is a systemic inflammatory disease, Ig A, deposits, causing damage mainly to capillaries, arterioles and venules of the skin, joints, abdominal cavity and kidneys, which is based on multiple thrombovasculitis. It is more common in children 4-11 years old and is a classic immune complex disease.

Clinical syndromes. Skin syndrome - maculopapular rashes on the lower extremities with transition to the buttocks. stomach.

Articular syndrome - polyarthralgia, arthritis of large joints without deformation.

Abdominal syndrome - sharp cramping pain in the abdomen, worsening after eating; nausea, vomiting.

Renal syndrome - micro-, macrohematuria, severe capillary-toxic glomerulonephritis.

Damage to the central nervous system - headaches, strokes, subdural hematomas, ubdural hematomas.

Diagnostic criteria. Palpable purpura, age of onset of the disease - younger than 20 years, attacks of abdominal pain, hematuria, in the biopsy specimen there is granulocytic infiltration in the walls of arterioles and venules.

Treatment. Exclusion of provoking factors, sanitation of foci of infection, treatment of the underlying disease, anticoagulants and antiplatelet agents, anti-inflammatory therapy, local treatment. Takayasu arteritis is a disease from the SV group, characterized by granulomatous inflammation of the aorta and its branches with the development of panarteritis; more often manifests itself in women 10-20 years old, chronic inflammation with destructive changes in the walls of large arteries, the aorta and its branches, which is accompanied by their stenosis and ischemia of the blood supplying organs.

Localization of the process (IV anatomical type).

1. Aortic arch (I type).

2. Region of the descending abdominal aorta (type II).

3. Mixed forms (type III).

4. Involvement of the pulmonary artery and its branches (type IV). Clinical syndromes. Clinical syndromes in the acute phase of inflammation: general inflammatory, cardiovascular, peripheral blood flow insufficiency syndrome, cerebrovascular, pulmonary, arterial hypertension syndrome.

Diagnosis criteria. The onset of the disease is before 40 years of age, a decrease in the pulse in the brachial artery, the difference in blood pressure in the arms is more than 10 mm Hg. Art., murmur heard above the subclavian artery and in the aorta, intermittent claudication, changes in the arteriogram.

Treatment. Conservative (glucocorticoids, NSAIDs, aminoquinoline drugs, cytostatics, treatment of concomitant pathologies - tuberculosis, anticoagulants and antiplatelet agents, α-blockers).

Surgical (excision of the occlusal part). Excision of the occlusive part of the vessel.

Author: Pavlova N.V.

<< Back: Cardiac arrhythmias in children. Clinic, diagnosis, treatment (Dysfunction of automaticity function. Disorders of conduction function)

>> Forward: Renal failure. Clinic, diagnosis, treatment (Acute renal failure. Chronic renal failure (CRF))

We recommend interesting articles Section Lecture notes, cheat sheets:

▪ General biology. Lecture notes

▪ Teria of the organization. Crib

▪ Enterprise economy. Lecture notes

See other articles Section Lecture notes, cheat sheets.

Read and write useful comments on this article.

<< Back

Latest news of science and technology, new electronics:

The existence of an entropy rule for quantum entanglement has been proven 09.05.2024

Quantum mechanics continues to amaze us with its mysterious phenomena and unexpected discoveries. Recently, Bartosz Regula from the RIKEN Center for Quantum Computing and Ludovico Lamy from the University of Amsterdam presented a new discovery that concerns quantum entanglement and its relation to entropy. Quantum entanglement plays an important role in modern quantum information science and technology. However, the complexity of its structure makes understanding and managing it challenging. Regulus and Lamy's discovery shows that quantum entanglement follows an entropy rule similar to that for classical systems. This discovery opens new perspectives in the field of quantum information science and technology, deepening our understanding of quantum entanglement and its connection to thermodynamics. The results of the study indicate the possibility of reversibility of entanglement transformations, which could greatly simplify their use in various quantum technologies. Opening a new rule ... >>

Mini air conditioner Sony Reon Pocket 5 09.05.2024

Summer is a time for relaxation and travel, but often the heat can turn this time into an unbearable torment. Meet a new product from Sony - the Reon Pocket 5 mini-air conditioner, which promises to make summer more comfortable for its users. Sony has introduced a unique device - the Reon Pocket 5 mini-conditioner, which provides body cooling on hot days. With it, users can enjoy coolness anytime, anywhere by simply wearing it around their neck. This mini air conditioner is equipped with automatic adjustment of operating modes, as well as temperature and humidity sensors. Thanks to innovative technologies, Reon Pocket 5 adjusts its operation depending on the user's activity and environmental conditions. Users can easily adjust the temperature using a dedicated mobile app connected via Bluetooth. Additionally, specially designed T-shirts and shorts are available for convenience, to which a mini air conditioner can be attached. The device can oh ... >>

Energy from space for Starship 08.05.2024

Producing solar energy in space is becoming more feasible with the advent of new technologies and the development of space programs. The head of the startup Virtus Solis shared his vision of using SpaceX's Starship to create orbital power plants capable of powering the Earth. Startup Virtus Solis has unveiled an ambitious project to create orbital power plants using SpaceX's Starship. This idea could significantly change the field of solar energy production, making it more accessible and cheaper. The core of the startup's plan is to reduce the cost of launching satellites into space using Starship. This technological breakthrough is expected to make solar energy production in space more competitive with traditional energy sources. Virtual Solis plans to build large photovoltaic panels in orbit, using Starship to deliver the necessary equipment. However, one of the key challenges ... >>

Random news from the Archive

car without a person 27.09.2007

Engineers from the United States are creating a car that can travel 60 miles without human assistance in six hours, traveling along the roads of California.

“Two years ago, we tested a prototype of such a robot car in the Mojave Desert. Then our team showed 8th and 9th results, thanks to which we received financial support from the Department of Defense, Ford and Caterpillar companies. Of course, to travel It’s much more difficult for a robot to drive on the roads of California than in the desert, but we are well prepared,” says one of the participants in the work, graduate student of the University of Virginia Patrick Courier.

The robot, converted from a donated Ford Escape car, was named "One". It was equipped with a powerful on-board computer, a GPS receiver, laser scanners and video cameras. Sophisticated software allows you to simulate human behavior and recognize the maneuvers of vehicles in front.

As a result, the robot is able to drive along a marked freeway, change lanes, go around a stopped car, cross intersections and park. And he does all this without going beyond the rules of the road.

Three laser scanners 25 times in two seconds inspect the surrounding space and measure the speed of approaching "Odin" to a particular object on the road. Four more scanners are installed on the roof. Two of them look for potholes on the road, and two more follow objects that, when maneuvering, fall into the blind zone of the three main scanners.

It is assumed that such robots will carry out tasks for the delivery of goods to the battlefield along a given route during the conduct of hostilities by the US Army.

Other interesting news:

▪ Teleportation repeater for quantum internet

▪ Roadside Magnetic Leaves

▪ INA209 - power control circuit

▪ Motorola Skip NFC tag unlocks smartphone without entering password

▪ Smart glasses save energy and reduce CO2 emissions

News feed of science and technology, new electronics

Interesting materials of the Free Technical Library:

▪ section of the site For a beginner radio amateur. Article selection

▪ article Agrarian law. Lecture notes

▪ article Why do people stutter? Detailed answer

▪ article Drimiya seaside. Legends, cultivation, methods of application

▪ article Active speakers with bridge UMZCH on the TDA7266L chip. Encyclopedia of radio electronics and electrical engineering

▪ article Radio station Astra-1-FM-CB. Encyclopedia of radio electronics and electrical engineering

Leave your comment on this article:

All languages of this page

Home page | Library | Articles | Website map | Site Reviews