Septic shock

Septic shock is the variety of pathogens and toxins from the body after the invasion caused to the microcirculation, tissue perfusion of blood shortage, leading to an important organ of life of acute dysfunction syndrome, and often occur in toxic bacillary dysentery, and the outbreak of flow Brain, bleeding of necrotizing enterocolitis, sepsis, severe pneumonia and acute biliary tract infection and other infectious diseases on the basis of clinical to looking pale and limbs of the cooler skin Fahua, reduce the amount of urine, blood pressure dropped as the main performance. Pediatrics is one of the common critical illnesses.
Clinical performance
1. Or looking pale lips, Zhizhi cyanosis, skin Fahua. 2. Hand, Foot and a cooler filled capillaries to extend the time. 3. Thin-speed pulse, blood pressure measuring less than even decline, the narrow pulse pressure. 4. Urine output reduction. 5. Fuzzy consciousness, a coma or indifferent expression. 6. Anal toe temperature> 6 ℃.
Diagnosis
1. Are the primary infection. 2. Looking pale, peripheral and mucosal cyanosis, skin-like patterns change, peripheral cold. 3. Pulse of small-speed, filling time again capillary> = 2 seconds. 4. Urine output reduction, mild shock five babies per hour ￣ 10 ml, children 10 ￣ 20 ml, severe shock babies per hour less than 5 ml, children less than 10 ml. 5. Measurement of blood pressure dropped to less than, pulse pressure <4 Kpa (30mmHg), early mild shock to normal blood pressure. 6. Make them apathetic, fuzzy consciousness, respiratory markedly accelerated.
Treatment principle
1. Expansion of blood volume, correct acid poisoning. 2. Microcirculation to lift the vessel spasm. 3. Cardiac treatment. 4. Anti-infection. 5. Application of adrenal glucocorticoid. 6. The protection of critical organ function, prevention and treatment of brain edema, heart failure, acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC) and acute renal failure.
Treatment principle
1. Septic shock, according to the incidence of bacteria on the choice of at least two sensitive to antibiotics, intravenous injection, the dose should be enough, treatment should be enough. Pathogens do not know, the choice of two broad-spectrum, highly effective microbicides, and take into account cocci bacteria, identify pathogens, according to drug sensitivity. 2. Shock patients with various degrees of cardiac function decline in the first batch of quick infusion should be used cardiac drugs, with heart failure, it is necessary to appropriately control the speed and the infusion of liquid aggregate limit Hanna hypertonic dehydration solution and the application of . 3. Fulminant ECM with shock, often disseminated intravascular coagulation and fibrinolysis hyperthyroidism exist, the rescue without waiting for laboratory results when, according to clinical signs and symptoms of immediate treatment, while heparin and 6 — Amino acid. 4. Shock with acute renal failure, should be accurate calculation of access and maintain water and electrolyte balance, improve the application of dopamine and 654-2 renal microcirculation. 5. Naloxone for morphine receptor antagonist, the antagonism of β-brown Fei’s role in reversing the shock when low blood pressure, often used in refractory shock will be good effect, when the shock treatment with traditional methods invalid , Should be timely use of naloxone.

Children shock

Shock is common in pediatric critical severe, according to the cause can be divided into different reasons: septic shock, anaphylactic shock, cardiogenic shock, hemorrhagic shock, neurogenic shock, and its effective cycle output reduction, Is a common pathophysiological basis. Reduce blood volume, cardiac output and reduce the microcirculation, the shock is the key to the development.

Cause

① septic shock is a serious infection on the basis of the results of interaction between a variety of factors, both humoral factors and the role of cell damage, but also the changes in microcirculation, together form the complicated process of the pathophysiology.
② hemorrhagic shock due to blood loss and more, the loss of so sharp decrease in blood volume.
③ cardiogenic shock due to heart Bengxue dysfunction, cardiac output caused a sharp decrease.
④ anaphylactic shock outsiders antigen enters the body of material generated by the strong reaction of the body, leading to expansion of blood vessels, increased permeability, plasma leakage, the result of sharp decline in blood circulation.
⑤ neurogenic shock occurred in severe pain caused vascular expansion, microcirculation congestion, effective when the sharp decline in circulating blood volume, due to trauma Most of it is also called traumatic shock.

Diagnosis

Primarily on the basis of clinical manifestations, various types of shock is a common feature: looking pale and limbs Jueleng, shortness of breath, Xiruo pulse, blood pressure dropped, urine output reduction, the spirit of Weimi or irritability, and so on.

Infection in infants and young children on the basis of a fever or body temperature or not, looking pale and limbs Jueleng, anorexia, lethargy or irritability, staring eyes, irregular breathing, heart rate> 160 / points, consideration should be given shock.

Older children, after repeated chills high fever, or rectal means (toe) temperature> 6 ℃ above, Jingshenbuzhen, no significant loss of body fluids circumstances orbital depression, body temperature and pulse out of proportion, sweat Lin Li, pulse pressure on the poor, There should also consider the shock.

Advanced disease has become more severe, breathing rhythm is not the whole, skin mucosa cyanosis, limbs Jueleng, Zhoushen a pattern, no palpable pulse or breakdown, measurement of blood pressure lowering or not, reduce the amount of urine, seizures or unclear consciousness, and often With organ failure.

Monitoring

In a simple principle, the following items through the monitoring of the estimated illness and prognosis help:

① drastic changes in temperature: T> 40 ℃ or not or, or anus that (toe) temperature> 6 ℃;
② consciousness change: indifferent, irritability, semi-conscious or unconscious;
③ blood pressure: pulse pressure <2 6kPa (20mmHg), or decreased blood pressure than the original 4 kPa (30mmHg), close to the pulse and blood pressure, pulse if the rules effectively, is also quite normal blood pressure, pulse Xiruo if they fail, blood pressure is also the majority Reduced or no measurement;
④ urine or decreased urine: urine monitoring cycle is an important indicator of the situation, oliguria means school-age children <400 ml / d, pre-school children <300 ml / d, baby <200 ml / d, 24 hours of urine < 30 ~ 50m1 said no urine;
⑤ edema, usually with albumin concentrations decrease.

How samples ventilator

When a patient stopped breathing, use artificial respiration and help maintain respiratory function independently stimulate the resumption of the method is artificial. Ventilator is the scene where critically ill patients (in the absence of oxygen under the conditions of) one of the most commonly used Jijiu Fa.

There are many ways to go out, the family used a mouth-to breathing and chest supine pressure ventilator law.
Mouth-to go out of the main points are as follows: First the patient supine, head Yang, the first export suction chamber part of the throat secretions, to maintain respiratory unobstructed. Emergency patients who stay in the side of the primary Tuoqi patients with lower, with nostrils Niezhu the other hand, patients with mouth open and covered apply gauze, first aid, first Shenxi breath, at the mouth of force Chuiru, and then rapidly The rise, and at the same time loosened his hands, listening to echo there, said if the airway open. So repeatedly, each time about 16-20 minutes, until the automatic resumption of breathing.

CPR

Because of injury, disease, poisoning, accidents low temperature, drowned and a variety of reasons, such as electric shocks, resulting in breathing and heartbeat stop, we must take urgent reconstruction and the promotion of heart and respiratory function of effective measures to preserve and promote the effective function of the brain Cardiopulmonary recovery is the restoration of the brain.

Kawasaki disease

Kawasaki disease also known as the mucous membrane of skin lymph node syndrome (mucocutaneous lymphnode syndrome) is the major mucosal skin rash and swollen lymph nodes multiple artery inflammation characterized by acute febrile diseases, from Kawasaki rich role in the world after the first report of different Another race of the disease reported in Japanese children in the highest prevalence rates in Japan every year, there had been a pandemic continued each month in the United States and South Korea to more cities every year, is popular in China also have Kawasaki disease epidemic However, the prevalence of the vast majority of children with no detailed reports in the months to the age-year-old but there are also adult patients ratio of men to women. ~.: Relapse rate%%
Cause: the cause of Kawasaki disease causes the disease causes have not yet been fully clarified once suspected of dust mites spread of the Rickettsia and sore blisters acid bacilli (prupionilacterium acnes) is the cause of the disease-but not confirmed, nor reports with the relevant retroviral The patients in the peripheral blood mononuclear cells found associated with retroviral retroviral activity of the Japanese study found that patients with the HLA-BWzz frequency than the general population about high-power while the United States popular in the Boston area while the detection rate of HLA-BW Therefore increased genetic susceptibility and infection may be the cause of the disease

The acute phase of T-lymphocytes reduce the cycle of T cells activated T cells decreased activation of these B-lymphocyte immune abnormalities might be lymphoid tissue infection from the virus and the affinity of the endothelial cells may be multiple reasons for vasculitis the recent discovery of giant Macrophage T cells and B cells of the vascular endothelial cells cytokines proliferator-activated cell surface antigen, such as cell adhesion factor may be in the incidence of this disease plays an important role in national study found that the disease was increased to IgGIgG characterized as B cells Cloning activated B cell growth factor and the activation of IL– mean significantly increased activity of tumor necrosis factor also increased other acute phase of increased blood coagulation and platelet activation may be related to aneurysm formation

An autopsy found that coronary artery damage is still up to other parts of the aortic abdominal aorta carotid subclavian artery and pulmonary artery pathological changes in infants with nodular more arteritis was similar to the whole of the artery inflammation; endometrial thickening of blood vessel cells and a single grain Nuclear cell infiltration within the stretch of the wall and the membrane rupture necrosis and a heart aneurysm endocarditis myocarditis and coronary thrombosis can be caused by myocardial infarction often leads to death
Symptoms: Kawasaki disease clinical performance based on clinical performance and to exclude other diseases in the following items can be set up with the diagnosis

⑴ sustained fever, more

⑵ bilateral film with congestive

⑶ erythema multiforme

⑷ strawberry-red lips tongue, mouth and throat mucous membrane diffuse congestive

⑸ acute congestive sclerosis hand and foot edema recovery began peeling fingertips

⑹ acute suppurative neck swelling
Inspection: Kawasaki disease should do what checks up to the acute phase increased leukocyte × / L above the left with the mild anemia in the prevalence of weeks or more up to platelet × / L above; ESR by up to mm / h more positive C-reactive protein serum immunoglobulin especially IgE complement increased slightly increased serum aminotransferase under increased involvement of other organs of different laboratory abnormalities were proteinuria pyuria; CSF lymphocytes increased low-voltage electrocardiogram ST-T wave PQ and change the QT interval and the Director of arrhythmia; X-check the heart increases-dimensional echocardiography visible coronary artery or coronary artery expansion and formation of the majority is about coronary artery involvement at the same time

Bacterial infection and the virus cultivation serological examination found that some cases without positive anti-Proteus antibody or OXq OX-X-specific antigen positive but Rickettsia of serological tests negative

Complications: What are the cause of Kawasaki disease complications No information about the treatment: the treatment of Kawasaki disease in most cases the disease is self-limited period of acute febrile diseases can be used aspirin ~ mg / kg at the oral; according to blood Concentration ~ mg / dl dose adjustment period after the fever can reduce dose ~ mg / kg daily times aspirin can slow down and prevent the occurrence of coronary thrombosis in the treatment of ECG should be regular inspections and follow-up peacekeeping echocardiography Necessary to do coronary angiography aspirin treatment based on clinical course may be to serve as a few months if the treatment of coronary artery aneurysms occurred should continue to coronary artery aneurysms dissipated

Have a high risk of coronary patients in the use of aspirin at the same time can still be γ-globulin daily mg / kg for aspirin use, compared with single-γ-globulin can significantly reduce coronary artery disease

Adrenal Paper on the application of controversial hormone was identified that promotes the formation of aneurysms, but also a report in the incidence of early impact of glucocorticoid to prevent the occurrence of coronary

A small number of coronary artery aneurysms are larger and can not flinch from the need for coronary artery bypass surgery
Differential Diagnosis: Kawasaki disease easily be confused with the diseases and bacterial diseases (especially Staphylococcus epidermis scarlet fever and leptospirosis loss syndrome) virus rash (such as measles) Rickettsia of disease (such as with the Rockies Banzhen Heat) toxoplasmosis limb pain of juvenile rheumatoid arthritis and multiple nodules in infants distinguish artery Yandeng

Allergic Purpura

Purpura is allergic inflammation of capillary-based allergic diseases. Purpura is mainly skin, gastrointestinal symptoms, joint swelling and pain and urinary symptoms. More common in children over the age of 5.

[Causes]

Cause is not clear, perhaps because some caused by allergic sensitization due to the original, but direct allergen is not clear. Often before the onset of hemolytic streptococcus caused by the upper respiratory tract infection, the incubation period of one to three weeks after the onset.

In addition, viruses such as measles, mumps, and parasites such as roundworm, hookworm, food such as eggs, fish, shrimp, drugs such as chloramphenicol, salicylic acid salts, such as other Chongyao, pollen, are likely to become Allergen; occurred in the autoimmune response, resulting in capillary inflammatory changes.

[Pathology:

Basic diseases for the capillary wall of the inflammatory response, increased permeability of the capillaries, blood cells and plasma leakage, caused edema and bleeding. Small arteries and veins can also suffer, the small blood vessels around the neutrophils, monocytes, lymphocytes, may have eosinophil infiltration and the different levels of red blood cells exudation, the peripheral vascular involvement can have nuclear weapons And residual swelling of connective tissue, small blood vessels of endometrial hyperplasia, and a transparent degeneration and necrosis, so that narrows blood vessels cavity, or even infarction, and that small necrotizing arteritis. Skin and gastrointestinal tract are visible above changes, intra-articular serous and interleukin leakage, but no bleeding, ureter, urethra and bladder mucosa can have bleeding, and often involving the kidney, Purpura nephritis severity of the pathological changes ranging from . Light, for the focal nephritis, compared Most of those for re-proliferation nephritis with crescent change, immunofluorescence checks can be found in glomerular C3 and IgG, but also to see fibrinogen deposition in vascular Of the film also found that IgA.

[Clinical]

More acute onset, in addition to fever, loss of appetite, nausea, vomiting and other symptoms in general, the main performance skin purpura, gastrointestinal symptoms, joint swelling and pain and urinary symptoms. Onset of different cases from time to the same situation, to see the most skin purpura, may appear separately or simultaneously or one after another with joints, gastrointestinal or urinary tract symptoms.

First, the skin purpura often at the onset of the first performance, Purpura size, higher than the skin surface, a purple, the pressure does not fade, and can be integrated into films, or a herpes-like, urticaria kind or shape Erythema, and with nerve edema.
Even when serious ulcers and necrosis can occur. Purpura more common in the limbs stretch side and hip, leg and ankle, knee and other joints, more significantly, there was symmetry in batches and easy to repeated attack.

Second, many children have gastrointestinal symptoms of abdominal pain, paroxysmal keen for more of colic, or Duntong to Qizhou or significantly lower abdomen, tenderness, but no abdominal tension. May be associated with the severity ranging from diarrhea and blood in the stool, stool or a tar-like bright red. Can have severe vomiting, but hematemesis rare. Such as abdominal pain, blood in the stool before seen in the skin purpura, with the identification of acute abdomen. The disease can intestine mucosal hemorrhage and edema, leading to intestinal disorders, or even induced intestinal sets again and again.

Third, some children with symptoms of joint swelling and pain of the festival, many involving large joints, such as the knee, ankle, wrist, elbow, small joints do not suffer. Can be single, multiple or were migratory. Joint swelling, pain, pain when aggravated, accompanied local micro-hot, hot flu-have. Joint symptoms dissipated after no after-effects.

4, urinary symptoms due to urinary tract mucosa capillary permeability increase, there hematuria and microalbuminuria, with the retirement Purpura disappeared. But the children with Purpura in about 1 / 3 to 1 / 2 kidney involvement, said Purpura nephritis. Pathological changes in the kidney is determined by the prognosis. Urine acute phase of the change more than two to three weeks there, but also in Purpura dissipated in the rear.
Most children showed a small amount of protein in urine and a red blood cell under a microscope, and sometimes see a tube, there can be gross hematuria. Generally good prognosis, even with the radical nephritis, for the development of acute renal failure, poor prognosis. Part of a large number of children with proteinuria, hematuria, edema, hypertension, hypoproteinemia and hypercholesterolemia, such as nephrotic syndrome.

Hematuria, proteinuria sustainable few months or few years, most of the last still fully recovered. A very small number of children with different degrees of renal damage after a chronic nephritis, the final development of chronic renal failure.

5, occasionally other symptoms of cerebral hemorrhage, there may be convulsions, temporary paralysis, aphasia, severe cases can cause death. Others such as nosebleeds, bleeding gums, muscle hemorrhage, bleeding or swollen testicle pulmonary hemosiderosis, are extremely rare.

[Diagnosis]

According to the typical skin purpura, or with nerves and blood vessels and edema, urticaria, and other performance easy diagnosis, with joint swelling and pain, abdominal pain, blood in the stool, laboratory platelets, bleeding, clotting time, and so normal, can be confirmed. Should be asked in detail about history, as far as possible to find allergenic factors.

[Diagnosis]

First, idiopathic thrombocytopenic purpura Purpura under the skin form of not higher than the skin, and the asymmetric distribution of platelet count reduction, it is not difficult to identify. Allergic Purpura rash associated with vessels and nerves such as edema, or urticaria shape more easily distinguish between erythematosus.

Second, sepsis meningococcal septicemia caused by rash and Purpura similar, but the weight of poisoning symptoms, WBC increased significantly, the punctured skin rash smear positive for the bacteria found.

Third, the two are related to rheumatoid arthritis and low heat of swelling and pain, Purpura appear before the more difficult to identify, with the development of disease, skin purpura, help identification.

4, intestinal sets again and again more common in infants and young children. Such as children again and Kujiao, abdominal reach mass, abdominal tension should be suspected of the disease. Barium enema perspective can be identified. However, allergic purpura with intestinal both sets again and again, it should be cause for concern.

5, appendicitis can be both a Qizhou right lower abdominal pain and tenderness associated with. But not allergic purpura abdominal tension, skin purpura, to be identified.

[Treatment]

No special effects therapy, the acute phase should be bed rest, looking for allergens, the suspected food or drug, should not the time being, or of suspicious food, in close observation, from the beginning of application, gradually increase.

First, Chinese medicine treatment of the disease in Chinese medicine in the areas belonging to the spot for the evil of injuries caused by blood, and the plaque-like syndrome, while Qingrejiedu governance, mainly Liangxue Huayu. Huang Jiawei horns commonly used in soup: 1 g horns, Yinhua 15 grams, Forsythia, Shikonin, various Paeonol 10 grams, 6 grams Salvia, situ, Rhizoma Imperatae of 15 grams, 30 grams Chi Xiaodou.

Purpura heavy and deep colors are hot for the drug increases the performance of Super Zixue Dan Chongfu 0.5 to 0.75 grams per day 1-2 times. Yan Hu abdominal pain and weight 15 grams, 6 grams myrrh. Blood in the stool and Garden Burnet carbon, the carbon Wumei 10 grams, 1.5 grams or powder Chongfu March 7.

Such as the amount of bleeding children, and not just deferred, looking pale and flustered, shortness of breath Dengzheng, are two losses of qi and blood, spleen not perturbation of blood, while Ziyin Jianpi governance, blood-based Air perturbation. Common to the spleen Decoction j dangshen 15 grams, white tricks, longan meat, 10 grams of Angelica, 15 grams Shude, Ejiao, 10 grams of carbon Garden Burnet, jujube 5. Qi and 15 grams of astragalus, blood deficiency and TGP, Huang Jing of 10 grams, or reuse Shude.

Second, the adrenal hormone therapy adrenal cortex hormones on the part of children with effective, may improve symptoms of abdominal pain and joint symptoms associated with blood in the stool to good effect, but can not prevent recurrence, the effect of nephritis are often poor, simple skin Purpura can not . Regular use of prednisone 1 to 2 mg / kg / day, the oral administration, ease the symptoms gradually after the withdrawal to the reduction, treatment is generally one to two weeks. Abdominal pain or blood in the stool serious brain hemorrhage, de-hydride can be 150 to 300 mg / day (5 to 10 mg / kg / day), or dexamethasone 15 to 30 milligrams (1 to 2.5 mg / kg / day) vein Drip, kidney involvement with nephrotic syndrome, according to nephrotic syndrome treatment.

Third, symptomatic therapy
(A) joint swelling and pain are available aspirin.

(B) of abdominal pain, can be used tranquilizers, such as Rumi that, while there had abdominal observation sets the signs again and again.

(C) of gastrointestinal bleeding, less time to time, restricted diet, fasting in a long time, can also be used procaine (allergy test should be negative, the optional) in a vein closed, with 8 to 15 mg / kg / day 10% glucose infusion of 200 ml, on the 10th of July to a course of treatment.

(D) infection, especially Streptococcus infection, penicillin and other antibiotics available infection control.

(E) intestinal parasites, have to wait until after the cessation of gastrointestinal bleeding insecticide.

(6) lesions, such as dental caries, sinusitis and tonsillitis, and so should be thoroughly treated.

(7) may generally be added vitamin C, P, or calcium, and so on.

(8) The amount of bleeding, anemia may cause blood transfusion.

Purpura and the EB virus

Immune thrombocytopenia purpura is a common children’s blood diseases, Kaohsiung Chang Gung Children’s Hospital pediatric oncology blood found on the EB virus, can globulin or high-dose steroid treatment, but if non-EB virus, must be other ways to Treatment.

Immune thrombocytopenia purpura is in the blood of a number of spontaneous anti-platelet antibodies, and attached to the platelets, the lead was swallowed cell damage, a serious decrease the number of platelets, the normal platelet count in the 150,000 to 400,000, immunization Thrombocytopenia purpura patients only a few thousand to one, 20,000.

Immune thrombocytopenia purpura occur in two to five-year-old child, the majority of cases the onset of the first three, four weeks or at the same time, a respiratory tract infection symptoms, it is often misdiagnosed as common cold, is unknown, but the infection was medical That the sector is an important pathogenic factor.

Kaohsiung Chang Gung Children’s Hospital pediatric oncology director of the blood on the 9th Chih-Cheng Hsiao said that child care skin blood, up or bruise, epistaxis bleeding or mucosal immune thrombocytopenia purpura common illnesses, or even 1% of intracranial hemorrhage Leading to death.

Hospital pediatric blood cancer diagnosis and treatment of the past decade 108 immune thrombocytopenia purpura young children, aged from one month to 16 years old, the average age of 4.5 years, testing has confirmed that 35 people are due to EB virus Trigger, and the other 73 were non-EB virus.

Including two 10-year-old girls intracranial hemorrhage due to the death rather than rule, they are not EB virus, because the globulin, the slow response to steroids, the platelet count increased slowly, leading to death.

Chih-Cheng Hsiao said that 90 percent of children in Taiwan in the 20-year-old former EB virus infection, far more than abroad, is the main reason parents Juesui Food and feeding young children.

Most people infected with the virus after the EB will recover, but the existence of the human body the virus, spread by Koumo, in addition to trigger immune thrombocytopenia purpura, a more serious cause infectious mononucleosis more of the ball (commonly known as the kissing disease), hemolytic Anemia, renewable bad anemia, the virus relevance of hemophagocytic syndrome, ruptured spleen and Alice in Wonderland syndrome, even with lymphoma, nasopharyngeal cancer-related.

He said, EB virus and non-EB virus induced immune thrombocytopenia purpura symptoms similar, but different treatment modalities, to determine if the EB virus, immunoglobulin or high-dose steroids is the best therapy.

Allergic Purpura Syndrome

Said Schonlein-Henoch purpura, hemorrhagic capillaries of poisoning (Hemorrhagic Capillary Toxicosis), is due to abnormal capillary caused by systemic hemorrhagic disease, can affect the skin, joints, kidneys and gastrointestinal tract in the corresponding symptoms. This disease more common in children and adolescents.

[Diagnosis]

According to the upper respiratory tract infection, a skin purpura, and joints, stomach and kidney involvement at the same time the performance of a recurrent feature, should consider the possibility of this disease. It should be noted and ITP, acute abdomen, glomerulonephritis, rheumatoid arthritis for identification.

[Treatment]

1. Removal causes include: anti-infection, remove Gan Ranzao to remove intestinal parasites, to avoid application of the food and drug allergies. 2. Anti-histamine drugs: choice of chlorpheniramine, promethazine, diphenhydramine, such as drug Astemizole oral or intramuscular injection. Applications can also be 10 per cent of calcium gluconate 10 ml intravenous injection, 1 to 2 times daily.

3. Glucocorticoid: the acute phase and applied to the abdomen, joint pain obviously, can quickly ease the symptoms. Prednisone can be given orally, if necessary, hydrocortisone infusion. Short-term medication (3-5) can ease the withdrawal symptoms, but to use a longer time after the withdrawal should be gradual reduction.

4. Other: the acute phase should be bed rest, gastrointestinal symptoms should be fasting. High-dose intravenous vitamin C (3 ~ 5g / day). Abdominal pain can be intense intramuscular injection of atropine 0.5 ~ 1 mg. Bleeding tendencies may choose to stop bleeding drugs. Have kidney damage.

[ET]

The disease of unknown, and a variety of factors may be relevant, ① infection, the disease often in patients with acute infection, the incubation period and after a certain morbidity, and more acute upper respiratory tract infection, hemolytic streptococcus pathogens to mainly, but also for the Staphylococcus aureus, viruses, parasites and infections, ② food allergy, such as fish, shrimp, crab, milk protein allergy, and other allograft, can be induced by the disease, ③ drugs, such as the Green streptomycin, sulfonamides, salicylic acid , And other preparations. It is also possible with the cold, insect bites, pollen dust and other factors related to contacts. All these factors on the body as small arteries, veins and capillaries on the wall of inflammatory changes in vascular permeability-increasing, from subcutaneous tissue, mucous membrane and vascular organ of the exudative hemorrhage edema, and a corresponding clinical manifestations.

[Pathological changes:

Blood and skin around the lymphocytes and plasma cell infiltration, the dermis layer of capillary was inflammatory changes, leakage, swelling, bleeding, caused by skin purpura. Edema of the intestinal mucosa, leakage, bleeding caused by abdominal pain, and so is the reason. And joint pain around joints mainly due to edema, joint cavity caused by leakage. Kidney involvement that glomerular cell proliferation, stoves necrosis, capillary thrombosis, but also the foreseeable edema tubular epithelial cells, degeneration, fibrosis.

[Clinical]

Before the onset 1 to 3 weeks often have the upper respiratory tract infection, the slow onset, duration protracted, often alternating attack and mitigation, according to the lesions of different positions, and have different clinical features:

1. Skin performance: most of the skin purpura as the first symptom. Often seen in the limbs remote stretch side, hip back, face and torso while rare, Purpura was symmetrical distribution, in batches, large and small, and integration into films, even hemorrhagic form of herpes and hemorrhagic necrosis. Purpura general a few days to be dissipated. At the same time be accompanied by a small number of eyelids, lips, hand, foot and part of vascular edema, or urticaria.

2. Gastrointestinal change: more skin purpura after abdominal symptoms, but also to gastrointestinal symptoms as the first persons. Mainly for the onset of Chang Jiaotong, and for continuing Duntong in Qizhou or lower abdomen, accompanied by nausea and vomiting, are re-emerging blood in the stool, hematemesis, intussusception and intestinal perforation. Investigations have tenderness in the abdomen, but no muscle tension and anti-Tiaotong. If abdominal symptoms as the main performance, as abdominal allergic purpura (Henoch Purpura).

3. Joint performance: performance for the swelling limbs joint pain, knee, ankle, elbow, wrist, etc. Most of regular migration, a few days dissipated, can be repeated attack, attack often accompanied by low heat. To joint symptoms for outstanding performance, known as joint-allergic purpura (Schonlein Purpura).

4. Kidney performance: changes in the kidney often purpura after the emergence of performance for proteinuria, hematuria, the management of urine, some patients may be accompanied by swelling, oliguria and hypertension. Under normal circumstances the disease better kidney damage restoration, leaving after-effects, to be a small number of chronic nephritis, even uremia. Should pay attention occasionally to kidney disease and the main performance was not obvious to Purpura.

In addition vascular leakage bleeding and edema can also affect the nervous system, such as respiratory and corresponding symptoms.

[Examinations]

Bleeding, clotting time, the platelet count and function normally, ESR can be normal or mildly by fast. Some patients with vascular brittle test (beam arm test) positive. Kidney involvement may have proteinuria, hematuria, the type of urine.

Thrombocytopenia

Platelet abnormalities and quality of the two types of abnormal disease during pregnancy can be painful, but for those of the majority. Clinical need to pay attention to the following three points: a certain risk factors (such as drugs, infection) can cause the decrease in platelets, can also cause some degree of platelet dysfunction (of the anomaly); ② in cases of thrombocytopenia , Certain risk factors (such as drugs, infection, immune response, etc.) can inhibit the platelet formation of bone marrow function, but also directly undermine the peripheral platelet, or to which a party as the main pathological mechanisms; ③ by platelet dysfunction caused by bleeding Sometimes can be very serious and often than other hemorrhagic disease more difficult to identify.

Purpura

Purpura is allergic inflammation of capillary-based allergic diseases. Purpura is mainly skin, gastrointestinal symptoms, joint swelling and pain and urinary symptoms. More common in children over the age of 5. Cause is not clear, perhaps because some caused by allergic sensitization due to the original, but direct allergen is not clear. Often before the onset of hemolytic streptococcus caused by the upper respiratory tract infection, the incubation period of one to three weeks after the onset.