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.

Common causes of anaemia in children

Anemia is common in children iron deficiency anemia. This is because:

(l) children with birth certificates less than iron. The normal full-term newborn from the mother of iron sufficient access to their health after three to four months of blood needs. However, premature birth, twins, fetal and maternal blood loss with iron deficiency anemia, may make children less than iron certificates.

(2) insufficient iron intake. Newborn human diet mainly milk or milk, and milk and milk were both lower in the iron content, rather than simply using dairy feeding iron to add more timely food supplement, prone to anemia.

(3) Growth and Development summary. Period of rapid growth and development of infants. 3 to 5 months for the birth weight of 2 times, 1-year-old at birth weight three times, if premature infants gain weight faster then. As weight increases blood volume also increased rapidly, then prone to iron deficiency, anemia caused.

(4) the loss of too much iron. Normal daily excretion milling babies than adults, loss of skin from the iron is relatively more, if the protein allergens in the case of intestinal bleeding, then lost more iron. In addition, some chronic diseases such as diarrhoea, of intussusception, intestine, polyps and so increase the consumption of iron caused by anemia.

Ectopic pregnancy first aid measures

Fertilized egg in the uterine cavity, “camping” called ectopic pregnancy. 95% of the ectopic pregnancy in the fallopian tube, ovary and also in the abdominal cavity. These sites not suitable for pregnancy, abortion easy peeling, there perforation caused bleeding.

Amenorrhea, vaginal bleeding, abdominal pain fall is a typical expression of ectopic pregnancy. Therefore, Tianjin China gynecological clinics experts advise, if the pain intensified, with nausea, vomiting, dizziness, sweating and looking pale, the stomach bleeding, Katherine is dangerous and should be dealt with first aid at the same time, quickly notify the emergency center.

Emergency measures

Before the ambulance arrived, it should be the first low, feet high, to keep quiet, to prevent bleeding, anemia because of bleeding and shock lead. Insulation blankets and other goods used is also important.

Notes

1. When women under abdominal pain, we must guard against ectopic pregnancy.

2. Ectopic pregnancy abortion is more serious than the disease, with the fetus grow, fallopian tube ruptured and caused the bloodshed. Not only is the fetus is more important to a threat to the mother’s life.

3. Spread in obstetrics and gynecology doctors in the sentence: “The most typical ectopic pregnancy is not typical.” Ectopic pregnancy because the symptoms are often vague, since the onset patients to the doctor on the details.

4. Ectopic pregnancy also easy to abdominal pain and other illnesses confusion, it should be noted distinction. Intussusception is intense abdominal pain, Dabiandaixie; appendicitis pain from the chest began to move to the right lower abdomen; volvulus is a mentor stomach pain; gallstone is right upper quadrant pain. And ectopic pregnancy, which is pregnancy outside the uterus rupture, abdominal pain and bleeding.

Typical female diarrhea cases

Abstract records

Patients, female, 40 years old, “repeated abdominal pain, diarrhoea, 38,” admitted.

With 2-year-old around, lips, hands and feet the palm of a black spot, and gradually increased. Shortly after no incentive paroxysmal recurring abdominal cramps, mainly Qizhou, sometimes accompanied by abdominal distension and exhaust stop defecation, anal after improved exhaust. Diarrhea 2 to 5 times / d, thin paste-like, there are intermittent mucus and then a small dark red blood. Without Lijihouchong, fever, abdominal mass, nausea, vomiting, etc.; melanoma calmly at the age of 25 the most obvious, then gradually reduced, stain smeared out. Five years ago gastroscopy and colonoscopy examination suggested that the stomach and colon polyps more, endoscopic resection of dozens of polyps, but no improvement in symptoms, and symptoms of a bowel obstruction, and carry out exploratory laparotomy during colonoscopy. See some of the intussusception, diffuse distribution of hundreds of intestinal polyps, partial jejunum, local excision of part of the transverse colon and descending during endoscopic resection of the small bowel polyps. Postoperative symptoms has clearly improved. Four months ago the patient also suffered from diarrhoea, we are undigested food residue, sometimes to the acid, burning sensation, the navel, and other upper gastrointestinal symptoms. Patients past history, family history, and no history of abnormal menstruation.

Admission investigation of the lips and mouth weeks, buccal mucosa, acromegaly palmar that multiple Peutz (Figure 1), the investigation of cardiopulmonary no obvious abnormalities, abdominal surgical scar visible, less than the liver and spleen Jinxia, Changming sound normal. Anal investigation: around the anus that several black spot, I no anomaly.

Hematuria conventional laboratory tests: normal; repeatedly fecal occult blood (OB) positive fecal Sudan III were negative; liver and kidney function, sugar antigen (CA) series, lung cancer screening, pancreatic function, erythrocyte sedimentation rate, antinuclear antibodies (ANA) are normal ; abdomen and pelvic B ultrasound, chest X-ray were normal; abdominal X-ray showed in the lower abdomen intestinal gas in the middle of plot, no solution plane; intestinal X-ray angiography (Figure 2) shows that: small intestine multiple filling defects; Virtual Colonoscopy microscope (Figure 3): colon multiple filling defects; gastroscopy (Figure 4): All of the stomach and duodenum drop that multiple polyps in diameter 0.2 cm to 0.8 cm, or no pedicle Edi, mucosal surface smooth and complete, pathology consistent with Peutz-Jeghers Syndrome (PJS, Peutz - polyposis syndrome). Colon microscopy (Figure 5): Multi-size colon polyps, congestive surface, and some were lobulated or branch-shaped, the majority have long pedicle line of endoscopic polyps Fulguration, with a total of 15 polyps, in the view of the liver Qu piles polyps, showed that the roots unclear about 3 cm × 10 cm, could not be further into the mirror; pathology consistent with PJS (Figure 6).

Diagnosis Peutz - polyposis syndrome (PJS)

Preparations for trypsin, and promoting gastrointestinal motility, such as drug therapy, the patient diarrhea, abdominal distension symptoms improved. Surgical consultations: in the last postoperative wound infections, intestinal adhesions are severe difficulties surgery again, no obvious symptoms of intestinal obstruction, not recommended surgery to medical therapy. Patients discharged from follow-up.

Case discussion

PJS is a rare gastrointestinal tract to multiple hamartoma polyps mucosa with skin pigmentation syndrome characterized. Peutz is the first in 1921 in a family in the Netherlands discovered the disease, in 1945 after Jeghers first detailed description of the characteristics of the disease. Current research shows that, PJS is a genetic disease, autosomal dominant inheritance, the disease gene located in 19 p13.3 the STK11 gene, but the pathogenesis of withdrawal. Men and women equal risk of incidence, were seen various ethnic, multi-family history. In the United States about once every 60,000 to 300,000 people have one case of PJS patients.

Clinical characteristics of the disease include: (1) mucosal skin pigmentation is seen at 95% of the patients with melanoma is rich in macrophages induced aggregation in the dermal layer. The performance characteristics of the flat, blue-gray or dark brown, has a diameter of 1 mm to 5 mm dot, similar freckles. In a good week lips and mouth (94%), hands (74 per cent), buccal mucosa (66%) and foot palm (62%), other sites such as the nose, anal, genital and even the rare gastrointestinal tract. Peutz more than 1 ~ 2 years old when the emergence of the age increase and increase growth, puberty and then gradually dissipated (buccal mucosa exceptions), a rare malignant transformation. (2) multiple gastrointestinal polyps found in the majority of patients with polyps without endoscopic characteristic performance, pedicle without Beattie, lobulated can see. Under a microscope showed that proliferation of smooth muscle into the mucosal dendritic lamina propria, and the surface of epithelial cells of normal. Distribution of polyps in the small intestine (64%), colon (64%), stomach (49 per cent), rectum (32%). The number and size of polyps ranging in diameter from 1 mm to 5 cm above can be single, but multiple common. Polyps in more than 10 years ago, growth, the majority of patients 10 to 30 years old when symptoms. There are major obstruction (43%, or intestinal obstruction due to intussusception), abdominal pain (23%, due to infarction or ulcers caused by polyps), hematochezia (14%, due to ulcer), rectal polyps prolapse ( 7%). Nearly half of the patients appears in the life of intussusception, located in the small intestine. PJS patients with malignant tumors easy merger, including the digestive system and other systems, the mechanism has been prescribed. There are reports PJS patients before the age of 60 in about 50% of malignant tumors found in (1) digestive system cancer, mainly in the small intestine (48%), stomach (24%), colon (24%), pancreas (5%), can be found in bile duct system and the esophagus. (2) other malignancies, mainly seen in the lung, genital mutilation (female’s uterus, ovary, cervix and the male testis).

Current treatment includes: symptomatic treatment, endoscopic treatment (including during colonoscopy), the surgical treatment (laparoscopy, laparotomy), domestic use of Chinese medicine treatment were reported. Because the disease is malignant merger, the close clinical follow-up and screening is very important. Some scholars have suggested annual physical examination (including lung, breast, abdomen, pelvis, testis), and blood tests. If repeated bleeding or polyps larger than 5 mm in diameter, the proposed endoscopic removal. Screening for cancer: small bowel imaging, endoscopy and colonoscopy examination every 2 years 1; pancreas ultrasound, pelvic ultrasound (female) or testicular ultrasound (male) 1 per year; breast radiography (25,30,35, 38-year-old at the 1 st, 2 years after each one, a year after 50-year-old); full colonoscopy every three years 1. Patients also can be the future home of the Department of Preventive gene detection. Prognosis: About half of patients develop and die from cancer, other patients may not affect normal life expectancy.

On infantile diarrhea complications

Diarrhea often leads to malnutrition, vitamin deficiency and a variety of multiple infections.

1. Digestive tract, digestive tract infection, infection may be the cause of diarrhea, but also due to diarrhoea after the lower body resistance by the infection. Suppurative a common skin infection, urinary tract infection, middle ear infection, upper respiratory tract infection, bronchitis, pneumonia, septicemia and phlebitis. Occasional virus enteritis with myocarditis.

2. Thrush protracted course of the original or malnourished children with thrush easy, especially in long-term use of broad-spectrum antibiotics after more timely if not stop, fungi can invade and gastro-intestinal and even causing systemic fungal disease.

3. Toxic hepatitis diarrhea can occur in the course of jaundice, and was particularly prevalent in the original malnourished children. E. coli may be caused by enteritis, with E. coli sepsis, resulting in toxic hepatitis. Diarrhea illness soon after the increase, jaundice died soon after. But if early detection of polymyxin timely injection, ammonia or benzyl carboxymethyl benzylpenicillin, most curable.

4. Malnutrition and the lack of diarrhea persisting lack of vitamin, or repeated fasting, long-term energy shortage, easily leads to malnutrition, anemia and peacekeeping A deficiency. Jiuxie induced liver damage, vitamin K absorption reduction and prothrombin reduced, a result of bleeding.

5. Other heavy dehydration can be complicated with acute renal failure. In addition: toxic intestinal paralysis, intestinal bleeding, intestinal perforation, intussusception and stomach expansion. Can be caused by improper infusion acute heart failure, high sodium or hyponatremia, or hyperkalemia. Nursing infant vomiting can cause suffocation when ill.

Child care complications diarrhea

According to reports, since the beginning of winter, diarrhea children have noticeably increased, and some children’s hospital, due to diarrhoea in children with attendance accounted for almost half of the total outpatient amount. Here, we prepared and the following articles of infantile diarrhea that can help point parents busy.

Diarrhea is common diseases in children, it is the result of intestinal infection, can be due to improper diet or abrupt climatic factors such as non-infectious cause.

Diarrhea in children by the length of the course can be divided into:

Acute diarrhea (in the course of less than two weeks), chronic diarrhea (in the course of more than two months), as well as the one in between persistent diarrhea. Both acute diarrhea or persistent diarrhea and chronic diarrhea, if the treatment and care of properly, will trigger a variety of complications.

Water and electrolyte imbalance diarrhea in children, can not be effectively from food and beverages absorb water and electrolytes, but because of diarrhea and massive loss. So, if not promptly and effectively to add water and electrolytes, there will be varying degrees of water and electrolyte imbalance, including hyponatremia, hypokalemia, low calcium and low magnesium, from the intractable abdominal distension, hand-foot-pumped Nuo or convulsion.

Viral myocarditis diarrhea, a further decline in the resistance of children, some children with heart v. before discomfort, chest tightness, chest pain, palpitation, dizziness, fatigue, etc.. This is because the virus violation of the myocardial cells or cardiac conduction system. Children with severe because of serious arrhythmia caused heart failure, cardiogenic shock, or even life-threatening.

Intussusception 2% to 8% of children with intussusception secondary to diarrhea.

Diarrhea peristalsis rhythm disorders, intestinal Central Local persistent muscle spasm can occur because of the proximal severe intestinal peristalsis, and will be pushed into spasm Changduan within the distal colon.

Malnutrition occurs in persistent diarrhea or chronic diarrhea after. Mild malnutrition appear only subcutaneous fat reduction and mild muscle atrophy, severe malnutrition that wall thinning, mucosal folds disappear, myocardial fiber swelling, lymphoid tissue and thymus atrophy and significantly reduced, and other organs. Malnourished children with a further decline in immunity, various secondary infections, such as thrush, bronchial pneumonia, tuberculosis, otitis media, such as urinary tract infection, and to increase the children’s malnutrition, a vicious cycle.

Therefore, the parents of children with diarrhea can not be taken lightly, and should be treated promptly with children with medical treatment, home care and conscientiously do a good job.

Constipation and straight intussusception

Chronic constipation can be a straight intussusception patients, bowel obstruction for performance, often straight Intussusception is a long-term severe constipation, fecal obstruction results and not the causes, of intussusception straight bowel obstruction after a family drama, and even complete obstruction. Necessary for surgery, surgical treatment can be used perineal rectum fixation, to achieve more satisfactory results.

Children susceptible cold constipation

Winter, suffering from respiratory tract infection in children increased, a considerable portion is not due to open by the stool. This is because children in the development period, a better appetite, metabolism exuberant, but still not mature intestinal function development; reduce outdoor activities, peristalsis corresponding decline in the unaccustomed stool at the nursery or more winter clothing , stool after mentioning pants and dress will cause inconvenience to children and other customary forbearance will, which led to constipation. The gastrointestinal illness would affect lung function, “lung and colorectal phase exterior”, constipation long stranded on the one hand will gastrointestinal virus, the flu and recurrent easily add, on the other hand will trigger intussusception, obstruction and so acute abdomen.

Therefore, the experts pointed out that attention should be paid to the prevention of influenza children so that they dietary restraint, eat some of the crude fiber-rich fruits and vegetables (such as spinach, celery, apples, kiwifruit, etc.) and some of the role Runchang purge the food (such as honey, walnut, bananas, Tremella, sesame, etc.). There should be awareness to train children to develop the habit of regular stool.

Common causes of anemia in children

Anemia is common in children of iron deficiency anemia. This is because:

(L) birth certificates in children less than iron. The normal full-term newborn from the mother of iron sufficient access to their hygiene 3 ~ 4 months of hematopoietic needs. But premature, twins, mother suffering from fetal blood loss and iron deficiency anemia, may make children less than iron certificates.

(2) inadequate iron intake. The main human newborns milk or eating milk, and milk and milk were both lower in the iron, not only by the timely addition of dairy feeding iron more supplementary food, vulnerable to anemia.

(3) Growth summary. Infant Growth and Development rapidly. 3 to 5 months for newborn weight of 2 times, 1-year-old at birth weight, three times, but if the weight gain in premature infants faster. As weight increases blood volume also increased rapidly at this time was prone to iron deficiency, anemia caused.

(4) the loss of too much iron. Normal daily excretion milling baby more than adults, by the skin of iron losses are relatively high, if the emergence of protein allergies and intestinal bleeding occurred, the stolen iron more. In addition, the number of diseases such as chronic diarrhea, intussusception, intestine, polyps, and so increase the consumption of iron caused anemia.