Ebook Atlas of pediatric emergency medicine (2/E): Part 2
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Ebook Atlas of pediatric emergency medicine (2/E): Part 2
RHEUMATOLOGYChapter 12RHEUMATOLOGYBinita R. ShahRaynaud phenomenon453KAWASAKI DISEASEClinical SummaryKawasaki disease (KD: also known as mucocutaneous Ebook Atlas of pediatric emergency medicine (2/E): Part 2s lymph node syndrome) is an immune-med iated disorder of unknown etiology that occurs in genetically predisposed children leading to endothelial cell injury and vasculitis of mainly mediumsized arteries (predilection for coronary arteries). Small arterioles, larger arteries, capillaries, and veins Ebook Atlas of pediatric emergency medicine (2/E): Part 2are affected to a lesser extent. KD occurs in all ethnic groups: however, incidence is highest in East Asia and in children of Asian descent. ClinicalEbook Atlas of pediatric emergency medicine (2/E): Part 2
and epidemiologic features strongly support an infectious etiology. About 80% of patients are <5 years of age (peak: between 18 and 24 months): aboutRHEUMATOLOGYChapter 12RHEUMATOLOGYBinita R. ShahRaynaud phenomenon453KAWASAKI DISEASEClinical SummaryKawasaki disease (KD: also known as mucocutaneous Ebook Atlas of pediatric emergency medicine (2/E): Part 2ude extreme irritability, aseptic meningitis (50%). urethritis (sterile pyuria. 70%). hepatic dysfunction (40%). hydrops of gallbladder, diarrhea, vomiting, abdominal pain, arthritis, or arthralgia (knees, ankles, hips), uveitis, pneumonitis, testicular swelling, peripheral gangrene, erythema, or in Ebook Atlas of pediatric emergency medicine (2/E): Part 2duration at bacille Calmette-Guerin inoculation site.Incomplete Kawasaki disease refers to KD with incomplete clinical manifestations and occurs moreEbook Atlas of pediatric emergency medicine (2/E): Part 2
commonly in young infants than in older children. Incomplete KD IS the preferred term over atypical KD as these patients do not have any atypical feanRHEUMATOLOGYChapter 12RHEUMATOLOGYBinita R. ShahRaynaud phenomenon453KAWASAKI DISEASEClinical SummaryKawasaki disease (KD: also known as mucocutaneous Ebook Atlas of pediatric emergency medicine (2/E): Part 2awasaki Disease. A 3-year-old child with a history of high fever of 6 days* duration associated with diffuse erythematous maculopapular rash, red lips, and bilateral conjunctival injection. (Photo contributor: Binita R. Shah. MD.)TABLE 12.1 ■ CLINICAL FEATURES OF KAWASAKI DISEASEDiagnosis is establi Ebook Atlas of pediatric emergency medicine (2/E): Part 2shed clinically by:a.Presence of fever and at least 4 of the 5 criteria listed below, orb.Presence of fever and at least 3 of the 5 criteria listed beEbook Atlas of pediatric emergency medicine (2/E): Part 2
low, and evidence of coronary artery abnormalities1Fever: high and unremitting (lasting 5 days or more, unresponsive to antipyretics and antibiotics)2RHEUMATOLOGYChapter 12RHEUMATOLOGYBinita R. ShahRaynaud phenomenon453KAWASAKI DISEASEClinical SummaryKawasaki disease (KD: also known as mucocutaneous Ebook Atlas of pediatric emergency medicine (2/E): Part 2ucous membrane changes (at least one of the following): erythematous or fissured lips: erythema of buccal mucosa and pharynx; “strawberry" tongue4Conjunctivitis: bilateral bulbar involvement; nonexudative5Changes in distal extremities (at least one of the following): erythema of palms or soles; indu Ebook Atlas of pediatric emergency medicine (2/E): Part 2rative edema of hands or feet; periungual desquamation of fingers and toes (1-3 weeks after onset of illness)6Cervical lymphadenopathy (least constantEbook Atlas of pediatric emergency medicine (2/E): Part 2
finding): unilateral; at least one node 1.5 cm or larger in diameter: nonpurulentClinical phases (after onset of illness):•Acute febrile phase: up toRHEUMATOLOGYChapter 12RHEUMATOLOGYBinita R. ShahRaynaud phenomenon453KAWASAKI DISEASEClinical SummaryKawasaki disease (KD: also known as mucocutaneous Ebook Atlas of pediatric emergency medicine (2/E): Part 2eurysms)•Convalescent phase: up to 6 to 8 weeks (illness disappears. ESR. C-reactive protein return to normal)454KAWASAKI DISEASE (CONTINUED) > 455FIGI JRE 12.2 ■ Features of Kawasaki Disease (KD). (A) Temperature curve in a typical untreated ease ofKD. With the administration of intravenous immune Ebook Atlas of pediatric emergency medicine (2/E): Part 2globulin on the seventh day of hospitalization (diagnosis of KD entertained), temperature remrned to normal. (Bl Red lips with fissuring. giving rhe aEbook Atlas of pediatric emergency medicine (2/E): Part 2
ppearance of red lipstick. (C) Nonexudative conjunctivitis. I D> Red strawberry tongue. (E) Erythema of rhe palm with desquamation of fingers, seen onRHEUMATOLOGYChapter 12RHEUMATOLOGYBinita R. ShahRaynaud phenomenon453KAWASAKI DISEASEClinical SummaryKawasaki disease (KD: also known as mucocutaneous Ebook Atlas of pediatric emergency medicine (2/E): Part 2nt with KD on the fourth day of illness. (Hl Cervical adenopathy. (I) Desquamation of the fingers on the 12th day of illness. (Photo contributor: Binita R. Shah. NfD.)456 a KAWASAKI DISEASE (CONTINUED)FIGURE 12.3 ■ Kawasaki Disease (KD).Ebook Atlas of pediatric emergency medicine (2/E): Part 2
ding coronary arteries may be involved. IB) Sonogram of the right upper quadrant shows thick-wall, dilated gallbladder Acute acalculous hydrops OCCUISRHEUMATOLOGYChapter 12RHEUMATOLOGYBinita R. ShahRaynaud phenomenon453KAWASAKI DISEASEClinical SummaryKawasaki disease (KD: also known as mucocutaneous Ebook Atlas of pediatric emergency medicine (2/E): Part 2onObtain CBC (normal to elevated WBC count with a predominance of polymorphonuclear leukocytes and normocytic anemia). ESR and C-reactive protein (usually elevated). liver enzymes (elevated with hypoalbuminemia). and urinalysis (sterile pyuria and proteinuria). If clinically indicated, perform a lum Ebook Atlas of pediatric emergency medicine (2/E): Part 2bar puncture; cerebrospinal fluid will show mild pleocytosis with normal glucose and usually normal protein. Obtain chest radiograph to look for cardiEbook Atlas of pediatric emergency medicine (2/E): Part 2
omegaly and an ECG for evidence of myocarditis, pericarditis, or arrhythmias. Admit patients with clinical diagnosis of RD or incomplete KD for continRHEUMATOLOGYChapter 12RHEUMATOLOGYBinita R. ShahRaynaud phenomenon453KAWASAKI DISEASEClinical SummaryKawasaki disease (KD: also known as mucocutaneous Ebook Atlas of pediatric emergency medicine (2/E): Part 2ose aspirin (given until patient is afebrile for at least 3-4 days) followed by antithrombotic dose (given until platelet count. ESR and ECHO are normal). Low-dose aspirin therapy is continued indefinitely if a coronary' artery abnormality is detected. Consult cardiology on admission. Patients need Ebook Atlas of pediatric emergency medicine (2/E): Part 2a 2-dimensional ECHO at baseline and during subsequent follow-ups.Pearls1RD is a lead ing cause of acquired heart disease in children.2AdministrationEbook Atlas of pediatric emergency medicine (2/E): Part 2
of IVIG in the acute phase (within 10 days of onset of fever) significantly reduces the prevalence of coronary artery' dilation and aneurysms.RHEUMATOLOGYChapter 12RHEUMATOLOGYBinita R. ShahRaynaud phenomenon453KAWASAKI DISEASEClinical SummaryKawasaki disease (KD: also known as mucocutaneousRHEUMATOLOGYChapter 12RHEUMATOLOGYBinita R. ShahRaynaud phenomenon453KAWASAKI DISEASEClinical SummaryKawasaki disease (KD: also known as mucocutaneousGọi ngay
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