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Angioedema

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    Angioedema Angioedema Presentation Transcript

    • Learning objectives • Define Angioedema & Mention its types. • State the Etiological Causes. • Explain the Pathophysiology. • Mention the Signs & Symptoms. • Clarify the Diagnostic Investigations. • Demonstrate the Treatment & prevention.
    • Angioedema • Rapid nonpitting edema of the dermis, subcutaneous tissue, mucosa and submucosal tissues. • Self-Limited, subcutaneous edema resulting from increased vascular permeability o Dilation of venules and capillaries o Limited to the superficial dermis • Generally resolves over 24-48 hours
    • Etiology Allergic Angioedema Ace Inhibitor Induced Angioedema Chronic Idiopathic Angioedema Acquired Angioedema Hereditary Angioedema
    • Allergic Angioedema• Most Common Type• Classic histamine response• Causes; Food, Drugs, Bee Sting, venom, latex• Urticaria Present Urticaria• Complement assays normal
    • AllergenPathophysiology 1. Allergic reaction Mast cell FcɛRIHistamine IgE
    • Pathophysiology2. Systemic effects↑ mucus BV expansion Conservative Itching &secretion & edema Respiratory rash airways
    • Ace Inhibitor Induced Angioedema • Increased Bradykinin • Airway edema is the most common presentation • Causes; nonsteroidal anti- inflammatory drugs (NSAIDs) and intravenous contrast material; aspirin is the most common culprit. • Complement assay normal
    • Bradykinin• A mediator that functions to; o Potent endothelium vasodilator o Contraction of non-vascular smooth muscle o Increases vascular permeability o Involved in mechanism of pain
    • Chronic Idiopathic Angioedema • The exact mechanisms are unclear. Some may be associated with urticaria. Based on responses to medication, some cases are mediated by mast cell activation. • Urticaria present. • Laryngeal edema rare. • Causes are, by definition, not identifiable. • Complement assays normal.
    • Hereditary Angioedema • Rare (1:50 000-1:150 000) • Autosomal Dominant • Cause; chromosome 11 abnormality • Disorder of C1INH (only regulator of classical complement pathway activation) o Type 1 (85%) low levels of C1INH and functional deficiency o Type 2 (15%) Normal protein concentration but functional defect
    • Hereditary Angioedema Pathophysiology C1-INH Vaso-plasmin kallikrein Bradykcinin Angioedema dilation
    • Acquired Angioedema • Most similar in mechanism to HAE • No Family History • Causes; Deficiency of C1-INH due to o Type I: Lymphoproliferative Disorder (MDS/MGUS) o Type II: Autoimmune Disorder (SLE) 4th decade of life • All complement assays are low including C1q
    • Signs & Symptoms • Sudden appearance of red welts, near eyes & lips, also hands, feet, and inside of throat • Burning, painful, swollen areas; sometimes itchy • Discolored patches or rash on the hands, feet, face, or genitals • hoarseness, tight or swollen throat, breathing trouble
    • Complications The distinction Anaphylaxis between symptoms of Angioedema & complications of Angioedema is unclear or Life- arbitrary. threatening airway blockage
    • Diagnosis • The health care provider will o Look at your skin o Ask about beening exposed to any irritating substances. • A physical exam might reveal abnormal sounds (stridor) when you breathe in if your throat is affected. • The health care provider may perform o blood tests o allergy testing
    • Treatment• If the person has trouble breathing, seek immediate medical help.• Medications include Antihistamines Anti-inflammatory medicines (corticosteroids) Epinephrine shots Inhaler medicines that help open up the airways Ranitidine (Zantac)
    • Prevention Avoid irritating the Stay away from known affected area. allergens. Never take medications that are not prescribed
    • References • http://el.trc.gov.om:4000/htmlroot/MEDICAL/tcolon/biochemistry/Gen eral/Presentations/Angioedema.ppt • http://www.medicine.uottawa.ca/Otolaryngology/assets/documents/Gr and_Rounds_Archive/General%20Otolaryngology/Angioedema%20(S.%20J ohnson).ppt • https://dl.dropbox.com/s/ly1bc2of9mz31rs/pathophysiology%20of%20An gioedema.pptx?dl=1 • http://health.nytimes.com/health/guides/disease/angioedema/overvie w.html • http://aacallergy.com/angioedema/ • http://www.nlm.nih.gov/medlineplus/ency/article/000846.htm • http://emedicine.medscape.com/article/135208- overview#aw2aab6b2b2aa
    • Fatima AlAwadh