Angioedema

1,772 views

Published on

angioedema

Published in: Health & Medicine, Technology
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,772
On SlideShare
0
From Embeds
0
Number of Embeds
27
Actions
Shares
0
Downloads
50
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • 1882 - Heinrich IrenaeusQuincke (German surgeon and physician 1842-1922)– first to document and recognise angioedema. Referred to as Quinke’s oedema.
  • ABC. Resus area.Adrenaline IM. IV access. Difficult airway trolley + ScalpelBackground – Anaphylaxis/Allergy. Drugs/Exposure/Toxins. HAE.
  • J Emerg Med. 2013 Apr;44(4):764-72. doi: 10.1016/j.jemermed.2012.07.055. Epub 2012 Oct 28.Fresh frozen plasma for progressive and refractory angiotensin-converting enzyme inhibitor-induced angioedema.http://www.medscape.com/viewarticle/781861_1Fresh frozen plasma in the treatment of resistant angiotensin-converting enzyme inhibitor angioedema.Warrier MR, Copilevitz CA, Dykewicz MS, Slavin RG.http://www.ncbi.nlm.nih.gov/pubmed/15191027
  • A2RB’s shouldn’t inhibit degradation of bradykinin??
  • Angioedema

    1. 1. A is for Angioedema Shane Colliss SCGH ED 31/10/13
    2. 2. • Quincke HI (1882). "Über akutes umschriebenes Hautödem". Monatsh Prakt Derm 1: 129–131. http://en.wikipedia.org/wiki/Heinrich_Quincke
    3. 3. :p “I’ve got a patient over in C18NO and he won’t stop sticking his tongue out at me.”
    4. 4. Angioedema • Self limited, asymmetric, localised, non-pitting swelling • Results from increased vascular permeability • Affects lips, eyes, tongue, respiratory and GI mucosa – Less connective tissue = Increased capacity to swell • Laryngeal oedema = 25-40% mortality http://academiclifeinem.com/paucis-verbis-card-angioedema/ http://lifeinthefastlane.com/traumatic-angioedema/
    5. 5. Shane, did you say Urticaria or Angioedema? • Urticaria – Epidermal and dermal oedema – Redness and raised areas on skin only – Itchy. Rarely painful. • Angioedema http://www.virtualmedicalcentre.com/diseases/hives-urticaria/762 – Subcutaneous and mucosa oedema – Swelling below skin and mucosa – Often painful. Sometimes itchy. http://www.dermnetnz.org/reactions/angioedema.html http://en.wikipedia.org/wiki/File:Angioedema2013.JPG
    6. 6. Types of Angioedema • • • • • Allergic / IgE mediated angioedema Non-allergic drug induced angioedema Idiopathic Angioedema Hereditary Angioedema Acquired C1 inhibitor deficiency http://www.dermnetnz.org/reactions/angioedema.html
    7. 7. Management of Angioedema • General approach: – ABC • Low threshhold for intubation – IM Adrenaline – PO/IV steroids – PO/IV antihistamines • Specific management
    8. 8. Allergic Angioedema • IgE mediated / Type I Hypersensitivity • Causes: – Food – Shellfish, Nuts, Eggs – Drugs – Penicillin, NSAIDS, Sulphur – Latex – Venom - Bees • Investigations: – Mast cell tryptase
    9. 9. Mast Cell Tryptase
    10. 10. Non-allergic Drug Induced Angioedema • Commonly ACE inhibitors – ACE inhibitors inhibit ACE • ACE normally degrades bradykinin • Bradykinin causes vasodilation and increases vascular permeability • Inhibition results in rapid accumulation of fluid in the interstitial space
    11. 11. ACEi Induced Angioedema • Approximately 2% of patients are affected • Higher incidence in first month of use • • • • • • Antihistamines won’t work Adrenaline will* work for laryngeal oedema FFP – Try two units Icatibant – Bradykinin B2 receptor antagonist Ecallantide – Kallikrein inhibitor Recombinant C1-Inhibitor http://www.ncbi.nlm.nih.gov/pubmed/15191027
    12. 12. ACEi induced angioedema • “…cessation of the ACEI is necessary to reduce the risk of recurrent episodes.” – http://www.racgp.org.au/download/documents/A FP/2011/December/201112andrew.pdf • A2RB safety?
    13. 13. Idiopathic Angioedema • 38% of presentations http://academiclifeinem.com/paucis-verbis-card-angioedema/ • Frequent, relapsing • ?Autoimmune relationship (SLE?) http://www.dermnetnz.org/reactions/angioedema.html
    14. 14. Hereditary Angioedema • • • • Autosomal dominant Type 1 = Reduced level and function of C1-INH Type 2 = Normal level, poor function of C1-INH Type 3 = Factor XII gene coding mutation • Reduced C1 esterase inhibitor activity  excessive kallikrein  excessive bradykinin production
    15. 15. Hereditary Angioedema • Not associated with urticaria • Precipitants – Stress, trauma, hormonal changes, exercise, alcohol • Onset usually with puberty • Gastrointestinal/Urological/Respiratory/Derm atological symptoms
    16. 16. Hereditary Angioedema • World Allergy Organisation guidelines: – Test for C4, C1-INH protein, C1-INH function – Treat with: • Icatibant – Bradykinin B2 receptor antagonist • Ecallantide – Kallikrein inhibitor • Recombinant C1-Inhibitor – Treat early if airway involvement +/- ETT/trache – HAE 1/2 patients should carry “on demand” treatment for two attacks – Prophylaxis: • Androgen (danazol, stanazolol) increase circulating C1-INH http://emedicine.medscape.com/article/135208-overview
    17. 17. Acquired C1 inhibitor deficiency • Associated with: – B Cell Lymphoma – C1 Inhibitor antibodies http://www.dermnetnz.org/reactions/angioedema.html • Diagnosed at advanced age • No family history • Treatment as for HAE
    18. 18. Who needs admission? http://academiclifeinem.com/wp-content/uploads/2010/03/20100326Angioedema.png
    19. 19. ABC’s of Angioedema • • • • • • A is for Airway and Adrenaline B is for Bradykinin C is for C1 Esterase Inhibitor D is for Drug induced – ACEi, gliptins E is for EpiPen prescription F is for FFP x2 Thanks for listening. I hope you’ve had a swell time.
    20. 20. • Title image: http://thechive.files.wordpress.com/2013/10/pumpkincarving-3.jpg?w=500&h=375 • http://www.dermnetnz.org/reactions/angioedema.html • http://academiclifeinem.com/paucis-verbis-card-angioedema/ • http://lifeinthefastlane.com/education/ccc/angioedema/

    ×