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Learning objectives • Define Angioedema & Mention its types. • State the Etiological Causes. • Explain the Pathophysiology...
Angioedema • Rapid nonpitting edema of the   dermis, subcutaneous tissue, mucosa and   submucosal tissues. • Self-Limited,...
Etiology     Allergic Angioedema     Ace Inhibitor Induced Angioedema     Chronic Idiopathic Angioedema     Acquired Angio...
Allergic Angioedema• Most Common Type• Classic histamine response• Causes; Food, Drugs, Bee  Sting, venom, latex• Urticari...
AllergenPathophysiology 1. Allergic reaction                        Mast cell                        FcɛRIHistamine       ...
Pathophysiology2. Systemic effects↑ mucus     BV expansion   Conservative   Itching &secretion     & edema       Respirato...
Ace Inhibitor Induced Angioedema • Increased Bradykinin • Airway edema is the most   common presentation • Causes; nonster...
Bradykinin• A mediator that functions to; o Potent endothelium vasodilator o Contraction of non-vascular smooth   muscle o...
Chronic Idiopathic Angioedema • The exact mechanisms are unclear. Some may be   associated with urticaria. Based on respon...
Hereditary Angioedema • Rare (1:50 000-1:150 000) • Autosomal Dominant • Cause; chromosome 11 abnormality • Disorder of C1...
Hereditary Angioedema    Pathophysiology          C1-INH                                               Vaso-plasmin       ...
Acquired Angioedema • Most similar in mechanism to HAE • No Family History • Causes; Deficiency of C1-INH due to    o Type...
Signs & Symptoms        • Sudden appearance of red welts, near eyes          & lips, also hands, feet, and inside of throa...
Complications  The distinction                     Anaphylaxis between symptoms of Angioedema &  complications of   Angioe...
Diagnosis • The health care provider will   o Look at your skin   o Ask about beening exposed to any irritating     substa...
Treatment• If the person has trouble breathing, seek immediate  medical help.• Medications include         Antihistamines ...
Prevention     Avoid irritating the       Stay away from known       affected area.                 allergens.            ...
References • http://el.trc.gov.om:4000/htmlroot/MEDICAL/tcolon/biochemistry/Gen   eral/Presentations/Angioedema.ppt • http...
Fatima AlAwadh
Angioedema
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Angioedema

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Angioedema

  1. 1. 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.
  2. 2. 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
  3. 3. Etiology Allergic Angioedema Ace Inhibitor Induced Angioedema Chronic Idiopathic Angioedema Acquired Angioedema Hereditary Angioedema
  4. 4. Allergic Angioedema• Most Common Type• Classic histamine response• Causes; Food, Drugs, Bee Sting, venom, latex• Urticaria Present Urticaria• Complement assays normal
  5. 5. AllergenPathophysiology 1. Allergic reaction Mast cell FcɛRIHistamine IgE
  6. 6. Pathophysiology2. Systemic effects↑ mucus BV expansion Conservative Itching &secretion & edema Respiratory rash airways
  7. 7. 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
  8. 8. 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
  9. 9. 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.
  10. 10. 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
  11. 11. Hereditary Angioedema Pathophysiology C1-INH Vaso-plasmin kallikrein Bradykcinin Angioedema dilation
  12. 12. 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
  13. 13. 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
  14. 14. Complications The distinction Anaphylaxis between symptoms of Angioedema & complications of Angioedema is unclear or Life- arbitrary. threatening airway blockage
  15. 15. 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
  16. 16. 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)
  17. 17. Prevention Avoid irritating the Stay away from known affected area. allergens. Never take medications that are not prescribed
  18. 18. 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
  19. 19. Fatima AlAwadh

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