A Case of Nursing Experience of an Adult Abdominal HSPGr upSM
How to cite this article Qing L and Zhangrong Y. A Case of Nursing
Experience of an Adult Abdominal HSP. SM J Cardiolog and Cardiovasc
Disord. 2019; 5(1): 1025.OPEN ACCESS
Introduction HSP is a common vasculitis allergic hemorrhagic
disease. According to the location and clinical
manifestations of the disease, it can be classified into simple
type, abdominal type, joint type and renal type. Abdominal HSP is
the most potentially dangerous type [3]. A combination of two or
more types of the disease that occurs simultaneously is mixed type.
In addition to skin petechiae or purpura, the most common symptom
of abdominal HSP is abdominal pain. It mostly occurs in the
periumbilical, lower or whole abdomen, showing paroxysmal colic
with nausea, vomiting, diarrhea and other symptoms. Renal purpura
is the most severe type [4], hematuria and albuminuria may occur in
a week after the onset of purpura, and edema probably occurs in a
few patients.
Case Analysis A case analysis of abdominal HSP admitted in our
department is as follows:
The patient developed pain in the epigastric and periumbilical
region without obvious inducement three days before
hospitalization. He developed continuous swelling pain, which is
paroxysmal increasingly severe, with nausea, vomiting, diarrhea.
One day later, the pain metastasized to the right lower quadrant.
There was no obvious abnormality in blood routine. Ultrasonography
of the epigastrium and appendix indicated a small amount of
effusion in the right lower intestinal space. After treatment the
pain is getting severe, and then hospitalized. Pelvic cavity CT
scan showed effusion of small intestine in pelvic cavity, the part
intestinal wall became edematous and thicker. No abnormality was
found in urinary color ultrasound, the sonogram showed thickening
of the appendix, so the patient was treated with acute
appendicitis.
The patient underwent emergency appendectomy on the same day,
intraoperative findings: there was 200 ml pale red clear effusion
in perihepatic, right sulci paracolici and pelvic cavity, and no
obvious displacement of greater omentum. The appendix lies in the
inferior position of the cecum, which is about 7cm in length and
0.6cm in diameter. The appendix is full of hyperaemia and edema.
Ileal hyperemia and edema were obvious in 20-50 cm from the
ileocecal valve. Anti-inflammatory therapy was given after
operation.
The patient still had pain and weakness in the epigastric and
periumbilical region after surgery, gurgling sound was regular. Six
days after surgery, the patient developed petechiae, pruritus and
no pain in the lower limbs, and gradually developed symptoms of
swelling in the limbs, lower back, and face. It is concluded to be
abdominal HSP. After the treatment of intravenous injection of
10mg/ qd dexamethasone, VC and calcium gluconate, 10 mg/qd/po
loratadine purpura was alleviated, but abdominal pain and anasarca
were not.
12 days after surgery, the urine showed a dark brown color. 24-hour
urinary protein quantity is 4800.5mg/d, the urine volume was 3830
ml in 24h. Urine protein was 1253.4 mg/L. Albumin was 32.1 g/L,
urea was 4.55 mmol/L, creatinine was 57.2 mmol/L, and leukocyte was
7.11 ×109/L. The patient was transferred to nephrology department
for further treatment 20 days after operation. The anti-allergic,
anti-inflammatory and other treatment was continued to given.
Case Report
A Case of Nursing Experience of an Adult Abdominal HSP Lin Qing*
and Yang Zhangrong Department of Cardiology, Pidu District People’s
Hospital, P.R. China
Article Information
Received date: Dec 21, 2018 Accepted date: Jan 15, 2019 Published
date: Jan 17, 2019
*Corresponding author
Lin Qing, Pidu District People’s Hospital, Chengdu 611730, P.R.
China, Email:
[email protected]
Distributed under Creative Commons CC-BY 4.0
Keywords Adults; HSP; Acute abdomen; Appendicitis; Renal
impairment
Abstract
The incidence of adult abdominal HSP is relatively low, and the
early symptom is abdominal pain [1], therefore it is often
misdiagnosed as acute abdomen. By summarizing the manifestations,
stating the treatment and nursing, and reviewing the domestic and
foreign literature in recent years of abdominal HSP. We found the
rate of misdiagnosis of abdominal HSP is relatively high,
especially in primary hospitals [2]. The recognition and
identification of abdominal HSP in adults is still insufficient. In
order to raise people’s awareness of the disease, reduce the
misdiagnosis and missed diagnosis of the disease, and strengthen
the nursing care, further study needs to be done.
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Gr upSM Copyright Qing L
The patient developed pain in the epigastric region without obvious
inducement. CT image shows the appendix enlarged in diameter.
Appendix was excised under laparoscopy, and then purpura symptoms
appeared, hormonotherapy was given. The patient developed
irreversible kidney damage. In the course of nursing after surgery,
it was found that the abdominal pain was not alleviated, the
incision pain and complications were excluded, purpura and edema
appeared in the observation of the condition, and then the
abdominal HSP was treated symptomatically. 24-hour urine volume was
checked and the changes of urine volume and body weight were
recorded.
Discussion and Conclusion In order to reduce the occurrence of
missed diagnosis and
misdiagnosis and strengthen the observation and discrimination
ability of nurses. Through the collection and integration of
literature, this paper lists the common symptoms, treatment and
nursing process of adult abdominal HSP.
Abdominal HSP is more common in children, and rare in adults [5].
IL-34 may be involved in the pathogenesis of HSP, this may be
related to the abnormal expression of proinflammatory factors in
HSP [6], which promotes the occurrence and development of vascular
inflammation. Studies have shown that ligustrazine combined with
urbason has good clinical effect in the treatment of adult
abdominal HSP [7].
The initial symptoms of abdominal HSP in adults are usually acute
abdomen without obvious inducement [8]. Anaphylaxis may or may not
occur prior to the illness onset. Symptoms could not be alleviated
after routine treatment of acute abdomen [9], typical symptoms of
HSP such as rash appeared along with the course of disease.
In clinical treatment and nursing, nurses should handover and take
physical examinations strictly, and observe the changes of
abdominal physical signs, systemic symptoms, rashes, edema
regression, urine color, character, quantity and other changes
[10]. These could reduce the long-term impact of HSP on
patients.
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