To download my ANIMATED presenation VISIT https://www.dropbox.com/s/5rfb35jcq45uexa/ANIAngioedema.pptx?m To watch my ANIMATED vedio presentation VISIT www.youtube.com/watch?v=hlqNGUGphuk Thank you

2. 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.

3. 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

4. Etiology
Allergic Angioedema
Ace Inhibitor Induced Angioedema
Chronic Idiopathic Angioedema
Acquired Angioedema
Hereditary Angioedema

5. Allergic Angioedema
• Most Common Type
• Classic histamine response
• Causes; Food, Drugs, Bee
Sting, venom, latex
• Urticaria Present
Urticaria
• Complement assays normal

6. Allergen
Pathophysiology
1. Allergic reaction
Mast cell
FcɛRI
Histamine IgE

7. Pathophysiology
2. Systemic effects
↑ mucus BV expansion Conservative Itching &
secretion & edema Respiratory rash
airways

8. 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

9. 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

10. 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.

11. 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

12. Hereditary Angioedema
Pathophysiology
C1-INH
Vaso-
plasmin kallikrein Bradykcinin Angioedema
dilation

13. 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

14. 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

15. Complications
The distinction
Anaphylaxis
between symptoms
of Angioedema &
complications of
Angioedema is
unclear or
Life-
arbitrary. threatening
airway
blockage

16. 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

17. 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)

18. Prevention
Avoid irritating the Stay away from known
affected area. allergens.
Never take
medications that are
not prescribed

19. 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

20. Fatima AlAwadh