Content of Oslers and Janeway

[alicealicealice]

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Is there a consensus answer for the pathogenesis of these in IE? Ive read conflicting sources. Can anyone verify if this is correct?
Oslers = Painful = immune complex
Roth = retinal hemorrhage, immune complex
Janeway = Flat painless = dermal abscess (bacteria present)

Thanks

 

[ChessMaster3000]

Is there a consensus answer for the pathogenesis of these in IE? Ive read conflicting sources. Can anyone verify if this is correct?
Oslers = Painful = immune complex
Roth = retinal hemorrhage, immune complex
Janeway = Flat painless = dermal abscess (bacteria present)

Thanks

that sounds like a good summary. for janeway, just wanted to add that it is septic emboli from the infected vegetations on the valves. In addition, at least for oslers, its not just immune complex damage but also the inflammation surrounding that complex that causes the pain as well as nodular presentation. While they could ask about immune complexes, I would bet that an answer choice would more likely describe "inflammatory lesions". Hope that helps.

 

[Transposony]

I think Osler’s nodes are due to vasculitis and Janeway's lesions are slightly raised hemorrhages.
However, all three are due to microembolization and the character of the lesion depends on the bacterial load of the thrombi, site of microembolization and the body's response to it.

They are not going to ask the pathophys of these since no one really knows being a case of "blind men and an elephant"

 

[alicealicealice]

UW Spoiler Alert:

Thanks. I was asking because UW stated that janeway had bacteria in them (right answer, but they gave complexes as an answer choice), which I picked bc thats the classical teaching, though I have read different things and it got me confused.
Just had a UW question too about COPDer who lost his respiratory drive after receiving supplemental O2, another thing that's "classical" teaching but which my school taught was mostly apocryphal; i dont know which for sure is true, but its annoyingly confusing!

 

[Transposony]

UW Spoiler Alert:

Thanks. I was asking because UW stated that janeway had bacteria in them (right answer, but they gave complexes as an answer choice), which I picked bc thats the classical teaching, though I have read different things and it got me confused.
Just had a UW question too about COPDer who lost his respiratory drive after receiving supplemental O2, another thing that's "classical" teaching but which my school taught was mostly apocryphal; i dont know which for sure is true, but its annoyingly confusing!

Guess we have to keep classical teaching in mind.
I researched this topic a lot while preparing for CK and consulted Harrison, Davidson, Medstudy, Robbins and Goljan RR etc
Most say that Janeway lesions are due to septic emboli also saying that it is painless and hemorrhagic ?
A patient with SABE is going to throw off septic emboli only so why Janeway & Roth are hemorrhagic while Osler's is nodular & painful?
Maybe because of the site ? of embolism in Osler's (rich capillary plexus under the dermal pappila>inflammation/vasculitis?)

You are right about the COPD.
They don't lose their respiratory drive after receiving supplemental O2. Only that CO2 rises due to increased physiological dead space but you still give them supplemental O2.