(1) Blood Vessels ; Part 2 (Martin) Flashcards
Noninfectious vasculitis
What is the major cause?
IMMUNE RESPONSE
*This is REALLY common
What are the four most prominent forms of noninfectious vasculitis?
Giant cell (temporal) arteritis
Polyarteritis nodosa (PAN)
Granulomatosis with Polyangiitis
Thromboangiitis Obliterans (aka Buerger disease)
What is the only form of vasculitis that is associated with the aorta?
Giant cell arteritis
What is the only form of vasculitis that REQUIRES eosinophils?
Churg-Strauss syndrome
What is the only form of vasculitis that REQUIRES neutrophils?
Behcet disease
Clinical history: Name the associated vasculitis
>40yrs old , +/- polymyalgia rheumatica
Giant cell arteritis
Clinical history: Name the associated vasculitis
Asthma, Atopy
Churg-Strauss Syndrome
Clinical history: Name the associated vasculitis
Young male smoker
Buerger Disease
*It’s nice for young males to eat a BUERGER while smoking
Clinical history: Name the associated vasculitis
Orogenital ulcers
Behcet disease
Immune complex vasculitis
Describe the pathogenesis
Autoantibody production and formation of immune complexes
Deposition of antigen-antibody complexes in vascular walls
Immune complex vasculitis may be seen in…
1.
2.
3.
- Systemic immunologic diseases (SLE)
- Drug hypersensitivity
- Secondary exposure to infectious agent
What is the only infectious agent involved in immune complex vasculitis?
What is it associated with?
Polyarteritis nodosa
Hep B
Giant cell (temporal) arteritis and aortitis
Population?
Immune players?
Anatomy?
Symptoms?
Older pts
T cell mediated
Temporal arteries
Double vision, constitutional symptoms (fever, fatigue, wt loss, headache)
***Remember: The symptoms make sense because headaces, double vision are in close proximity to the temporal artery
Takayasu arteritis
Unique sx?
Population?
Similar to giant cell arteritis except?
Pulseless disease, weak pulse and low BP in UE
Historically Japanese, now global , <50
Involves aortic arch and major branch vessels
Polyarteritis nodosa (PAN)
Anatomy?
Population?
1/3 of pts have?
Unique sx?
Involves Renal vessels, GI tract
Young adult
Chronic hepatitis B
Abdominal pain, bloody stools
***You use a PAN to cook food that you will eat, and your GI system will digest. (way to remember symptoms and anatomy of PAN)
Kawasaki disease
Population?
Anatomy?
Unique symtpoms?
Infants and Small children
Coronary arteries
Erythema of the conjunctiva, oral mucosa, palms and soles
***Imagine: A small child riding a Kawasaki motorcycle…the child’s palms and soles must be firmly on the motorcyle or it will fall off and die
Microscopic polyangiitis
Anatomy?
Associated with?
Aka?
Unique Sx?
Renal glomeruli and lung capillaries
MPO-ANCA
Leukocytoclastic vasculitis/hypersensitivity vasculitis
Palpable cutaneous purpura
Churg-Strauss syndrome
HIGHLY associated with?
Highly resembles PAN or microscopic polyangiitis with the addition of?
Allergies!!!
Eosinophils and granulomas
What is the classic triad sx of behcet disease?
- Aphthous ulcers of the oral cavity
- Genital ulcers
- Uveitis
What non-infectious vasculitis is associated with HLA-B51?
Behcet disease
Granulomatosis with Polyangiitis
Sx?
Associated with?
Morphology?
Penumonitis, sinusitis, renal disease and nasopharyngeal ulceration
PR3-ANCA
Geographic patterns of central necrosis, lung cavitations
Thromboangiitis obliterans (Buerger disease)
Anatomy?
Sx?
Popoulation?
Tibial and radial arteries
chronic ulcerations, may lead to gangrene
Heavy smokers <35y/o
What are the three direct infectious agents for infectious vasculitis?
- Pseudomonas
- Aspergillus
- Mucor
Raynaud phenomenon
What is it?
Common saying?
Excessive vasospasm of small arteries and arterioles, especially fingers and toes
“red, white and blue”=proximal vasodilation, central vasoconstriction and distal cyanosis
What are the main differences b/w Primary and Secondary Raynaud?
Primary= induced by cold or emotion, symmetric, common in young women, benign
Secondary= Scleroderma, asymmetric, worsens with time
Varicose veins are…
SUPERFICIAL
This is important because you do NOT get DVTs from varicose veins
What is the most important risk factor for developing a DVT?
Thrombophlebitis
What is the most common agent of lymphangitis?
Group A Beta-hemolytic streptococci
What is lymphangitis?
Acute inflammation and spread of bacterial infection into lymphatics
Red, painful subcutaneous streaks & painful enlargement of draining lymph nodes
What are hemangiomas?
Common tumors that are benign and vascular
What are kaposi sarcomas (KS) caused by?
HHV8
What are the three major ways to stent endovascularly?
Balloon angioplasty
Coronary stents
Drug-eluting stents
