2: Vasculitis & HTN Flashcards
What does the word vaculitis mean?
Vessel wall inflammation
What is the most common cause of vaculitis? (Hint: think general, not specific conditions)
Immune-mediate inflammation
Other general causes:
- Direct invasion of vascular wall by infectious pathogens
- Physical/mechanical injury
What are the clinical symptoms of vasculitis?
Fever, myalgias, arthralgias, malaise
What is the immune complex associated cause of noninfectious vasculitis?
SLE (Lupus)
- specific antigen rarely identified
- drug hypersensitivity and secondary to infections
What cause of noninfectious vasculitis is associed with anti-endothelial cell antibodies?
Kawasaki disease–> antibodys against your own endothelial cells
Which conditions fall under Large Vessel Vasculitis? (Picture the diagram!)
Takayasu Arteritis
Giant Cell Arteritis (Temporal Arteritis)
What conditions fall under Medium Vessel Vasculitis?
Polyarteritis Nodosa (PAN)
Kawasaki Disease
Where in the body would you expect to see the effects of Giant Cell Arteritis?
Temporal region–> because GCA is also known as Temporal Arteritis
Symptoms: headache, facial pain, temporal pain, jaw claudication
What gross pathology would you expect to see with Giant Cell Arteritis?
- Segmental nodular thickening of artery
- Narrowing of lumen (similar to atherosclerosis)
What microscopic pathology would you expect in active Giant Cell Arteritis?
- Mononuclear cell (macrophage, T lymphocyte) infiltration in internal elastic lamina and tunica media
- Granulomatous inflammation–> multinucleated giant cells at internal elastic lamina
- Focal involvement
What is the hallmark of the healed phase of Giant Cell Arteritis?
Elastic Fragmentation
Also would see: medial scarring and adventitial fibrosis
A 3yr old child is being seen in the ER with the following symptoms: fever, enlarged lymph nodes, strawberry tongue, edema of hands/feet, erythema of palms/soles, rash, and redness of the mucosal membranes.
What condition should you suspect?
Kawasaki Disease (AKA Mucocutaneaous Lymph Node Disease)
Hints
- On the test, anything with a kid is probably Kawasaki’s
- “Strawberry tongue”
- “Fever” –> Acute febrile (feverish), usually self-limited illness of infant/child
What is the expected microscopic pathology of Kawasaki Disease?
- Dense transmural inflammatory infiltrates (not symmetrical, more focal)
- Fibrinoid necrosis (less common)
- Thrombosis may occur
A 30yr old male with a history of smoking is urgently referred to the vascular clinic because he has been experiencing claudication in his lower legs, Raynaud’s like symptoms, and (per his primary care physician) superficial thrombophlebitis. The patient relates to you that he has severe pain, and ulcers on his hands and feet, with some of them turning black and he is very scared. Upon testing, you can tell that both his arteries and veins are being affected, and that he has HLA-A9 and HLA-B5 haplotypes.
What is your diagnosis?
Thromboangiitis Obliterans (Buerger Disease) –> hypersensitivity to tobacco antigens
Key points:
- Male, < 35yrs, cigarette smokers
- Triad: Raynaud phenomenon, claudication, superficial thrombophlebitis
- Severe pain, ulceration of toes/feet/fingers, gangrene
- Linked to HLA-A9 and HLA-B5 haplotypes
Treatment: STOP SMOKING
What are the two main components of Raynaud phenomenon?
Pallor and Cyanosis
What disease is characterized by the following triad of symptoms:
- Necrotizing/granulomatous vasculitis of small and medium sized vessels (most prominent in lung, upper airways, kidney)
- Necrotizing granulomas of upper respiratory and/or lower respiratory tract
- Focal/segmental necrotizing glomerulonephritis w/ crescent formation
Granulomatosis w/ Polyangiitis (AKA Wegeners Granulomatosis)
During an autopsy, you encounter a set of kidneys that show signs of benign nephrosclerosis, including reduced size, finely granular cortical surfaces, and cortical scarring. Under a microscope, you see hyaline arteriolosclerosis, aterial intimal fibrosis and mild hyperplasia, and chronic ischemic changes.
What do you think this patient suffered from that caused their benign nephrosclerosis?
Benign HTN
Clinical features: proteinuria, slow progression to renal failure
Which of these image sets are related to malignant HTN and it’s affects on the kidney?
a.
b.
c Uhhh, I thought this was brain cancer??
a. benign
b. malignant
In malignant HTN, what gross pathology would you expect to see on the kidneys?
Punctate hemorrhages–> looks like a stabbing pattern (petechiae)
