5. Arteritis and Aneurysms Flashcards
What is arteritis?
Inflammation of the arterial wall
Why does a negative biopsy not exclude a diagnosis of arteritis?
Not uniform along the length of artery so could have been missed
What are the consequences of arteritis?
Thrombus > occlusion > infarction
Aneurysm > Rupture > haemorrhage
What are the infective causes of arteritis?
Neisseria Syphilis Rickettsia Aspergillus Herpes
What are the immunological causes of arteritis?
T2HS: ANCA, Anti-GBM disease
T3HS: SLE, RA
T4HS: allograft organ rejection
IBD and paraneoplastic
Name 3 large elastic arteries
Aorta
Carotids
Iliacs
Name 2 medium muscular arteries
Coronary
Renal
Name 2 large vessel vasculitis
Temporal (>50)
Takayasa(<50)
What arteries are effected by temporal arteritis?
Extracranial branches of the carotid
Can cause blindness
What arteries are affected by Takayasa arteritis?
Aorta and its major branches
Narrowing of vessel lumen
Name a medium vessel arteritis
Polyarteritis nodosa
What vessels are affected by PAN?
Renal and systemic
Necrotising causes nodules
None found in arterioles, capillaries, venules
What infection is associated with PAN?
Hep B
Name 2 small vessel vasculitis
GPA
EGPA
What systems are affected by GPA?
Respiratory
Glomerulonephritis
What system is affected by EGPA?
Respiratory tract
Asthmatics
Blood eosinophilia
What are the causes of aneurysms?
Atherosclerosis Cystic medial degeneration Congenital (berry) Inflammatory (PAN) Infection (syphilis) Trauma
What is cystic medial degeneration?
Deposition of mucopolysaccharides in replacement of elastic tissue in artery wall
Weakens walls
What artery is most commonly involved with an atherosclerotic aneurysm?
Abdominal aorta below renal arteries
What is a thoracic aortic dissection?
Blood flows into the wall and causes an intramural haematoma
Usually caused by cystic medial degeneration
What complications are associated with thoracic aortic dissection?
Haemopericardium
Reduced blood supply to organs
What are the risk factors for thoracic aortic dissection?
Men age 40-60 with hypertension
Marfan’s syndrome
Arterial cannulation
Pregnancy
What stage of syphilis is associated with syphilitic aneurysms?
Tertiary
What are berry aneurysms?
Most common type of intracranial aneurysm
Saccular aneurysm around circle of willis
What type of haemorrhage is caused by a ruptured berry aneurysm?
Subarachnoid haemorrhage
What are the risk factors for berry aneurysms?
Polycystic kidney
Ehler’s-Danlos syndrome
Marfan’s syndrome
Smoking and hypertension
What are capillary microaneurysms?
Caused by hypertension in brain
What type of haemorrhage is caused by a ruptured capillary microaneurysm?
Intracerebral
What other morbidity are capillary microaneurysms associated with?
Retinal haemorrhage in diabetics
