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AS - N935 Advanced Patho II > Autoimmune Diseases > Flashcards

Autoimmune Diseases Flashcards

1
Q

Autoimmune Diseases

Organ-Specific Diseases Mediated by Antibodies

A 
Autoimmune hemolytic anemia
Autoimmune thrombocytopenia
Autoimmune atrophic gastritis or perniculous anemia
Myasthenia gravis
Grave's disease
Goodpasture syndrome
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2
Q

Autoimmune Diseases

Systemic Diseases Mediated by Antibodies

A

Systemic lupus erythematosus

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3
Q

Autoimmune Diseases

Organ-Specific Diseases Mediated by T Cells

A

Type 1 diabetes

Multiple sclerosis

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4
Q

Autoimmune Diseases

Systemic Diseases Mediated by T Cells

A

Rheumatoid arthritis
Systemic sclerosis (scleroderma)
Sjogren syndrome

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5
Q

Autoimmune Diseases

Organ-Specific Diseases Postulated to be Autoimmune

A

Inflammatory bowel diseases (Crohn’s disease or ulcerative colitis)
Primary biliary cholangitis
Autoimmune (chronic active) hepatitis

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6
Q

Autoimmune Diseases

Systemic Diseases Postulated to be Autoimmune

A

Polyarteritis nodosa

Inflammatory myopathies

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7
Q

Lupus

A

Systemic disease mediated by antibodies
Complex multi-systemic autoimmune disease characterized by presence autoreactive B & T cells & production broad heterogenous group auto-antibodies

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8
Q

Lupus Pathogenesis

A

Women 15-44yo
African American, Asian Americans, Hispanic/Latinos, Native Americans, or Pacific Islanders
50 genes associated w/ SLE
UV light, infection, virus, stress
Auto-antibodies production w/o regulation
Immune activation T & B cells hyperactive & innate immune systems programmed towards inflammation eventually leading to tissue damage & clinical disease manifestations

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9
Q

Lupus Diagnosis

A 
CBC
Antibody tests
- ANA
- Anti dsDNA antibody
Complement test
Blood clotting tests
Urine test
Biopsies
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10
Q

Lupus Classification

A 
Malar rash
Photosensitivity
Oral or nasopharyngeal ulcers
Discoid rash
Renal disorders
Serositis (pleurisy, pericarditis)
Neurologic disorders
Hematologic disorders
Immunologic disorders
Non-erosive arthritis at least 2 peripheral joints
Presence antinuclear antibody (ANA)
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11
Q

Lupus Types

A

Systemic lupus erythematosus
Drug-induced lupus erythematosus (hydralazine, procainamide, isoniazid)
Cutaneous lupus erythematosus - caused by maternal antibodies, born w/ skin rash, liver problems, & low blood counts, congenital heart block
Neonatal lupus

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12
Q

SLE S/S

A

CNS - vasculitis, anxiety, depression, psychosis, seizures, stroke
CV - pericarditis, pericardial effusions, CHF, HTN, mitral/aortic regurgitation, conduction defects, thrombocytopenia, anemia, leukopenia, antiphospholipid syndrome (acquired hypercoagulability - embolism)
Pulmonary - pleural effusions, restrictive disease, atelectasis
Airway - mucosal ulceration, cricoarytenoid arthritis, recurrent laryngeal nerve palsy
Renal - glomerular nephritis, proteinuria, hypoalbuminemia, hematuria, renal failure
Musculoskeletal - arthritis, avascular necrosis d/t steroid use

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13
Q

Lupus Treatment

A 
Tylenol 
NSAIDs
Immunosuppressants
Corticosteroid
Antimalarial
Anticoagulants
Monoclonal antibodies
Repository corticotropin injections
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14
Q

Lupus Anesthetic Implications

A 
Pre-anesthesia evaluation
Cricoarytenoid arthritis (airway implications)
Recurrent laryngeal nerve palsy
Preop testing - PFTs, echo, EKG, renal function, labs
Corticosteroids stress dosing
Discontinue anticoagulants
Consult w/ rheumatologist
Potential postop obstruction
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15
Q

Rheumatoid Arthritis

A

Onset 25-55yo
2-3x more prevalent in women

Environmental
Heredity (genetic factors 50%)
Viral/bacterial infection

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16
Q

Osteoarthritis

A 
Degenerative disease
Morning stiffness lasting <30min
Heberden's nodes
Asymmetrical
Cartilage loss
17
Q

Rheumatoid Arthritis S/S

A 
Autoimmune disease
Morning stiffness lasting >30min
Extra-articular involvement
Symmetrical - vary in severity (S/S come & go)
Inflamed synovium

Smaller joints involved 1st (hands, feet, wrists) & progresses to ankles, hips, shoulders
Inflamed synovial joint membrane
Rapid division & cell growth w/in joint
Pro-inflammatory cytokines
Release osteolytic enzymes, collagenases, proteases

Nerve entrapment - carpal tunnel syndrome
TMJ - synovitis 45-75% involvement

18
Q

Atlantoaxial Instability

A

C1-C2 (atlas-axis) involvement
Atlanto-odontoid separation → neurologic damage
Atlantoaxial subluxation → impairs vertebral artery blood flow

19
Q

Cricoarytenoid Joint

A

26-86% patients w/ severe RA
Vocal cord nodules or polyps
Present w/o clinical symptoms

Hoarseness
Pain w/ swallowing
Stridor
Dyspnea

20
Q

RA Treatment

A 
Disease modifying anti-rheumatic drugs DMARDS
Non-biologic
Anti-metabolite
- Methotrexate (Rheumatrex)
- Sulfasalazine
- Azathioprine
Biologic TNF inhibitors
- Etanercept (Enbrel)
- Adalimumab (Humira)
- Infliximab (Remicade)
Interleukin-1 receptor agonists
- Leflunomide (Arava)
Anti-CD20 monoclonal antibody
- Rituximab (Rituxan)
21
Q

RA Anesthetic Considerations

A

Medications - NSAIDs & corticosteroids
Airway - TMJ, cervical spine, cricoarytenoid joint
Positioning - padding to prevent further joint damage
Spinal anesthesia - sensory & ↓CSF

22
Q

Scleroderma

A

“Hard skin”
Inflammation
Vascular sclerosis
Skin & viscera fibrosis
Injury to vascular endothelium results in protein leakage into interstitial space
Collagen production not slowed down & deposited throughout body

23
Q

Scleroderma Causes

A 
Unknown
Collagen vascular disease & autoimmune characteristics
Onset 20-40yo
Women
Accelerated by pregnancy
CREST syndrome
- Calcinoses Ca2+ deposits
- Raynaud's phenomenon
- Esophageal hypomotility
- Sclerodactyly (thickened/tight skin)
- Telangiectasia (dilated capillaries)
24
Q

Scleroderma S/S

A

CNS - peripheral & cranial neuropathies d/t nerve compression by thickened connective tissue, trigeminal neuralgia, dry eyes
Musculoskeletal - thickened skin, diffuse edema, contractures, skeletal muscle myopathy, arthritis & limited joint mobility, avascular necrosis
CV - coronary arteries & conduction system sclerosis, replace cardiac tissues w/ fibrous tissue, systemic & pulmonary HTN, pericarditis & pericardial effusion, intermittent vasospasm, Raynaud’s
Respiratory - diffuse interstitial pulmonary fibrosis 80% patients, arterial hypoxemia 2° ↓diffusion capacity, ↓pulmonary compliance
GI - dry oral mucosa, progressive GI tract fibrosis, dysphagia, hypomotility, ↓LES tone → aspiration risk, malabsorption vitamin K deficiency (coagulopathies)
Renal - ↓renal blood flow → systemic HTN, renal artery stenosis d/t arteriolar intimal proliferation

25
Q

Scleroderma Anesthetic Considerations

A 
Fibrosis potential to lead to limited mouth opening & difficult intubation
Dermal thickening → difficult IV access
Pulmonary HTN
↓pulmonary compliance ↓O2 diffusion
Chronic system HTN
LES hypotonia → aspiration risk
Sensitive to respiratory depressants
Regional anesthesia challenging d/t contractures & ↓joint mobility
Protect eyes from corneal abrasion
Renal dysfunction & drug elimination

AS - N935 Advanced Patho II (20 decks)

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