blood vessels Flashcards
what is raynauds
condition where spasms of the arteries cause episode of reduced blood flow
what is the cause of primary raynauds, who commonly gets it
teenagers
it is idiopathic with no underlying disease
what is the cause of secondary raynauds, who commonly gets it
older people
underlying autoimmune disease, ulcers, gangrene
what is the treatment of raynauds
keep warm
vasodilators
what vasodilators are used in raynauds
Ca2+ channel blockers
PDE5 inhibitors e.g. sildenafil
what would the treatment for a digital ulcer causing raynauds
prostacyclin analogue e.g. iloprost
what is vasculitis
inflammation of blood vessel s
what can vasculitis result in
vessel wall thickening, stenosis, and occlusion with subsequent ischaemia
what are the types of vasculitis
large vessel
medium vessel
small vessel
ANCA-assocaited small vessel
what are the types of large vessel vasculitis
takayasu arteritis
Giant cell arteritis
what are the types of medium vessel vasculitis
polyarteritis nodosa
Kawasaki disease
what are the 4 types of ANCA associated vasculitis
granulomatous with polyangitis (aka Wegeners)
Eosinophilic granulomatosis with polyangiitis (aka Churg-strauss)
microscopic polyangitis
renal limited vasculitis
what is large vessel vasculitis
applies to primary vasculitis which causes chronic granulomatous inflammation predominately of the aorta and its greater branches
who does Takayasua arteritis affect
young women, 20-30
higher rates in asia
what is the most common type of systemic vasculitis in adults
Giant cell arteritis
what is the histology of Giant cell arteritis
transmural inflammation of the intimate, media, and advent of the affected arteries
PATCHY infiltration by lymphocytes, macrophages, and multinucleate giant cells
vessel wall thickening which can result in arterial lumina narrowing causing distal ischemia
what are the symptoms of Giant cell arteritis
visual disturbances (loss, blurring)
continuous headache with focal tenderness
jaw claudication
scalp tenderness
temporal artery may be thickened and tender to touch, non-pulsatile
systemic manifestations (fatigue etc)
what investigations should be done in Giant cell arteritis
raised inflammatory markers
temporal artery biopsy ASAP
what is the treatment of Giant cell arteritis, when should it be started
novisual impairment = 40mg prednisolone
visual impairment = 60mg prednisolone
start as soon as suspected, don’t wait fir biopsy
what is henoch-schonlein purpura
this in an acute, IgA mediated disorder characterised by generalised vasculitis involving the small vessels of the skin, GI tract, kidneys, joints and rarely the lungs and CNS
what are the symptoms of henoch-schonlein purpura
URI predates symptoms by a few weeks purpuric rash over buttocks and lower limbs abdominal pain vomiting joint pain
what is the treatment for henoch-schonlein purpura
self-limiting
settles over the course of a few weeks to months
what can occur in microscopic polyangiitis
glomerulonephritis (occurs in 90% of patients)
what ENT symptoms are associated with granulomatous with polyangitis (aka Wegeners)
nose bleeds deafness recurrent sinusitis nasal crusting mouth ulcers collapse of nose over time
what non-ENT symptoms are associated with granulomatous with polyangitis (aka Wegeners)
purpuric, non-blanching rash most obvious on gravity dependent rash
formation of granulomas anywhere
haemoptysis
cavitating lung lesions
what autoantibodies are specific to granulomatous with polyangitis (aka Wegeners)
proteinase-3 (PR3)
what investigations should be done in ACNA positive vasculitis
raised inflammatory markers autoantibodies (ANCA, MPO, anti-PR3) low C3 and C4 U&E = renal involvement urinalysis = renal vasculitis CXR biopsy of affected area = god standard
what is the treatment of ACNA positive vasculitis
IV steroids + cyclophosphamide until the condition is under control
then regular oral steroids and less intense immunosuppressive drug
