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Clinical Medicine Ortho > Polyarteritis Nodosa > Flashcards

Polyarteritis Nodosa Flashcards

1
Q

What is Polyarteritis Nodosa described as?

A

Systemic vasculitic syndrome

Small and medium vessels

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2
Q

What is the pathology of Polyarteritis Nodosa?

A

Necrotizing inflammation of arterial media and inflammatory cell infiltration

Occurs at bifurcations/branch points

Weakens the vessels

  • Aneurysms
  • Thrombi development
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3
Q

What is a possible cause of Polyarteritis Nodosa?

A

Hepatitis B and C

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4
Q

What is the epidemiology of Polyarteritis Nodosa?

A

M:F 2:1

Any age group; typical 40-60

No racial predilection

Asscociated with hairy cell leukemia

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5
Q

What are the clinical manifestations of Polyarteritis Nodosa?

A 
Constitutional
Nervous system
Cutaneous
Gastrointestinal
Renal
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6
Q

What are the constitutional symptoms?

A
  • Fever
  • Malaise
  • Fatigue
  • Anorexia/wt loss
  • Myalgia
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7
Q

What are the nervous system symptoms?

A
  • Transient cerebral ischemia
  • Monocular blindness
  • Periphereal neuropathy
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8
Q

What are the cutaneous symptoms?

A
  • Rash
  • Purpura
  • Gangrene
  • Nodules
  • Livido reticularis
  • Raynaud’s phenomenon
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9
Q

What are the GI symptoms?

A
  • Postprandial abdominal pain
  • N/V
  • Organ infarction
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10
Q

What are the renal symptoms?

A

Renal failure

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11
Q

What is included in the DDX of Polyarteritis Nodosa?

A 
SLE
Infections
Lymphoma
Other vasculitis diseases
- Henoch-Schӧnlein purpura
- Wegener granulomatosis
- Kawasaki disease
HIV
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12
Q

What labs are included in Polyarteritis Nodosa?

A 
CBC with diff
CRP
ESR
Liver function
HBV/HCV serology
Negative RF and ANA
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13
Q

What diagnostic studies are involoved with Polyarteritis Nodosa?

A

Angiography
Aneurysmal dilation- renal, mesenteric or hepatic arteries

Biopsy- skin; affected organs

Abdominal CT scan

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14
Q

What is the diagnostic criteria for Polyarteritis Nodosa?

A
  • *** NEED 3 of 10
  • Weight loss > 4 kg
  • Livedo reticularis
  • Testicular pain/tenderness
  • Myalgias, weakness or leg tenderness
  • Neuropathy
  • Diastolic bold pressure > 90 mmHg
  • Elevated BUN > 40 mg/dl or creatinine >1.5 mg/dl
  • Positive Hep B virus
  • Arteriography with aneurysms
  • Arterial biopsy with necrotizing inflammatory infiltrate
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15
Q

What is the treatment for Polyarteritis Nodosa?

A

Prednisone 1-2 mg/kg/day
- Start with higher doses and then taper

Methotrexate with steroids

Anti-viral treatment in Hep B patients

Treat HTN

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16
Q

What should you do for chronic treatment of Polyarteritis Nodosa?

A

Monitor for

  • infections
  • thrombosis
  • infarctions
  • organ necrosis
17
Q

What is the prognosis of Polyarteritis Nodosa?

A

If untreated- 5 yr survival rate is

Clinical Medicine Ortho (42 decks)

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