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Stage 3 > Vascular - AAA & Vasculitis > Flashcards

Vascular - AAA & Vasculitis Flashcards

1
Q

Why is abdominal aortic aneurysm (AAA) potentially life threatening?

A

Without repair, ruptured AAA is usually fatal

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2
Q

What abdominal aorta diameter is considered an aneurysm?

A

> 3cm

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3
Q

What is the most common site for AAA?

A

Between the renal and inferior mesenteric arteries

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4
Q

Which arteries to 5% of AAAs involve?

A

The renal or visceral arteries

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5
Q

How do AAA present?

A

1) Most aneurysms are asymptomatic
2) Can present with abdominal mass - usually pulsatile and expansile

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6
Q

When is screening for AAA offered in the UK and how is AAA screened for?

A

Screening is offered at age 65 (men?) using abdominal ultrasound scan - screening is one-off

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7
Q

What screening is offered if someone has a small AAA diameter 3-4.4cm?

A

Repeat ultrasound YEARLY

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8
Q

What screening is offered if someone has a medium AAA diameter 4.5-5.4cm?

A

Repeat ultrasound EVERY 3 MONTHS

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9
Q

What is offered if someone has a large AAA diameter >5.5cm?

A

Surgery is generally recommended - refer to vascular surgeons via 2ww

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10
Q

What are the indications for AAA repair?

A

1) Size > 5.5cm OR
2) Rapid expansion

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11
Q

What are the two main surgical options for AAA repair?

A

1) Open repair
2) Endovascular Aneurysm repair (EVAR)

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12
Q

What are the definitions of rapid expansion in the context of AAA?

A

1) Increase in diameter >5mm over a 6 month period OR
2) Increase in diameter >10mm over one year
These limits have been developed due to clinical evidence which balances the risk of surgery vs the risk of aneurysm rupture

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13
Q

Below what diameter is it very uncommon for aneurysms to rupture?

A

Below 5cm

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14
Q

How should you manage a patient whose AAA is < 3cm on screening?

A

Discharge - AA is unlikely to expand and rupture in his lifetime

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15
Q

How should you manage a patient whose AAA is > 3cm on screening?

A

Refer to vascular surgeons within 12 weeks

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16
Q

How should you manage a patient whose AAA is > 5.5cm on screening?

A

Refer to vascular surgeons via 2ww

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17
Q

What is Leriche syndrome?

A

Vascular syndrome caused by severe aorto-iliac occlusion

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18
Q

How does Leriche syndrome present?

A

1) Buttock wasting
2) Claudication
3) Signs of lower limb vascular disease

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19
Q

Which condition can cause a vascular claudication syndrome and should always be considered in an elderly patient with suggestive symptoms who does not have a typical vasculopathic history?

A

Giant cell arteritis

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20
Q

What causes vascular claudication?

A

Atheromatous disease

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21
Q

What is a vasculitic rash?

A

Non-blanching rash caused by extravasation of blood into the skin

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22
Q

What is an example of a renal disease associated with a vasculitic rash?

A

HSP/IgA vasculitis (a condition mostly commonly seen in children after an URTI in which renal impairment is either nephritic or nephrotic and associated with a non-blanching purpuric rash on the lower limbs)

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23
Q

What is granulomatosis with polyangiitis?

A

Vasculitis that can lead to nephritic syndrome or a rapidly progressive crescentic glomerulonephritis

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24
Q

Which antibodies is granulomatosis with polyangiitis associated with?

A

c-ANCAs (c-antineutrophil cytoplasmic antibodies)

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25
Q

How does granulomatosis with polyangiitis present?

A

Symptoms depend on the location of the blood vessels that are inflamed but commonly tissues in the nose are damaged leading to:
1) Epistaxis
2) Sinusitis
3) Saddle-shaped nose deformity due to weakening of the underlying cartilage

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26
Q

Tissues in which organ are most commonly damaged by inflamed blood vessels associated with granulomatosis with polyangiitis?

A

The nose

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27
Q

How does Behcet’s disease present?

A

1) Painful sores in the mouth or genital area - oral or genital ulcers
2) Uveitis (eye inflammation)
3) Skin lesions
4) Joint pain
5) GI symptoms e.g. abdominal pain and diarrhoea
6) Neurological symptoms e.g. headaches and memory loss.
7) Lung, CNS, MSK inflammation

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28
Q

What is Behcet’s disease?

A

1) Rare, chronic, complex, autoimmune disorder that is characterised by inflammation of blood vessels throughout the body (autoimmune vasculitis)
2) It can affect multiple organ systems, including the skin, eyes, mouth, gastrointestinal tract, joints, and nervous system

29
Q

What is Kawasaki disease?

A

A systemic, medium-vessel vasculitis

30
Q

What are the diagnostic criteria for Kawasaki disease?

A

High grade fevers > 39 for > 5 days AND 4/5 of the CREAM features

31
Q

What are the CREAM features of Kawasaki disease?

A

1) Conjunctivitis - bilateral, non-exudative
2) Rash - any non-bullous rash
3) Erythema/oedema of hands/feet
4) Adenopathy - cervical, commonly unilateral and non-tender
5) Mucosal involvement - strawberry red tongue, oral fissures

32
Q

How does Kawasaki disease present?

A

1) High grade fevers
2) CREAM features - conjunctivitis, rash, erythema of hands and feet, lymphadenopathy, mucosal involvement
3) Typically very unwell and flat - far more so than with most other febrile illnesses they have
4) Cracked lips
5) Polymorphous macular rash all over his body which peels at the extremities

33
Q

What is the main complication that is of concern is Kawasaki disease and therefore which investigation should be urgently done?

A

Coronary artery aneurysms - urgent echocardiogram

34
Q

Which investigation should be urgently done in all patients suspected of Kawasaki disease?

A

Urgent echocardiogram - bc of risk of coronary aneurysms

35
Q

How do you manage Kawasaki disease?

A

1) IVIg + high-dose aspirin (to prevent thrombosis and coronary aneurysm)
2) Surveillance of coronary aneurysms via echocardiograms
3) Recovery from the acute episode can take weeks

36
Q

Which children are typically affected by Kawasaki disease?

A

Children < 5 years, Asian boys esp. Japanese and Korean descent

37
Q

How do you manage Behcet’s disease?

A

Corticosteroids + colchicine are used as first-line agents in the treatment of oral and genital ulcers

38
Q

What is microscopic polyangiitis?

A

Small vessel vasculitis - systemic condition that can affect any organ incl. lungs, kidney, skin and nervous system and may present with a palpable purpuric rash

39
Q

Which antibodies are associate with microscopic polyangiitis?

A

p-ANCA

40
Q

What is polyarteritis nodosa?

A

A segmental transmural necrotising vasculitis of medium-sized muscular arteries (NOT arterioles, capillaries or venules)

41
Q

Which patients are most commonly affected by polyarteritis nodosa?

A

Men aged 40-60

42
Q

What are complications of polyarteritis nodosa?

A

1) Destruction of the arterial media and internal elastic lamina
2) Aneurysm formation - life-threatening haemorrhage

43
Q

What is a risk of polyarteritis nodosa?

A

Life threatening haemorrhage due to aneurysm formation

44
Q

Which other condition is associated with polyarteritis nodosa?

A

Hepatitis B

45
Q

How do you diagnose polyarteritis nodosa?

A

1) Non-specific symptoms - constitutional symptoms + ischaemic symptoms in 1 or more organ system should raise possibility of a systemic vasculitis
2) Symptoms + physical examination + laboratory tests (to exclude other causes of symptoms) ± biopsy of affected area

46
Q

Which systems can be affected by polyarteritis nodosa (and relevant presenting symptoms)?

A

1) Kidney - renal failure
2) Coronary - IHD, acute MI
3) GI - abdo pain, nausea, malaena
4) Musculoskeletal - arthritis, myalgia, arthralgia
5) CNS - eye and skin complaints

47
Q

Which vessels (and organ) is NOT affected in polyarteritis nodosa?

A

Lungs - pulmonary vessels (PAN = Pulmonary Are Not affected)

48
Q

Does polyarteritis have any association with ANCA antibodies?

A

No

49
Q

What are indications for surgical management of carotid artery stenosis (carotid endarterectomy)?

A

Carotid artery stenosis > 70% + symptoms of an ischaemic event e.g. stroke or TIA in the corresponding vascular territory

50
Q

How is carotid artery stenosis surgically managed?

A

Carotid endarterectomy

51
Q

How do you manage patients with carotid artery stenosis who do not meet the criteria for surgery?

A

1) Clopidogrel 75mg (antiplatelet)
2) Cholesterol lowering therapy
3) BP control
4) Lifestyle advice

52
Q

What is Buerger’s disease?

A

Non-atherosclerotic vasculitis caused by occlusion in small and medium-sized arteries

53
Q

Which patients are most commonly affected by Buerger’s disease?

A

Young Mediterranean or Middle Eastern men (smokers)

54
Q

What is a risk factor for Buerger’s disease?

A

Smoking

55
Q

What is another name for Buerger’s disease?

A

Thromboangiitis obliterans

56
Q

How does Buerger’s disease typically present?

A

Acute limb ischaemia without a background of peripheral claudication

57
Q

What investigations are done for Buerger’s disease?

A

Aimed at excluding differentials e.g. atherosclerosis and autoimmune disease
1) Arterial doppler
2) Further imaging e.g. arterial duplex, CT/MR angiography

58
Q

What will arterial doppler show in Buerger’s disease?

A

Confirm the absence of peripheral pulses in the affected limb

59
Q

What will further imaging e.g. arterial duplex or CT/MR angiography show in Buerger’s disease?

A

Non-atherosclerotic occlusion

60
Q

What is the key sign in Buerger’s disease that shows on arterial duplex?

A

Martorell’s sign - corkscrew shaped collateral vessels (characteristic of Buerger’s disease)

61
Q

What is Martorell’s sign (Buerger’s disease)?

A

Corkscrew shaped collateral vessels (on arterial duplex)

62
Q

How is Buerger’s disease managed?

A

1) Smoking cessation
2) ± vasoactive medication e.g. nifedipine

63
Q

How do you manage Buerger’s disease presenting with critical limb ischaemia?

A

1) Hospital admission
2) Vasoactive medication
3) Debridement of gangrenous tissue

64
Q

What is an aneurysm?

A

Local dilation of the blood vessel > 50% the normal diameter

65
Q

What are the complications of aneurysms?

A

1) Rupture - due to weakening of the vessel wall
2) Thrombosis - due to turbulent blood flow
3) Compression of external structures causing radiculopathy or claudication
4) Fistula formation

66
Q

How does aneurysm rupture present?

A

Hypovolaemic shock

67
Q

Which aneurysms tend to rupture?

A

Aneurysms affecting the:
1) Abdominal aorta
2) Thoracic aorta
3) Iliac artery
4) Femoral artery

68
Q

Which aneurysms tend to cause thrombosis?

A

Aneurysms affecting the:
1) Popliteal artery
2) Upper limb arteries

69
Q

How does thrombosis due to aneurysm present?

A

Ischaemia distal to the site of occlusion

Stage 3 (61 decks)

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