Vasculitis Flashcards
VASCULITIS refers to _____ and ____ of ____
inflammation and necrosis
blood vessels
VASCULITIS only occurs in arteries
T/F
F
arteries, veins and capillaries
In VASCULITIS
These vessels may be damaged by
__________,_________,__________,_________ or _____
immune mechanisms, infectious agents, mechanical trauma, radiation or toxins
Majority of VASCULITIS are thought to involve immune mechanisms including;
- _______ of immune complexes
- ________ on vessels by _______
- various forms of _______
deposition
direct attack ; circulating antibodies
cell mediated immunity
BASIC PRINCIPLES of vasculitis
Inflammation of the blood vessel wall
• Arterial wall is comprised of three layers:_____ intima, _______ media, and _________ adventitia
•Etiology is usually (known or unknown?)
endothelial; smooth muscle ; connective tissue
unknown
BASIC PRINCIPLES of vasculitis
Clinical features include
Non specific symptoms of inflammation(e.g., ____,______,_____, and ______)
Symptoms of _______: due to _______ or ______ of the inflamed vessels
fever,fatigue, weight loss, and myalgias
Organ Ischemia; luminal narrowing or thrombosis
BASIC PRINCIPLES of vasculitis
Divided into _________,________,_______
large-, medium-, and small-vessel
BASIC PRINCIPLES of vasculitis
Large-vessel vasculitis involves the ____ and _________
Medium-vessel vasculitis involves _______ that supply organs.
Small-vessel vasculitis involves _____,______,________
aorta and its major branches.
muscular arteries
arterioles, capillaries, and venules.
most cases of vasculitis are infectious.
T/F
F
are not infectious
Mention 2 examples of large vessel vasculitis
Takayasu arteritis
Giant cell arteritis
Mention 2 examples of Medium-vessel vasculitis
Polyarteritis nodosa
Kawasaki disease
Mention 3 examples of Small-vessel vasculitis
Granulomatosis with polyangiitis
Eosinophilic granulomatosis with polyangiitis
Microscopic polyangiitis
Some vasculitides are associated with ________________(ANCA)
antineutrophil cytoplasmic antibodies
Some vasculitides are associated with antineutrophil cytoplasmic antibodies (ANCA) :
These can be detected by ______ assays using the patient’s ______ and __________
indirect immunoflourescence
serum and ethanol fixed neutrophils
C-ANCA-
P-ANCA-
Cytoplasmic antineutrophil cytoplasmic antibodies
Perinuclear antineutrophil cytoplasmic antibodies
C-ANCA- associated with _____ antibody
P-ANCA-associated with _____ antibody
Proteinase-3- antibody
Myeloperoxidase antibody
C-ANCA-
Majorly in _______ disease (__%)
Rarely in _____,____, and ______ disease
Granulomatosis with Polyangitis; 90
Microscopic polyangiitis; Eosinophilic granulomatosis with polyangiitis; infective endocarditis
P-ANCA-
Majorly in _______ disease (__%), and ________(___%)
Rarely in _____, and ______ disease
Microscopic polyangiitis; 70
Eosinophilic granulomatosis with polyangiitis; 50
Granulomatosis with Polyangitis; PAN
Atypical P-ANCA Is found in ____ and _____
Rarely in _____ and _____
PSC ; ulcerative colitis
Crohn’s disease, primary biliary cirrhosis
GIANT CELL ARTERITIS (aka. __________,__________)
TEMPORAL ARTERITIS
GRANULOMATOUS ARTERITIS
The most common vasculitis in older adults is ???
GIANT CELL ARTERITIS
GIANT CELL ARTERITIS
Average age at onset is ___ years (___-___)
It involves a (focal or widespread ?) , (acute or chronic?) ,granulomatous inflammation
70; 50-75
Focal; chronic
GIANT CELL ARTERITIS
Usually of the _______ (small or large ?) arteries and there branches
Male : Female =_:__
temporal
Large
1:3
GIANT CELL ARTERITIS
Clinical features
Patients presents with _______ and _________
_____ symptoms occur in almost half of the patients
headache and throbbing temporal pain
Visual
GIANT CELL ARTERITIS
Clinical features
______ and _______ are present in the skin overlying the affected artery
About half with clinical manifestation will have ______ involvement
Swelling and tenderness
systemic
Lesions of temporal arteritis are focal and may be missed on biopsy
T/F
T
GIANT CELL ARTERITIS
Biopsy of the temporal artery may be negative in ____% of patients with classical manifestation of this disease
40
GRANULOMATOUS ARTERITIS
Treatment
These patients are treated with ____ and the response is (disappointing or excellent?)
steroids
Excellent
TAKAYASU ARTERITIS (_____ syndrome)
Aetiology: _______ basis has been proposed
Refers to an inflammatory disorder of the ______ and ________
Aortic arch
An autoimmune
aortic arch and its major branches
TAKAYASU ARTERITIS
Affects (young or old?) (men or women?) (<__years), 15-25
Male : Female= __:__
Young
Women
30
1:9
TAKAYASU ARTERITIS
Pathology
Aorta is _____ and has _______
thickened; focal raised plaques
Aortic arch syndrome
Pathology
Branches of the aorta display ______ and _____, interfering with _____ and accounting for the synonym ‘ ______’
stenosis and occlusion
blood flow
pulseless disease
TAKAYASU ARTERITIS
Clinical features
General: Fever, malaise, arthralgia, night sweats
Specific: Vascular symptoms
Decreased bilateral _____ and _____ (so- called pulseless disease)
_____,______
Bilateral carotid bruits
Impaired _____
_____-induced muscular pain in one or more limbs
_______ phenomenon
Hypertension
brachial and radial pulses
Syncope, angina pectoris
vision; Movement; Raynaud
POLYARTERITIS NODOSA (PAN)
A multisystemic disease
This acute, necrotizing, vasculitis affects mainly __________-sized muscular arteries
small to medium
POLYARTERITIS NODOSA (PAN)
Male:Female =___:__
40-60 years
2:1
POLYARTERITIS NODOSA (PAN)
__-ANCA (15 – 30% of cases) immunoflourescence mainly against _________
P
myeloperoxidase
Pathology of PAN
every vessel of appropriate size would be affected
F
Not every vessel of appropriate size would be affected so a thorough search of the slide would be necessary
Pathology of PAN
Lesions are _____ and may not involve the ________ of the vessel
patchy
entire circumference
Pathology of PAN
Most prominent feature is an area of the __________, fused into ________
media and adventitia
an eosinophilic mass
Inflammatory response in PAN involves only some of the adventitia
F
the entire adventitia (periarteritis)
In PAN
Healed lesions have a _____ media & loss of fragmentation of the _________
fibrotic
internal elastic lamina
internal elastic lamina is ??
What separates the intima from the media