Vasculitis Flashcards
Vasculatis is
inflammation of the blood vessel wall (endothelial intima, smooth muscle media, and CT adventitia)
What causes vasculitis? What are some clinical features?
Etiology usually unknown, most cases are not infectious;
nonspecific symptoms of inflammation (fever, fatigue, weight loss, myalgias); symptoms of organ ischemia: due to luminal narrowing or thrombosis of the inflamed vessels
How is vasculitis subdivided?
Large-vessel: involves aorta and its major branches
Medium-vessel: muscular arteries that supply organs
Small-vessel: arterioles, capillaries, venules
For large-vessel vasculitis, what does temporal (giant cell) arteritis consist of? Involves what, most commoon, presentation, biopsy, treatment?
- Temporal (giant cell) arteritis: granulomatous vasculitis that involves branches of the carotid artery; most common form of vasculitis in older adults (>50 years), usually affecting FEMALES;
presents as: headache (temporal artery involvement), visual disturbances (ophthalmic artery involvement), and jaw claudication, flu-like symptoms with joint and muscle pain (polymyalgia rheumatica), ESR elevatned;
biopsy: inflamed vessel wall with giant cells and intimal fibrosis (segmental lesions; diagnosis REQUIRES BIOPSY of a long segment of vessel, but negative biopsy does not exclude disease);
Treat: corticosteroids: high risk of blindness without treatment
For Takayasu Arteritis?
Involves aortic arch at branch points;
presents in adults <50 years old (usually young Asian females) as visual and neurologic symptoms with a weak or absent pulse in upper extremity, with ESR elevated
Treat: corticosteroids
Polyarteritis Nodosa features
Necrotizing vasculitis involving multiple organs (lungs spared); presents in YOUNGADULTS as hypertension (renal artery involvment), abdo pain with melena (mesenteric artery involvement), neurologic disturbances, and skin lesions; associated with SERUM HBsAg!!
Lesions of varying stages present: early has transmural inflammation with fibrinoid necrosis that eventually heals with fibrosis producing a “string-of-pearls” appearance on imaging
Treat: corticosteroids and cyclophosphamide (fatal if not treated)
Kawasaki disease: who it affects, presentation, treatment
- Usually affects Asian children < 4 years old
- Nonspecific signs like fever, conjuncitivits, erythematous rash of palms and soles, and enlarged cervical lymph nodes
- Coronary artery involvement is common and leads to risk for 1. thrombosis with MI and 2. aneurysm with rupture
- Aspirin and IVIG (disease is self-limited)
Heerak’s 3 year old was complaining that he felt hot. He couldn’t see, he noticed his hands and feet were red, and he felt his neck get large. Heerok was tempted to go to CA, but knew THat MI was not going to cause him an aneurysm from all the trouble his son was causing him. He saw his pharmacist and got aspirin and IVIG.
In Buerger disease, what is involved, the presentation, and assocications and treatment?
- Necrotizing vasculitis involving digits
- Presents with ulceration, gangrene, and autoamputation of fingers and toes; Raynaud often present
- Highly associated with heavy smoking
Treat: smoking cessation
Buerger is a sick German nasty vermin who tries to cut off your fingers and toes. They become ugly, green, and achy, especially if his friend Reynaud gets involved. I wish they would at least both stop smoking!!
Wegener Granulomatosis: involves, presentation, serum levels, biopsy, treatment
Necrotizing granulomatous vasculitis involving nasopharynx, lungs, and kidneys;
presents: middle-aged male with sinusitis or nasopharyngeal ulceration, hemoptysis with bilateral nodular lung infiltrates, and hematuria due to rapidly progressive glomerulonephritis;
SERUM c-ANCA levels correlate with disease activity;
biopsy: large necrotizing granulomas with adjacent necrotizing vasculitis
Treatment: cyclophosphamide and steroids; relapse COMMON
Microscopic polyangiitis: involves, presents, serum levels, treat
Necrotizing vasculitis involves multiple organs, especially lung and kidney;
presents similar to Wegener, BUT nasopharyngeal involvement and granulomas are absent;
serum p-ANCA levels correlate with disease activity;
treat: corticosteroids and cyclophosphamide; relapse COMMON!!
Mike Patrick wants to be like Arsene Wenger: the problem is, he’s got that big Jewish nose of his, and also is lacking Wenger’s GReatness in general. Also, he prefers pepsi to coke. Give him the same treatment as Wenger.
Churg-Strauss syndrome
Necrotizing granulomatous inflammation with ESOINOPHILS involving multiple organs, especially lungs and heart;
also asthma and peripheral eosinophilia often present;
serum p-ANCA levels correlate with disease activity
This dumb NIGger got eight gun shot wounds, hitting his lung and heart. Now he has difficulty breathing and Pain Eating. Imagine if he wanted to play anchor in tug of war?
Henoch-Schonlein Purpura involves, presents, treat
Vasculitis due to IgA immune complex deposition (MOST COMMON VASCULITIS IN CHILDREN);
presents with palpable purpura on buttocks and legs, GI pain and bleeding, and hematuria (IgA nephropathy);
usually occurring following an upper respiratory tract infection;
disease SELF-LIMITED, but may recur;
treat with steroids if severe
VICky Dawes has a kid. She once asked me “pretty please, could you feel my legs and smack my ass!”; I did, but then she told me that in the morning she took a dump and had pain and noticed blood in her urine. I should have known that something was off based on her breathing that night. I told her take some steroids.
Behcet disease: what is it?
small-to medium-vessel neutrophilic vasculitis that classically presents as a clinical triad of recurrent oral aphthous ulcers, genital ulcers, and uveitis!!
Give me a blowjob, give me anal, and I’ll squirt in your eye!
Which arteries does Buerger disease typically hit up?
Tibial and radial arteries, with occasional secondary extension into the veins and nerves of the extremities
