Vasculitis - General Flashcards
What are the 2 main types of vasculitis?
Primary
Secondary
What are the 4 main causes of secondary vasculitis?
Infection
Underlying disease
Cold injury
Drugs
What are the 3 main types of primary vasculitis?
Large vessel vasculitis
Medium vessel vasculitis
Small vessel vasculitis
What are the 2 main types of large vessel vasculitis?
Giant cell vasculitis (temporal arteritis)
Takayaku’s disease
What are the 2 main types of medium vessel vasculitis?
Polyarteritis nodosa
Kawasaki’s disease
What are the 2 main types of small vessel vasculitis?
Immune complex mediated vasculitis
ANCA positive vasculitis
What are the 2 types of ANCA positive vasculitis?
c-ANCA positive vasculitis
p-ANCA positive vasculitis
Give 1 example of a c-ANCA positive vasculitis.
Wegener’s granulomatosis
What are the 2 types of p-ANCA positive vasculitis?
MPO positive vasculitis
MPO negative vasculitis
List 3 examples of MPO positive (p-ANCA) vasculitis.
Microscopic polyangiitis
Churg-Strauss syndrome
Crescentic GN/RPGN
List 3 examples of MPO negative (p-ANCA) vasculitis.
RA
IBD
Sclerosing cholangitis
Give 4 examples of infections which might cause secondary vasculitis.
Meningococcus
Streptococcus
Erythema nodosum
Hepatitis B/C
When would you suspect vasculitis to be secondary to infection? (2)
What are the features of meningococcal vasculitis, for example? (2)
WHEN TO SUSPECT INFECTION:
Other signs of infection present
Short history of vasculitis
MENINGOCOCCAL VASCULITIS:
Purpura
Purpura fulminans (tissue infarction)
Give 2 examples of underlying disease which could cause secondary vasculitis.
Cancer
Autoimmune disease
List 2 types of cold injury which could cause secondary vasculitis.
Frostbite
Cryoglobulinaemia
Describe the pathophysiology of cryoglobulinaemia. (3)
- Autoantibody production is stimulated by the cold
- Autoantibodies cause an acute inflammatory response in small blood vessels
- This makes RBCs agglutinate (stick together)
a. This causes blockage of small vessels
b. This causes tissue infarction
Give 3 examples of drugs which could cause secondary vasculitis.
Carbimazole
Panicillin
Other antibiotics
Describe the clinical features of primary vasculitis. Consider:
a) Inflammatory features. (5)
b) Features of large vessel vasculitis. (3)
c) Features of small vessel vasculitis. (3)
INFLAMMATION: Fever Weight loss Malaise Myalgia Night sweats
LARGE VESSELS:
End organ ischaemia/infarction
Arterial stenosis
Hypertension (due to activation of RAS system in kidneys)
SMALL VESSELS:
Inflammation
Purpura
Glomerulonephritis
Describe the clinical features of vasculitis in veins. (1)
Bechet’s disease
“an idiopathic disease of the immune system characterised by genital/mouth ulcers, skin lesions and severe uveitis; may also involve joints and veins”
What investigations would you do for vasculitis? (11)
HINT: split them up into 4 groups.
BLOODS:
- FBC
- CRP/ESR
- U&Es
- LFTs
- ANCA levels
OBSERVATIONS:
- Temperature
- Height/weight/BMI
EXAMINATION:
- Vascular system (incl. pulses, aneurysms)
- BP (in all 4 limbs)
IMAGING:
- Angiography
- Biopsy
