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NRP511 > Autoimmune > Flashcards

Autoimmune Flashcards

1
Q

Autoimmune Diseases| Organ-Specific Diseases Mediated by Antibodies

A

•Autoimmune hemolytic anemia
•Autoimmune thrombocytopenia
•Autoimmune atrophic gastritis or perniculous anemia
•Myasthenia gravis
•Graves’ disease
•Goodpasture’s syndrome

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2
Q

Autoimmune Diseases| Systemic Diseases Mediated by Antibodies

A

Systemic lupus erythematosus

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3
Q

Autoimmune Diseases| Organ-Specific Diseases Mediated by T Cells

A

Type 1 diabetes| Multiple sclerosis

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4
Q

Autoimmune Diseases| Systemic Diseases Mediated by T Cells

A

Rheumatoid arthritis
Systemic sclerosis (scleroderma)
Sjorgen syndrome

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5
Q

Autoimmune Diseases| Organ-Specific Diseases Postulated to be Autoimmune

A

Inflammatory bowel diseases (Crohn’s disease or ulcerative colitis)Primary biliary cholangitisAutoimmune (chronic active) hepatitis

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6
Q

Autoimmune Diseases| Systemic Diseases Postulated to be Autoimmune

A

Polyarteritis nodosa| Inflammatory myopathies

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7
Q

Lupus

A

Systemic disease mediated by antibodies
multi-systemic autoimmune disease characterized by presence autoreactive B & T cells & production broad heterogenous group auto-antibodies

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8
Q

Lupus Pathogenesis

A

•Women 15-44yo
•AfricanAmerican, Asian Americans, Hispanic/Latinos, Native Americans, or Pacific Islanders
•50 genes associated w/ SLEUV •light,
•infection,
•virus,
•stress
•Auto-antibodies production w/o regulation
•Immune activation T & B cells hyperactive & innate immune systems programmed towards inflammation eventually leading to tissue damage & clinical disease manifestations

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9
Q

Lupus Diagnosis

A 
CBCAntibody tests- ANA- Anti dsDNA antibodyComplement testBlood clotting testsUrine testBiopsies
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10
Q

Lupus Classification

A

•Malar (butterfly) rash
•Photosensitivity
•Oral or nasopharyngeal ulcers
•Discoid (thick, scaly) rash
•Renal disorders
(pleurisy, pericarditis)
•Neurologic disorders
•Hematological disorders
•Immunological disorders
•Non-erosive arthritis at least 2 peripheral joints
•Presence of• antinuclear antibody (ANA)```

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11
Q

Lupus Types

A

•Systemic lupus erythematosus
•Drug-induced lupus erythematosus (hydralazine, procainamide, isoniazid)
•Cutaneous lupus erythematosus - caused by maternal antibodies, born w/ skin rash, liver problems, & low blood counts, congenital heart block
•Neonatal lupus-passive transfer of autoantibodies from the mother to the fetus results in fetal and neonatal disease.

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12
Q

SLE S/S

A

CNS - vasculitis, anxiety, depression, psychosis, seizures, stroke
CV - pericarditis, pericardial effusions, CHF, HTN, mitral/aortic regurgitation, conduction defects, thrombocytopenia, anemia, leukopenia, antiphospholipid syndrome (acquired hypercoagulability - embolism)

Pulmonary - pleural effusions, restrictive disease, atelectasis

Airway - mucosal ulceration, cricoarytenoid arthritis, recurrent laryngeal nerve palsy

Renal - glomerular nephritis, proteinuria, hypoalbuminemia, hematuria, renal failure

Muskuliskeletal - arthritis, avascular necrosis d/t steroid use

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13
Q

Lupus Treatment

A 
Tylenol NSAIDsImmunosuppressantsCorticosteroidAntimalarialAnticoagulantsMonoclonal antibodiesRepository corticotropin injections
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14
Q

Blah

A

Blah

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15
Q

Rheumatoid Arthritis

A

•Onset 25-55yo
•2-3x more prevalent in women
•Environmental and genetic factors
(genetic factors 50%)
Viral/bacterial infection

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16
Q

Osteoarthritis

A

Degenerative disease
Morning stiffness lasting <30 min
Heberdens nodes
Asymmetrical cartilage loss

17
Q

Rheumatoid Arthritis S/S

A

Autoimmune disease

Morning stiffness lasting >30min
Extra articulation involvement
Symmetrical
- vary in severity (S/S come & go)Inflamed synovium```

Smaller joints involved 1st (hands, feet, wrists) & progresses to ankles, hips, shouldersInflamed synovial joint membraneRapid division & cell growth w/in jointPro-inflammatory cytokinesRelease osteolytic enzymes, collagenases, proteasesNerve entrapment - carpal tunnel syndromeTMJ - synovitis 45-75% involvement

18
Q

Atlantoaxial Instability

A

C1-C2 (atlas-axis) involvementAtlanto-odontoid separation → neurologic damageAtlantoaxial subluxation → impairs vertebral artery blood flow

19
Q

Cricoarytenoid Joint

A

•26-86% patients w/ severe Present w/o clinical symptoms
•Vocal cord nodules or polyps
•Hoarseness
•Pain w/ swallowing
•Stridor
•Dyspnea

20
Q

RA Treatment

A 
Disease modifying anti-rheumatic drugs DMARDSNon-biologicAnti-metabolite- Methotrexate (Rheumatrex)- Sulfasalazine- AzathioprineBiologic TNF inhibitors- Etanercept (Enbrel)- Adalimumab (Humira)- Infliximab (Remicade)Interleukin-1 receptor agonists- Leflunomide (Arava)Anti-CD20 monoclonal antibody- Rituximab (Rituxan)
21
Q

RA Anesthetic Considerations

A

Medications - NSAIDs & corticosteroidsAirway - TMJ, cervical spine, cricoarytenoid jointPositioning - padding to prevent further joint damageSpinal anesthesia - sensory & ↓CSF

22
Q

Scleroderma

A

“Hard skin”
•Inflammation
•Vascular sclerosis
•Skin & viscera fibrosis with injury to vascular endothelium results in protein leakage into interstitial space
•Collagen production not slowed down & deposited throughout body

23
Q

Scleroderma Causes

A

UnknownCollagen vascular disease & autoimmune characteristics
20-40yoWomen
Accelerated by pregnancy

CREST syndrome- Calcinoses Ca2+ deposits- Raynaud’s phenomenon- Esophageal hypomotility- Sclerodactyly (thickened/tight skin)- Telangiectasia (dilated capillaries)```

24
Q

Scleroderma S/S

A

CNS - peripheral & cranial neuropathies d/t nerve compression by thickened connective tissue, trigeminal neuralgia, dry eyes

Musculoskeletal- thickened skin, diffuse edema, contractures, skeletal muscle myopathy, arthritis & limited joint mobility, avascular necrosis

Vascular- coronary arteries & conduction system sclerosis, replace cardiac tissues w/ fibrous tissue, systemic & pulmonary HTN, pericarditis & pericardial effusion, intermittent vasospasm, Raynaud

Respiratory- diffuse interstitial pulmonary fibrosis 80% patients, arterial hypoxemia 2° ↓diffusion capacity, ↓pulmonary compliance

GI - dry oral mucosa, progressive GI tract fibrosis, dysphagia, hypomotility, ↓LES tone → aspiration risk, malabsorption vitamin K deficiency (coagulopathies)

Renal - ↓renal blood flow → systemic HTN, renal artery stenosis d/t arteriolar intimal proliferation

25
Q

Scleroderma Anesthetic Considerations

A 
Fibrosis potential to lead to limited mouth opening & difficult intubationDermal thickening → difficult IV accessPulmonary HTN↓pulmonary compliance ↓O2 diffusionChronic system HTNLES hypotonia → aspiration riskSensitive to respiratory depressantsRegional anesthesia challenging d/t contractures & ↓joint mobilityProtect eyes from corneal abrasionRenal dysfunction & drug elimination

NRP511 (23 decks)

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