Polyarteritis Nodosa (PAN) Flashcards
how is polyarteritis nodosa characterized?
necrotizing inflammation of the medium sized vessels (arteries)
what condition is PAN associated with?
hepatitis B
what organ does PAN spare?
lungs
what causes the inflammatory reaction resulting in ischemia, infarctions, and aneurysms in PAN?
neutrophil invasion of endothelium
PAN can involve many organs, especially the _____
kidney
what are the 5 clinical features of PAN?
“PAAAF”
Peripheral neuropathy
Abdominal pain
Anorexia/weight loss
Arthralgias/Arthritis
Fever
what are the 2 skin manifestations of PAN?
“SLUG”
Subcutaneous nodules (PAINFUL)
Livedo reticularis
Ulcers
Gangrene on digits
what do ulcers on the skin indicate?
involvement of deeper, medium sized blood vessels
what is the most common cutaneous presentation?
lower extremity ulcerations near the malleoli
what will labs show to indicate PAN? (5)
elevated ESR/CRP
anemia
leukocytosis
+ Hep B surface antigen
+/- presence of ANCA (antineutrophil cytoplasmic antibody)
what 2 diagnostics confirm PAN?
tissue biopsy
angiography
how does hep B lead to PAN?
PMNs + monocytes deposit in vessel walls = fibrinoid necrosis = inflammation = vessel narrowing = decreased blood flow
what is the initial treatment for PAN? alternative tx?
high dose corticosteroids
cytotoxic drugs + immunotherapy
treatment for PAN if patient has hep B? hypertension?
corticosteroids
anti-hep B therapy
hypertension: ACE inhibitor
what should we do if a patient with PAN is taking ACE inhibitors for hypertension?
what should we do if GFR declines?
monitor renal function
switch to CCB
