Vasculidities Flashcards
Large, Medium and Small Vessel Vasculidities (42 cards)
What is meant by the term vasculitis?
Inflammation of blood vessels
What are the three categories of vasculitis?
Small, medium and large vessel
List 4 types of small vessel vasculitis
- henoch-schonlein purpura
- microscopic polyangiitis
- granulomatosis with polyangiitis (Wegner’s)
- eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
List 3 types of medium vessel vasculitis
- polyarteritis nodosa
- Kawasaki disease
- Buerger’s disease
List 2 types of large vessel vasculitis
- giant cell arteritis
- Takayasu’s arteritis
Describe what happens in the body to cause vasculitis
Usually an auto-immune response where WBC’s attack the endothelial layer of blood vessels
What happens when endothelium is damaged in blood vessel walls?
Collagen and tissue factor are exposed, which leads to coagulation, and therefore an increased risk of stroke
Why does vasculitis increase the risk of aneurisms?
Fibrin is deposited in the vessel walls at an attempt to repair them, however this makes the walls less stretchy, so more vulnerable to aneurisms
List some systemic symptoms that may be seen in vasculitis
Symptoms related to inflammation such as fever, weight loss and fatigue
What blood vessels tend to be affected by giant cell arteritis?
Branches of the carotid arteries, e.g., the temporal, ophthalmic and facial arteries
List some symptoms of giant cell arteritis
headaches
visual disturbances
jaw claudication
What is seen on investigations for giant cell arteritis?
bloods show raised ESR
temporal artery biopsy shows giant cells in the elastic lamina
What is the treatment for giant cell arteritis?
Corticosteroids - high dose prednisolone
Dose depends on whether or not the patient has visual disturbances
What blood vessels are affected in Takayasu’s arteritis?
Branches of the aortic arch, that supply the upper extremities and head
List some symptoms of Takayasu’s arteritis
weak/no pulse
neurological symptoms
muscle aches
What is seen on investigations for Takayasu’s arteritis?
bloods show raised ESR
giant cells seen in elastic lamina
CT/MRI angiography helpful for diagnosis, instead of a biopsy
What blood vessels are affected by Kawasaki disease?
Coronary arteries
What demographic usually gets Kawasaki disease?
children under 5
more common in boys than girls
What is the CRASH + burn criteria for Kawasaki disease?
diagnosis can be made with 4/5 of the following:
C - conjunctivitis
R - rash that peels later on
A - adenopathy
S - strawberry tongue
H - hands and feet swollen
+ fever for 5 or more days
What is seen on investigations for Kawasaki disease?
bloods show anaemia and raised WBCs
blood film shows increase in immature WBCs
raised CRP and ESR
raised liver enzymes in late stage
echocardiogram used for diagnosis
How is Kawasaki disease treated?
IV Ig’s
aspirin - note that this is usually not given to children, but the benefits outweigh the risks in this case
What can cause polyarteritis nodosa?
infections/vaccines - key examples include strep, staph and hep B
Describe what happens to blood vessels in polyarteritis nodosa
all layers of the vessel wall are damaged (transmural disease)
angiogram shows a ‘string of beads’ which are multiple aneurisms
What symptoms may be seen in polyarteritis nodosa?
symptoms depend on affected vessels
- renal ischaemia can cause hypertension
- mesenteric ischaemia can cause abdo pain and GI bleeding
- neuro ischaemia can cause neurological symptoms
- skin is often affected, presenting as livedo reticularis
