Vasculitis Flashcards Preview

Term 3: Immunology/Pathology > Vasculitis > Flashcards

Flashcards in Vasculitis Deck (17):
1

What are the primary criteria for vasculitis pathology?

-vessel wall necrosis with nuclear fragmentation

-invasion of vessel walls with polymorphonuclear leukocytes

-Fibrinoid deposits in or adjacent to vessel wall

2

What are the secondary criteria for vasculitis pathology?

-perivascular hemorrhage

-Chronic granulomatous inflammation

-Perivascular fibrosis

-Thrombosis of vessel

3

What is humoral mediated vasculitis?

Circulating Ab-Ag immune complexes

Auto-antibodies (ANCA, anti-endothelial cell Abs):
-Increased permeability of vessel intima
-Immune complex deposition  inflammation
-Complement activation  inflammation
-Recruitment, invasion of neutrophils  necrosis
-Proinflammatory cytokines (IL-1, IL_6, TNFalpha)
-Endothelial cell injury is thrombogenic  clots

4

What is cell mediated vasculitis?

Lymphocytes and macrophage
-Granulomatous reaction
-Delayed type hypersensitivity (DTH) reaction

5

What is the difference between primary vasculitis and secondary vasculitis?

Primary:
-idiopathic loss of tolerance to self

Secondary:
Response to.....
-infection
-tumors
-immune complexes
-toxins

6

What are the cutaneous manifestations of vasculitis?

-rash

-purpura

-ulceration

-gangrene

7

Why are there nervous system manifestations in vasculitis?

-infarcts of vasa nervorum of peripheral nerves

8

What is Takayasu's disease?

LARGE VESSEL

-Decreased brachial artery pulse

-Upper to lower extremity BP differential >10 mm Hg

-Subclavian or aortic bruit

-Angiogram abnormality

9

What is hypersensitivity vasculitis?

-Reaction to drug

-Maculopapular rash: flat and raised lesions

-Palpable purpura

-Perivascular granulocytes on skin biopsy

-Joint pains

-Enlarging lymph nodes

10

How do corticosteroids treat vasculitis?

Binds intracellular hormone receptor

Inhibits cytokine production

Inhibit neutrophil/monocyte phagocytosis, granule release

Inhibit lymphocyte migration

Causes lympholysis

11

What types of drug agents can we use to treat vasculitis?

-Corticosteroids

-Cytotoxic agents

-B-cell depletion

-TNF blockade

-IL-1 inhibitors

12

What does the treatment of vasculitis depend on?

the size of the vessels involved

13

What is Kawasaki's disease?

MEDIUM VESSELS

-FUO (fever of unknown origin)

-red lips

-bilateral conjunctivits

-Cervical lymphadenopathy

-desquamination of fingers & toes

14

How does vasculitis cause clinical symptoms?

A. Inflammation leads to endothelial injury and vasospasm that contribute to thrombosis and downstream ischemia.

B. Inflammation of blood vessels leads to neo-angiogenesis and vascular tumors.

C. Cytokine production causes decreased endothelial cell adhesion, leaky vessels, hypovolemic shock, and low blood pressure.

D. Autoantibodies bind to trapped antigens in the vessel wall, leukocytes bind autoantibodies and damage endothelial cells, causing leaky vessels, hypovolemic shock, and low blood pressure.

E. Tissue macrophages infiltrate and proliferate in the media layer of the vascular wall in response to lipid accumulation, leading to plaque build-up, luminal narrowing, and downstream ischemia.

A. Inflammation leads to endothelial injury and vasospasm that contribute to thrombosis and downstream ischemia.

15

How are forms of vasculitis currently classified?

A. By organ system (kidneys, lungs, brain, etc.)

B. By etiology (immune complex, ischemic, infectious, neoplastic, etc.)

C. By MHC restriction (HLA-DR, HLA-DQ, HLA-B27, etc.)

D. By caliber of the vessels involved

E. By layer of vessel initially involved (intima, media, adventitia)

D. By caliber of the vessels involved

16

What does the abbreviation ANCA indicate when referring to vasculitic diseases?

A. anti-nucleolar antibodies

B. anti-nuclear and cytoplasmic antibodies

C. anti-neutrophil cytoplasmic antibodies

D. anti-neutrophil catalytic antibodies

E. anti-neutrophil cytolytic antibodies

C. anti-neutrophil cytoplasmic antibodie

17

Why is one of the manifestations of vasculitis a possibility of neuropathy?

vasa nervosum = small vessels supplying the nerves, get inflamed