Vasculitis Flashcards
(42 cards)
what is vasculitis?
inflammation and necrosis of blood vessel walls with subsequent impaired flow
What two processes are the result of vasculitis?
vessel wall destruction and/or
endothelial injury
What does vessel wall destruction lead to?
perforation and haemmorhage
what does endothelial injury result in?
thrombosis leading to ischaemia and infarction
what are the histological features of vasculitis?
vessel wall infiltration by neutrophils, mononuclear cells and giant cells
fibrinoid necrosis
leukocytoclasis (vascular damage caused by nuclear debris from infiltrating neutrophils)
How is vasculitis classified?
size of vessel affected - small, medium, large
target organ(s)
presence or absence of ANCA - anti-neutrophil cytoplasmic antibodies
primary or secondary disease
Name two primary large vessel vasculitis diseases
Giant cell (temporal) arteritis Takyasu's arteritis
Name two medium/small vessel vasculitic diseases
Wegener’s granulomatosis (granulomatosis with polyangitis)
Churg Strauss
microscopic polyangiitis
How does vasculitis present?
there is no single presentation: systemically unwell fever arthralgia arthritis rash weight loss headache footdrop major event eg stroke or bowel infarction
differential diagnoses of vasculitis
sepsis subacute bacterial endocarditis hepatitis malignancy cholesterol emboli
what type of vasculitis is ANCA involved in?
small/medium vessel vasculitis
NOT present in large cell vasculitis
how is ANCA detected?
indirect immunofluorescence microscopy
what are the two major patterns of ANCA?
cytoplasmic ANCA (cANCA) peri-nuclear ANCA (pAMCA)
What type of vessels does large vessel vasculitis affect?
aorta and its branches
Which vessels of the body does temporal arteritis affect?
the aorta and larger vessels eg extracranial branches of the carotid arteries
What would be seen on biopsy of the temporal artery in temporal arteritis?
granulomas
what is the epidemiology of temporal arteritis?
> 50 yrs old
incidence increases with age
twice as common in women
How does temporal arteritis present?
persistant severe headache
scalp tenderness
jaw claudication
acute blindness - this is a medical emergency
malaise
associated symptoms of polymyalgia rheumatica
Are pts with temporal arteritis at risk of stroke?
yes
How is temporal arteritis diagnosed?
3 or more of:
>50 yrs
new headache
temporal artery tenderness or decreased pulsation
ESR >50
abnormal temporal artery biopsies showing necrotising arteritis with mononuclear infiltrate or granulomatous inflammation
What would be seen on biopsy of the temporal artery?
giant cells granulomata necrotising arteritis infiltration of the vessel wall with mononuclear cells inflammation thickening of the vessel wall narrowed lumen
on examination, what are the qualities seen of the temporal artery?
palpable
tender
reduced pulsation
What is AION?
occurs in giant cell arteritis
anterior/arteritic ischaemic optic neuropathy
sudden, painless, monocular and severe visual loss
may be preceded by transient visual loss
may describe a curtain coming down over one eye
medical condition involving loss of vision caused by damage to the optic nerve as a result of insufficient blood supply (ischemia).
what are the features of the optic disc in AION on fundoscopy?
optic disc is pale and swollen
flame shaped haemorrhages at the margin of the optic disc
