Vasculotides Flashcards by Alicia Daum

Define Polyarteritis Nodosa

Necrotizing arteritis of medium-sized vessels

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What does polyarteritis nodosa commonly involve?

Skin
Peripheral nerves
Mesenteric vessels
Heart
Brain
Can affect any organ

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Etiology of PolyArteritis Nodosa

Idiopathic
Hep B & C
Hairy cell leukemia

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Pathogenesis of Polyarteritis Nodosa

Thickening of inflamed vessel wall leads to lumen narrowing
Reduce blood flow & thrombosis
Ischemia to involved organ
Inflammation can also lead to aneurysm formation

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Signs & Symptoms of Polyarteritis Nodosa

Fatigue
Weight loss
Weakness 
Fever
Arthralgias
Skin lesions
HTN
Renal insufficiency
Neurologic dysfunction
Abdominal pain

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Skin Manifestations of Polyarteritis Nodosa

Tender erythematous nodules
Purpura
Livedo reticularis
Ulcers
Bullous or vesicular eruption
Focal or diffuse &amp; usually on lower extremities

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Renal Manifestations of Polyarteritis Nodosa

Most commonly involved
Renal insufficiency &amp; HTN
Perirenal hematoma
Glomerular ischemia but not inflammation or necrosis
UA: minimal protein, moderate hematuria

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Neurologic Manifestations of Polyarteritis Nodosa

Moto & sensory deficits
Asymmetric neuropathy
CNS involvement

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GI Manifestations of Polyarteritis Nodosa

Abdominal pain: post prandial pain, weight loss, bowel infarction with perforation
N/V
Melena
Diarrhea
GI bleeding

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Cardiovascular Manifestations of Polyarteritis Nodosa

CAD
HF: vasculitis of coronary arteries or uncontrolled HTN due to renal disease
MI uncommon

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Musculoskeletal Manifestations of Polyarteritis Nodosa

Myalgias

Muscular weakness

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Other Manifestations of Polyarteritis Nodosa

Orchitis
Breast/uterine pain
Ischemic retinopathy
Retinal detachment

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Diagnosis of Polyarteritis Nodosa

H&P
Confirm with biopsy or angiography
Labs: CMP, CPK, HBV, HCV, UA, ESR

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Treatment of Polyarteritis Nodosa

High dose steroids
Cyclophosphamide
Azathiprine
Methotrexate

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Epidemiology of Kawasaki Disease

3-5 year old Asian or Pacific Islander males

Increased in summer & winter

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Pathophysiology of Kawasaki Disease

Vasculitis due to the infiltration of vessel walls with mononuclear cells & later IgA secreting plasma cells
Can result in destruction of tunica media & aneurysm formation

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Diagnostic Criteria for Kawasaki Disease

Fever >5 days without explanation
Bilateral bulbar conjunctival injection
Oral mucous membrane changes
Peripheral extremity changes
Polymorphous rash
Cervical lymphadenopathy

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Define Incomplete Kawasaki Disease

Only 2 of the criteria are met

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Classic Presentation of Kawasaki Disease

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Irritability or lethargy
Vomiting alone
Anorexia
Cough or rhinorrhea
Diarrhea, vomiting, or abdominal pain

Fever in Kawasaki Disease

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Minimally responsive to antipyretics
May be intermittent
>5 days

Conjunctivitis in Kawasaki Disease

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Bulbar injection
May spare limbus
Photophobia & anterior uveitis

Mucositis in Kawasaki Disease

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Cracked red lips
Strawberry tongue
Mild or not occur at all

Extremity Changes in Kawasaki Disease

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Early: erythema of hands & feet
Late: desquamation of hands & feet

Polymorphous Rash in Kawasaki Disease

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First days of illness
Perineal erythema & desquamation followed by macular, morbilliform or targeted skin lesion of the trunk & extremities

Lymphadenopathy in Kawasaki Disease

Anterior cervical nodes | May be able to palpate a single large node

Cardiovascular Complications of Kawasaki Disease

``` Coronary artery aneurysms CHF & decreased EF MI Arrythmias Peripheral arterial occlusion ```

Evaluation of Kawasaki Disease

Labs: CBC, CMP, ESR, CRP Echocardiogram CXR: pulmonary edema

Treatment of Kawasaki Disease

``` IVIG Aspirin (QID dosing) ```

Result of IVIG in Kawasaki Disease

``` Can reduce incidence of coronary aneurysm Anti-inflammatory effect Reduce acute phase reactants, cytokines Augments T cell suppressor activity Resolves fever ```

Function of Aspirin in Kawasaki Disease

Antipyretic Anti-inflammatory Anti-platelet effects

Second Line Therapies for Kawasaki Disease

Methylprenisolone | TNF inhibitors

Another Name for Wegener's Granulomatosis

Granulomatosis with polyangitis

Triad of Wegener's Granulomatosis

Necrotizing granulomas of upper respiratory tract Necrotizing granulomas of lower respiratory tract Necrotizing glomerulonephritis & thrombosis of capillary loops

What arteries does Wegener's Granulomatosis affect?

Small arteries

Presentation of Wegener's Granulomatosis

``` Nasal congestion Sinusitis Otitis media Mastoiditis Inflammation of the gums Stridor Cough Dyspnea Hemoptysis Fever Malaise Weight loss ```

Other Symptoms of Wegener's Granulomatosis

``` Arthritis of large joints Purpura Dysthesia Renal insufficiency Unilateral proptosis Red eye Eye inflammation Rashes/skin sores Kidney inflammation ```

Lab Results of Wegener's Granulomatosis

``` Mild anemia & leukocytosis Elevated ESR Hematuria Blood cell casts Elevated C-ANCA ```

Chest CT Results in Wegener's Granulomatosis

Infiltrates Nodules Masses Cavities

Treatment of Wegener's Granulomatosis

Corticosteroids Cyclophosphamide Rituximab

Henoch-Schonlein Purpura

Palpable purpura Abdominal pain: GI bleed Arthritis of lower extremities Hematuria or proteinuria: glomerulonephritis

Commonly Affected Organs in Henoch-Schonlein Purpura

Skin Joints GI tract Kidneys

Skin Manifestations of Henoch-Schonlein Purpura

Erythematous macular wheals Ecchymosis Petechiae Palpable purpura

Joint Manifestations of Henoch-Schonlein Purpura

Transient or migratory arthritis in large joints

GI Manifestations of Henoch-Schonlein Purpura

``` N/V Abdominal pain Ileus GI bleed Bowel ischemia Perforation Intussusception ```

Kidney Manifestations of Henoch-Schonlein Purpura

``` Hematuria + protein Nephritis syndrome Renal insufficiency nephrotic syndrome ```

Follow Up of Henoch-Schonlein Purpura

UA & BP weekly x 2 months | UA & BP every 1-2 months for 1 year

Vasculotides Flashcards

(46 cards)