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Flashcards in Vasculitis - general Deck (7)
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1
Q

How is vasculitis defined?

A

It is an inflammatory disorder if blood vessel walls, causing destruction (aneurysm/rupture) or stenosis.

2
Q

Where can it affect?

A

It can affect the vessels of any organ; presentation therefore depends on which organ is involved.

3
Q

How is vasculitis classified?

A
  • Large vessel: Giant Cell Arteritis, Takayasu’s arteritis
  • Medium vessel: Polyarteritis nodosa, Kawasaki disease
  • Small vessel:
    1) ANCA +ve vasculitis which has a predilection for the respiratory tract and kidneys; it includes p-ANCA associated microscopic polyangiitis, glomerulonephritis and Churg-Strauss syndrome and c-ANCA associated Wegener’s Granulomatosis
    2) ANCA -ve vasculitis includes Henoch-Schönlein purpura, Goodpasture’s syndrome and cryoglobinaemia
4
Q

What are the symptoms of vasculitis?

A

Different vasculitides preferentially affect different organs,, causing different patterns of symptoms.
Often may only present with overwhelming fatigue with raised ESR/CRP.

Consider vasculitis in any unidentified multi system disorder.

If presentation does not fit clinically or serologically into specific category consider malignancy-associated vasculitis.

A sever vasculitis flare is a MEDICAL EMERGENCY - organ damage may occur rapidly, e.g. critical renal failure

5
Q

What tests can you perform to help diagnose a vasculitis?

A
  • ESR/CRP will be raised
  • ANCA may be positive
  • Increased creatine in renal failure
  • Urine: check proteinuria, haematuria, casts
  • Angiography +/- biopsy for diagnosis
6
Q

What is the management of vasculitis?

A

Large vessel: steroid in most cases
Medium/small: steroids and cyclophosphamide (15mg/kg)
Aziothioprine may be useful as steroid sparing maintenance treatment.

7
Q

What are the general features of vasculitis?

A
  • SYSTEMIC - fever, malaise, Wertzolls, arthralgia, myalgia
  • SKIN - purpura, ulcers, livedo reticularis, nailbed infarcts, digital gangrene
  • EYES - episcleritis, scleritis, visual loss
  • ENT - epistaxis, nasal crusting, stridor, deafness
  • PULMONARY - haemoptysis and dyspnoea (due to pulmonary haemorrhage)
  • CARDIAC - Angina due to MI (coronary arteritis), heart failure, pericarditis
  • GI - Pain or perforation (infarcted viscous), malabsorption form chronic ischaemia
  • RENAL - Hypertension, haematuria, proteinuria, casts and renal failure (renal cortical infarcts; glomerulonephritis in ANCA +ve vasculitis)
  • NEUROLOGICAL - stroke, fits, chorea, psychosis, confusion, impaired cognition, altered mood. Arteritis of the vasa nervorum (arterial supply to the peripheral nerves) may cause mononeuritis multiplex or a sensorimotor polyneuropathy
  • GU - Orchitis