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Flashcards in Vasculotides Deck (46)
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1

Define Polyarteritis Nodosa

Necrotizing arteritis of medium-sized vessels

2

What does polyarteritis nodosa commonly involve?

Skin
Peripheral nerves
Mesenteric vessels
Heart
Brain
Can affect any organ

3

Etiology of PolyArteritis Nodosa

Idiopathic
Hep B & C
Hairy cell leukemia

4

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

5

Signs & Symptoms of Polyarteritis Nodosa

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

6

Skin Manifestations of Polyarteritis Nodosa

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

7

Renal Manifestations of Polyarteritis Nodosa

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

8

Neurologic Manifestations of Polyarteritis Nodosa

Moto & sensory deficits
Asymmetric neuropathy
CNS involvement

9

GI Manifestations of Polyarteritis Nodosa

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

10

Cardiovascular Manifestations of Polyarteritis Nodosa

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

11

Musculoskeletal Manifestations of Polyarteritis Nodosa

Myalgias
Muscular weakness

12

Other Manifestations of Polyarteritis Nodosa

Orchitis
Breast/uterine pain
Ischemic retinopathy
Retinal detachment

13

Diagnosis of Polyarteritis Nodosa

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

14

Treatment of Polyarteritis Nodosa

High dose steroids
Cyclophosphamide
Azathiprine
Methotrexate

15

Epidemiology of Kawasaki Disease

3-5 year old Asian or Pacific Islander males
Increased in summer & winter

16

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

17

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

18

Define Incomplete Kawasaki Disease

Only 2 of the criteria are met

19

Classic Presentation of Kawasaki Disease

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

20

Fever in Kawasaki Disease

Minimally responsive to antipyretics
May be intermittent
>5 days

21

Conjunctivitis in Kawasaki Disease

Bulbar injection
May spare limbus
Photophobia & anterior uveitis

22

Mucositis in Kawasaki Disease

Cracked red lips
Strawberry tongue
Mild or not occur at all

23

Extremity Changes in Kawasaki Disease

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

24

Polymorphous Rash in Kawasaki Disease

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

25

Lymphadenopathy in Kawasaki Disease

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

26

Cardiovascular Complications of Kawasaki Disease

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

27

Evaluation of Kawasaki Disease

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

28

Treatment of Kawasaki Disease

IVIG
Aspirin (QID dosing)

29

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

30

Function of Aspirin in Kawasaki Disease

Antipyretic
Anti-inflammatory
Anti-platelet effects