vasculitides

Information about vasculitides

Published on April 21, 2009

Author: Dr.Ellen

Source: authorstream.com

Content

The Vasculitides : Available on: http://www.authorSTREAM.com The Vasculitides Definition : Available on: http://www.authorSTREAM.com Definition Heterogeneous group of syndromes Presence of leukocytes in the vessel wall with reactive damage / necrosis Impairment of blood flow Clinical syndromes as a result of ischemia to tissues and systemic inflammation Presentation depends on the size of vessels involved and the extent of the disease Pathology : Available on: http://www.authorSTREAM.com Pathology Inflammation Increased permeability Bleeding Ischemia & necrosis of tissue/organs Aneurysm/stricture formation Thrombus Clinical Clues to Systemic Vasculitis : Available on: http://www.authorSTREAM.com Clinical Clues to Systemic Vasculitis Constitutional symptoms Unexplained ischemia, such as claudication, limb ischemia, angina, transient ischemic attack, stroke, mesenteric ischemia and cutaneous ischemia particularly in a young patient or a patient without risk factors for atherosclerosis Multiple organ dysfunction in a systemically ill patient, especially in the presence of other suggestive clinical features Differential Diagnosis : Available on: http://www.authorSTREAM.com Differential Diagnosis Fibromuscular dysplasia Cholesterol emboli Atrial myxoma with emboli Infective endocarditis Some malignancies Mycotic aneurysm with embolization Bacteremia Rickettsial infection Ergotism Thrombocytopenia and other processes associated with purpura Radiation fibrosis Neurofibromatosis Coarctation of the aorta Amyloidosis Livedoid vasculopathy Malignant atrophic papulosis (Degos disease or syndrome) Necrotic arachnidism (Loxosceles species spider bites) Categorizing Vasculitides : Available on: http://www.authorSTREAM.com Categorizing Vasculitides Clinical Manifestations (e.g., cutaneous, urticarial) Size of vessel involved Pathologic features (e.g., leukocytoclastic, granulomatous, etc.) Serologic (e.g., hypocomplementemic, cryoglobulinemia, etc.) Pathogenesis (e.g., Immune complex mediated, ANCA related, Cell mediated) Problems with Vasculitis : Available on: http://www.authorSTREAM.com Problems with Vasculitis Often a complication of other diseases: RA, SLE, Behcets More helpful to label by disease, not as “vasculitis” Often used interchangeably with vasculopathy” (eg, Beurger’s, Raynaud’s etc.) Not vasculitis unless vessels are inflamed Classification by Vessel Size : Available on: http://www.authorSTREAM.com Classification by Vessel Size Small capillaries and postcapillary venules Medium muscular arteries and arterioles Large the aorta and its major branches Slide 9: Available on: http://www.authorSTREAM.com Clinical: Large Vessel : Available on: http://www.authorSTREAM.com Clinical: Large Vessel Limb claudication Asymmetric blood pressures Absence of pulses Bruits Aortic dilation Renovascular hypertension Large Vessel Vasculitides : Available on: http://www.authorSTREAM.com Large Vessel Vasculitides Clinical: Medium Vessel : Available on: http://www.authorSTREAM.com Clinical: Medium Vessel Cutaneous nodules Ulcers Livedo reticularis Digital gangrene Mononeuritis multiplex Microaneurysms Renovascular hypertension Small & Medium Vessel Vasculitides : Available on: http://www.authorSTREAM.com Small & Medium Vessel Vasculitides Clinical: Small Vessel : Available on: http://www.authorSTREAM.com Clinical: Small Vessel Purpura Urticaria Glomerulonephritis Alveolar hemorrhage Cutaneous extravascular necrotizing granulomas Splinter hemorrhages Uveitis/episcleritis/scleritis Small Vessel Vasculitides : Available on: http://www.authorSTREAM.com Small Vessel Vasculitides Demographic Associations of the Vasculitides : Available on: http://www.authorSTREAM.com Demographic Associations of the Vasculitides Specific Laboratory Tests : Available on: http://www.authorSTREAM.com Specific Laboratory Tests ANA — If positive suggests the presence of an underlying connective tissue disorder. Systemic lupus erythematosus. Sjögren's syndrome Complement— Low levels in mixed cryoglobulinemia and SLE. Consider HCV if associated with cryoglobulins ANCA — Not diagnostic, but suggestive Wegener's granulomatosis, Microscopic polyarteritis, Drug-induced vasculitis and Churg-Strauss vasculitis Selected Bibliography : Available on: http://www.authorSTREAM.com Selected Bibliography ROANE DW, et al, An Approach to Diagnosis and Initial Management of Systemic Vasculitis, AFP, 1999; 1421 UpToDate, Classification of and approach to the vasculitides in adults http://www.authorstream.com/Presentation/Dr.Ellen-178291-vasculitites-science-technology-ppt-powerpoint/

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