Hello. Welcome to our
discussion of vasculitis.
In my opinion, the best approach to
take a look at vasculitis would be
to organize it into large, middle,
and small vessel vasculitities.
Let’s have a look.
So vasculitis itself—I want you to
step back for a second
and think of what that actually means.
Whatever blood vessel that we choose as
we go through the differentials here,
let it be large, middle, or small vessel,
well that vessel is undergoing
Well depending as to which blood
vessel we’re going to focus upon
will then depend on what kind of
that the patient’s presenting
Now for example, let’s say that there’s
inflammation taking place
of a large blood vessel such as the
branches of the arch of aorta.
You have pretty massive issues then.
For example, Takayasu, we’ll talk about.
What if it was a middle-sized
blood vessel such as
a mesenteric artery or maybe
the renal artery and such,
and then inflammation is
bringing about occlusion,
and then you would then have what?
End organ damage, wouldn’t you?
Or maybe you’re talking about
cutaneous blood vessels
that are undergoing inflammatory process
and how would that patient present?
Well then obviously you’re
looking at “rash.”
The best way to think about this;
however, is also the following:
it could be idiopathic or connective
tissue disease associations.
So for example, let’s say that we’re
discussing polymyalgia rheumatica
and you have an older lady
who, all of a sudden, starts
complaining about pain in the jaw or maybe
perhaps up here in the temporal region.
The combination of the 2, giant
cell arteritis overlapping with
polymyalgia rheumatica, where your patient
might then be having issues in the neck
and the upper shoulders and such.
Infectious? Often times there
might be an antecedent
prodrome of a viral infection
following the vasculitis.
Keep that in mind. And maybe
perhaps malignant as well.
As I said, the method that I like using here
is to organize your blood vessel issues.
For the large vessel. With that said, let’s
begin with our first discussion, Takayasu.
Who is this patient walking
through the door?
So a young lady, younger
than the age of 40,
and she’s of Asian descent most commonly.
Now which large blood vessel
are we referring to?
Well here, we’ll talk about
the branches of the aorta.
Our next patient, with large vessel
disease, will be giant cell.
Under giant cell arteritis, we’ll be talking
about the branches of the temporal artery;
and with this patient, older
lady most commonly,
that if left untreated,
then the ophthalmic branch
might then undergo granulomatous changes
resulting in blindness if left
untreated—we’ll talk about.
Medium vessel disease—we’ll take
a look at polyarteritis nodosa.
Want you to think about the GI and the
kidney. As soon as you think about PAN,
I want you to get in the habit of what
you’re looking for in your patient.
Therefore, you’re looking for abdominal pain
and you’re looking for maybe hematuria
because of renal blood vessels
are being affected.
Be careful here under medium vessel.
Technically speaking, some of
these blood vessel pathologies
could affect medium and small blood
vessels, so do not get trapped
or do not contain yourself or put
yourself into a box thinking,
“Oh, well mesenteric artery versus a
capillary—that must be small vessel.”
No, you’re going to be paying attention to
the most common presentation.
Buer-is what this says
you pronounce it pretty much the same.
Buerger or maybe Buerger.
What I’m saying is, to a layman, it sounds
exactly the same. Buerger and Berger.
Two different pathologies all together.
What is the most common
nephritis in the world?
That is not our topic.
Our topic is vasculitities.
This is Buer—a better name for this
would be thrombangitis obliterans
and I’ll give you the common presentation
where most likely a male, who’s a smoker,
and the little blood vessels in the
foot may be perhaps be affected
and therefore gangrene might set in.
<i>Another form of medium vessel
vasculitis is Kawasaki disease.</i>
<i>Its diagnosis requires a fever
lasting at least 5 days</i>
<i>without another explanation, and at least
4 out of 5 of the following symptoms:</i>
<i>first, bilateral conjunctival infection;</i>
<i>second, oral mucosal changes
like fissured lips,</i>
<i>strawberry tongue or something similar;</i>
<i>third, a rash; fourth,
<i>and fifth, erythema of the palms or
soles or other extremity changes.</i>
<i>Additionally, Kawasaki disease is the one
exception to giving aspirin to children.</i>
And under small vessel, we’ll
divide this into ANCA positive
or non-ANCA small vessel disease.
Of course under ANCA, the
prototype often used for
something that used to be cANCA positive
which is now called PR3-ANCA
or proteinase 3-ANCA.
It used to be called Wegener, but now we
call it granulomatosis with polyangiitis,
but you know what I’m trying to get at.
And then under non-ANCA, we’ll take
a look at Henoch-Schönlein purpura.
Another name for this, and properly
and correctly, is called IgA vasculitis.
Also take a look at quickly cutaneous
and also essential mixed cryoglobulinemia.