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Vasculitis

Vasculitis. Objectives. What is a vasculitis Know the more common and relevant vasulitides . Understand how to investigate and manage these conditions. Case scenario. Definition. Multi-system Inflammatory disorder of blood vessels, with systemic and system specific symptoms. Categories.

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Vasculitis

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  1. Vasculitis

  2. Objectives • What is a vasculitis • Know the more common and relevant vasulitides. • Understand how to investigate and manage these conditions. • Case scenario.

  3. Definition • Multi-system Inflammatory disorder of blood vessels, with systemic and system specific symptoms.

  4. Categories • Large Vessel • PMR • Giant cell/temporal • Medium Vessel • Polyarteritisnodosum • Kawasaki’s disease • Small vessel • Churg Strauss • Wegener’s • Henoch-schonleinpurpura

  5. Finals cases • Written • Any of them • Clinical • PMR (Giant cell) • Wegener’s • Churg Strauss

  6. Recognising Symptoms • All: fatigue, fever, weight loss, anaemia • PMR: Pain+stiffness in muscles. • Giant cell: temporal tenderness, headache, jaw claudication, Amaurosisfugax.

  7. Wegener’s: chronic rhinitis, saddle nose deformity. Cough, haemoptysis, arthritis. Eventually renal impairment. • Churg-Strauss: Asthma heart disease OR skin lesions/nasal polyps.

  8. Ix • Bedside – Urine dip • Bloods – U+Es, FBC, LFTs, - CRP, ESR, ANCA • Imaging – depends on symptoms • Special tests - biopsy

  9. Rx • Conservative – Advice • Medical – Steroids, immunosuppressants (azathioprine, cyclophosphamide)

  10. Case • 45 year old man comes to see you with a stuffy nose for the last 5 months. He is troubled by recurrent sinusitis and runny nose. He also feels his nose has changed shape, as if it has “caved in”. He has felt generally unwell with aches and tiredness for the last 3 months. The reason he has come today is that he coughed up blood yesterday and is worried it means he has cancer. On examination his temp is 37.3. He has mild conjunctival pallor and a deformity of his nose. Systemic examination is otherwise unremarkable. You send off some routine bloods and his urea come back at 17 and his creatinine at 350.

  11. Questions • What are your main differentials for this man? • How will you investigate him? • How will you manage him? • What is the classification for vasculitis? Give examples of each group • What are the ANCA positive vasculitides?

  12. Summary • State the obvious • Large medium and small vessel • Multi-system Inflammatory disorder of blood vessels, with systemic and system specific symptoms

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