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fema this is eric strong from stanforduniversity and today are we talking about vasculitits.after watching this video you should be able to define vasculitis.describe typical features suggesting vasculitis describe the modern classificationsystem of vasculitis and most importantly identify a probablevasculitis. in a patient with atypical presentation0 this video will not review the specificcriteria the

individual forms a vasculitis that'sbecause this will take an hour to do would be incredibly boring and itsunnecessary since the criteria is easy to look up when needed. instead i'll be focusing on vasculitis as the general category a disease particularly how to recognize a patientwho probably has vasculitis since the varied multisystempresentation can be easy to confuse with other diseases so first what is vasculitis? vasculitis is that they burstcategory of inflammatory diseases of the

blood vessels these diseases range in severity fromself-limited dermatological additions to acute andrapidly paid almost a system diseases all forms of vasculitis are characterized by endothelial damageinto more proliferation thrombosis and eventual vascularocclusion last letters can affect every organsystem typically in back in as both patternsbased on the size of the affected vessels

and the underlying pathologic mechanismsall so what do those recognizable patternslook like the first two layer a patternrecognition has to do with the size of the involved bustles and the knowledge that basket latesttends to affect by organ systems the most which other skingastrointestinal system can these no system and the muscles it can also affect the lungs which i'veleft of here because it's not common other when it does happen itsinvolvement is usually very prominent

when a patient has a basket like this affecting the small blood vessels hereshe can get a skin condition called palpable purpura which show apicture up in a minute gi involvement leads to me go siders and minor gi bleeding the gla merry lai the kidneys are affected which mostcommonly manifest as he maturity a without red blood cell casts andproteinuria patients can get a pollyanna robert pand the muscle involvement result in my algiers which is a fancyword for muscle pain

a medium vessel vasculitis a result into skin conditions calledearthy manado some and livid over to kill aris patients getabdominal pain and rarely pal preparations in thekidneys damage is not limited to the commerciali'm so now there may be mature your with rbc casts along withflank pain from ischemia in the brain patients can get a wide variety ofmental status changes from somnolence psychosis along withstrokes

and in the muscles they get my ownstatus which differs from i'll just and thatthere is a usually lab and pathologic evidence of muscle damagesuch as an elevated creatine kindness a large vessel vasculitis can result incyanosis and discoloration of the extremitiesbalan park shin hypertension from involvement of theaorta or renal arteries but no key macharia strokes from involvement other crowdedand claudication which is pain in the extremities due tolack of blood flow unfortunately

the presentation a basket by this ismuch more complicated than this because no one individual vasculitisdisease leads to all the findings in anyonecolumn all there are however certain clinicalfeatures that are highly suggest to the basket like this the first to something called monunderwriters multi-plex which is a simultaneous or sequential dysfunction a individual non-contiguousperipheral nerves in a seemingly random pattern thistypically presents as loss of sensory

and/or motor function with an individualnerves over days to weeks for example this patient picturedinvolvement up the owner might result in weakness of thefourth and fifth fingers involvement of the lateral cutaneousfrom raw nerve might result in past teachers over the lateral thigh and involvement other common peronealnerve could result in full drop all in addition to basket by this othercauses upon and rightist multi-plex include diabetes hiv and alloy dosis another feature that is highly suggestedthe vasculitis occurs when an

unknown multisystem disease as veryprominent involvement up the long and kidneys especially the combination of pulmonaryhemorrhage and i the renal failure and/or he macharia as the only otherdonbass tonight this diagnosis typically does this is anti gbm antibodydisease also known as good pastors disease all livid over to kill aris which is a placelike reddish depart role discoloration of the skin is frequentlyseen in medium and occasionally small vessel vasculitis

it certainly not pathan demonic howeveras an idiopathic form seen young women is the most common etiology this finding finally is palpable purpura which is thedevelopment up numerous raised non blanchingpurplish lesions on the skin which accused themost prominent in the lower legs ankles and pete as shown here in addition to these poor clinicalfeatures there are a variety of other features which are less specific but are also commonly seen a basket likethis

they include headache hypertension pulmonary hemorrhage without being onparliament obama pain abnormal urinary sediment a skin condition called earthy manadosome which consists up multiple red tender not short on theshins arthralgia is and claudication all here's a picture apparently min ago someall although i said that i wouldn't bereviewing individual diagnostic criteria of vasculitis

it's important to be familiar with thegeneral classification scheme unfortunately the classification ofvasculitis is confusing and unsatisfying due to many reasonsincluding overlapping presentations it makes a primary and secondary forms avasculitis evolving understanding of the underlyingpathophysiology is an evolving consensus regarding use ofeponymous names and varied opinion on whetherclassification should be based primarily on the size of the affected vessels or underlying pathologic process

as a consequence different sources maypresent slightly different classification schemes the following classification is largelybased on the most recent recommendations from the american college ofrheumatology the first order division withinvasculitis is based on that size would target muscles large muscle vascular disease includetalk to ya issues arteritis which predominantly affectsthe great vessels of the aortic arch and as a predilectionfor young asian women

and giant cell arteritis also known astemporal arteritis which primarily affects branches at thecrowded arteries and which is seen almost exclusively among the elderly medium vessel vasculitis includespolyarteritis todos a which is the most widely distributedwithin the body the vascular disease as it can affect any organ callous sakedisease affects almost solely young children andis best known for causing coronary artery aneurysms and primary cns vasculitis into mysterymimicking

all kinds of primary nor logic andpsychiatric disease small vessel vasculitis is furthersubdivided into that which is associated with an auto antibody called anti new to fillcytoplasmic antibody and that which is associated with immunecomplexes thank associated vasculitis includesthree diseases with long and frustratingly similarnames granulomatosis with poly and gids whichis a particularly dangerous vasculitis primarily affectingthe kines

longs upper airway nose and eyes houston affiliate granulomatosis withpoly and gids which is characterized by thecombination asthma sinus problems drop at the and peripheral your sinfilial and microscopic poly and gids which isclinically very similar to granulomatosis poly and gids theexception to the locker upper airway involvement and the lack of granulomas on biopsy all the final category opinion complexassociated vasculitis

includes i g a basket by this ittypically self-limited disease see mostly in children which is characterized by pop operaabdominal pain astrologers and renal involvementusually limited to macharia while globulin the mic basketlettuce which is caused by antibodies called while globulins whichprecipitate when the temperature drops below body temperature most cases are triggered by chronichepatitis c infection and last hypersensitivity vasculitis

which is usually limited to the skin butcan also cause bieber arthralgia stand accused limp and notthe it can be triggered by medicationsparticularly penicillins and cephalosporins along with a variety of chronicinfections a quick word about some %uh those namessome types a basket like this previously had different opinion basednames for example granulomatosis with poly any ideas wasknown as wagoner's granulomatosis until just a few years ago houstonaffiliate granulomatosis with poly and

gids was known as church strauss syndrome andi g a basket by this was known as he knocked shoreline purpura impact most positions they werepaired to these diseases by the eponymous even if the scientific literature shyingaway from them journals and professional societiesaren't just changing the names for the sake of avoiding opinions and general instead wegener'sgranulomatosis was named after

feat rick wagoner was a nazi doctor wasspeculated to participate in experiments on concentration camp prisoners but it seems that once one opinion wasintentionally removed from the formal ex-con all the others are following it seemslikely that copy of his arteritis and kawasaki disease will bothbe renamed in the near future in addition to the types of primaryvasculitis just listed some systemic diseases can trigger asecondary vasculitis

for example connective tissue diseasesmalignancy chronic infection sarcoidosis and bishops disease the last which isoften considered a primary basket latest itself there are also many diseases which canmimic basket like this including pic berger's disease house people axis cholesterol emelisande rum anti gbm antibody disease bacterialendocarditis and amyloidosis some sources

actually list berger's disease and antigbm and the body disease as true masculinities highlighting theoverlapping any incompletely understoodpathophysiology evolved these disorders so what are the general steps todiagnosing a basket latest first the commission must identify acollection of clinical findings which i this is just about the latest in general or optimally wanted to specificmasculinities second one should check with you labs inclinic why collation tasks and a urinalysis and consider checkingimaging studies

and/or anti-nuclear feels like a plasticantibodies this will help to now down thedifferential diagnosis to one or two specific vascular disease to search for an associated systemic onthis that would make the basket by the secondary and to rule out vasculitis mimics all finally the diagnosis to the basketlatest should be confirmed preferrably with biopsy of theclinically affected organ and/or and geography all

in the final minute out very quicklyreview the basic treatment options for although you should keep in mind thateach individual about the latest may have specific treatment algorithms at this extremely brief overview may notcapture all for limited 18 years past the latest forexample mild i g a basket latest orhypersensitivity vasculitis sometimes observation and removaloffending agents are all that is necessary theantihistamines and a short course a penicillin is oftenused all

for mild systemic vasculitis prime hisown on the order of 0.5 to 1 milligram perkilogram per day is common finally a rapidly progressive andlife-threatening basket lettuce prime is own plus they say the toxicaged such as cyclophosphamide is the most common regimencyclophosphamide can be transition to a less toxic agent such as is a biplane or methotrexate afterremission is achieved for fema

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