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Medium & Variable-Sized Vasculitis for NP

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Medium & Variable-Sized Vasculitis for the Nurse Practitioner Licensing Exam
Medium and variable-sized vasculitis includes Polyarteritis Nodosa (PAN), Kawasaki Disease, Thromboangiitis Obliterans (Buerger’s Disease), and Behçet’s Disease. These diseases can affect medium-sized vessels, with Behçet’s Disease involving both arteries and veins.
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Polyarteritis Nodosa (PAN)
  • Definition:
    • A systemic necrotizing vasculitis affecting medium-sized arteries, often involving the renal, GI, and nervous systems.
  • Clinical Presentation:
    • Systemic Symptoms: Fever, weight loss, and fatigue.
    • Renal: Hypertension, renal ischemia.
    • Gastrointestinal: Abdominal pain and potential for bowel infarction.
    • Neurologic: Mononeuritis multiplex (asymmetric neuropathies).
Polyarteritis Nodosa
  • Diagnosis and Management:
    • Biopsy shows transmural inflammation, and angiography may show microaneurysms.
    • Treated with corticosteroids and immunosuppressive therapy.
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Kawasaki Disease
  • Definition:
    • An acute vasculitis in children, primarily affecting the coronary arteries.
  • Clinical Presentation:
    • Fever >5 days, conjunctivitis, strawberry tongue, rash, extremity erythema, and cervical lymphadenopathy.
  • Complications:
    • Coronary artery aneurysms can lead to myocardial infarction if untreated.
  • Management:
    • Treated with IVIG and high-dose aspirin to reduce aneurysm risk.
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Thromboangiitis Obliterans (Buerger’s Disease)
  • Definition:
    • A non-atherosclerotic vasculitis affecting small- and medium-sized vessels, strongly linked to smoking.
  • Clinical Presentation:
    • Distal ischemia, pain, ulcers, and Raynaud’s phenomenon in extremities.
  • Management:
    • Requires smoking cessation to halt progression; symptomatic care as needed.
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Behçet’s Disease
  • Definition:
    • A variable vessel vasculitis with recurrent oral and genital ulcers, uveitis, and skin lesions.
  • Clinical Presentation:
    • Painful ulcers, uveitis, skin lesions (erythema nodosum), and risk of venous thrombosis.
  • Management:
    • Managed with corticosteroids for flares and immunosuppressants for chronic symptoms.
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Key Points
  • Polyarteritis Nodosa (PAN): Causes systemic symptoms, renal hypertension, GI ischemia; treated with corticosteroids.
  • Kawasaki Disease: Pediatric vasculitis with prolonged fever, mucocutaneous symptoms, and risk of coronary aneurysms; managed with IVIG and aspirin.
  • Thromboangiitis Obliterans (Buerger’s Disease): Occurs in smokers, causing extremity ischemia; smoking cessation is critical.
  • Behçet’s Disease: Presents with recurrent oral/genital ulcers and uveitis; treated with corticosteroids and immunosuppressants for severe cases.

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