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Polyarteritis Nodosa

Title               

Ñ    Polyarteritis Nodosa

Definition

Ñ    Vasculitis

Ñ    Involves medium sized vessels

Pathogenesis

Causes

Ñ    Not known

Ñ    Occasionally associated with Hepatitis B

Pathological Process

Ñ    Fibrinoid necrosis of vessel walls

Ñ    Formation of microaneurysms

Ñ    Thrombosis

Ñ    Infarction

Clinical Features

History

Sex and Age

Ñ    Commoner in middle-aged men

E&M

Ñ    Fever

Ñ    Malaise

Ñ    Weight loss

GIT

Ñ    Abdominal pain:

Due to infarction of viscera

May simulate cholecystitis, pancreatitis, appendicitis

Ñ    Gastrointestinal haemorrhage

KUS

Ñ    Haematuria

Ñ    Proteinuria

LMS

Ñ    Myalgia

Examination

IS

Ñ    Subcutaneous haemorrhage

Ñ    Gangrene

Ñ    Livedo reticularis

CVS

Ñ    Myocardial infarction

Ñ    Heart failure

Ñ    Pericarditis

RS

Ñ    Involvement rare

GIT

Ñ    Mimic acute abdomen

KUS

Ñ    Hypertension

Ñ    Acute renal failure

Ñ    Chronic renal failure

HS

Ñ    Anaemia

CNS

Ñ    Mononeuritis multiplex

Investigations

Fluids

Blood

Haematology

Ñ    Anaemia

Ñ    Leucocytosis

Ñ    ESR:

Elevated

Imaging

Angiography

Ñ    Demonstrates microaneurysms in hepatic, intestinal, renal vessels

Electrophysiology

ECG

Ñ    Changes due to ischaemia

Tissue Diagnosis

Biopsy

Ñ    Affected organs show fibrinoid necrosis of vessel walls, microaneurysms, thrombosis, infarction

Management

Control

Drugs

Ñ    Steroids

Ñ    Immunosuppressives:

Azathioprine

 

 

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