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home - Miscellaneous - Rheumatological Disease - Vasculitis Written by Dr Sebastian Zeki

Vasculitis

Symptoms: Inflammation of any intra-abdominal organ.Intussusception.Aneurysm formation.Mesenteric ischaemia. Condition Incidence Presentation Other Notes In SLE or as isolated disorder. Antiphospholipid syndrome (not a vasculitis)— Polyarteritis nodosa Mesenteric vasculitis esp if peripheral vasculitis or CNS lupus. SLE GI tract is affected in 50 % Henoch-Schönlein purpura Churg-Strauss Mesenteric ischemia can occur but rare Discrete ulcerations in the TI, cecum, ascending colon, and esophagus.Can look like Crohn’sRarely get acute pancreatitisRarely SMA aneurysm10% get Budd-Chiari Systemic disease is typically treated with steroids and immunosuppres-sive drugs Behcet's disease Takayasu arteritis Recurrent venous or arterial thrombosisRecurrent fetal lossPersistent thrombocytopeniaLivedo reticularisGI manifestations= GI ischaemia anywhere in tractLaboratory - IgG or IgM anticardiolipin antibody, anti-ß2-glycoprotein I antibody, and/or lupus anticoagulant activity Involves the GI tract in up to 50 % Abdominal painNVDConstipationGI bleeding.Waxes and wanes over several weeks and resolves spontaneously. Similar to PAN. Bloods ESR usually raised in active vasculitis.ANCA is normally not myeloperoxidase type (as opposed to UC related ANCA) Imaging studies — CT usually normal or non-specific eg thickened bowel wall Angiography for small and medium vessel vasculitis, such as PAN. Endoscopy — Video capsule endoscopy is an option. Treatment: Treatment of underlying disease and GI symptoms. Mesenteric ischemia resolves with vasculitis treatment. Scarring occurs in healed disease can also cause infarct. Surgery-needed if perforate or if infarction. If severe can cause: 1.Intestinal infarction or perforation 2.Pneumatosis intestinalis 3.Pseudomembranous colitis. If PAN inactive, can still get mesenteric ischaemia related to scarred vessels Also: Aneurysm of SMI/IMA/HA Pancreatic vessels - bleed into pseudocyst GI involved in 60%If GI involved 10y survival: 50%Associations: Hep B /gastric CA/marrow neoplasms/regenerative liver hyperplasia Wegener’s GranulomatosisErosive granulomatous oesophagi-tis with odynophagia and tracheo-oesophageal fistula Granulomatous gastritis Ulcers in mouth/small bowel/perianalHA aneurysms Can mimic pancreatic cancer Amyloidosis AA ameloid - 2% of Crohn's Usually presents with nephrotic syndrome AL ameloid - Causes macroglossia - Diffuse GI bleeding - UC like colitis - Fertility problems Familial ameloid polyneuropa-thy - Evaluation of The Patient Written by Dr Sebastian Zeki

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