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Polyarteritis nodosa
Picmonic Summary
Polyarteritis nodosa (PAN) is an immune complex-mediated systemic vasculitis of
medium and small arteries. This disease does not typically involve arterioles,
capillaries or venules. It affects various organs in the body including the heart,
liver, GI tract and kidneys, but spares the lungs. Unlike other types of vasculitis
such as Churg Strauss syndrome or Wegeners granulomatosis, PAN is not
associated with antineutrophil cytoplasmic antibodies (ANCAs). However, PAN is
associated with hepatitis B infections. In fact, 30% of patients with PAN have
chronic hepatitis B infections, and antibody complexes to hepatitis B surface
antigens are often found within inflamed vessels.
PAN vessel changes are defined by whats called segmental transmural
necrotizing inflammation. While the disease process may be chronic, during the
acute phase, the inflammation is characterized by infiltration of neutrophils,
mononuclear cells and eosinophils, resulting in whats called fibrinoid necrosis.
Another differentiating characteristic that makes PAN unique compared to the
other vasculitis is that different stages of inflammation can occur simultaneously
due to the recurrent nature of this process.
PAN is characterized by inflammation of the vessels which can lead to infarction,
ulceration, or aneurysm formation anywhere the disease process is taking place.
This disease can affect patients of all ages and can be intermittent, chronic or
acute. Common manifestations include fever, weight loss, hypertension, melena,
myalgia, malaise and peripheral neuritis. The disease process can be controlled
by corticosteroids and cyclophosphamide.
Educational Transcript
Polyarteritis nodosa is depicted in this Picmonic by the polly-artist painting the
his microscope and quickly rolled away to safety in a spare-tire and sought
help from the quarter-on-steroids wielding giant, Cyclops-phosphate-P.
Wegeners granulomatosis
Picmonic Summary
Wegeners granulomatosis, more recently termed granulomatosis with
polyangiitis, is a small and medium vessel necrotizing vasculitis that typically
affects the nose, lungs, and kidneys. Wegeners is characterized by granulomatous
inflammation against a nonspecific inflammatory background thought to be
caused by the presence of C-ANCA or cytoplasmic anti-neutrophil cytoplasmic
antibodies. These antibodies react with proteinase 3, an enzyme within neutrophil
granulocytes. The lungs and upper airways are classically involved and can cause
chronic sinusitis, otitis media, perforation of the nasal septum, and saddle nose
deformity. Individuals also commonly complain of cough and hemoptysis. The
kidneys are also classically involved and can cause glomerulonephritis with
hematuria. Cyclophosphamide and corticosteroids can be used as immune
suppressants in the treatment of granulomatosis with polyangiitis.
Educational Transcript
Wegener's granulomatosis, portrayed by the wagon and the granny llama, is a
small and medium vessel vasculitis that typically affects the nose, lungs and
kidneys. Involvement of the lungs, shown by the lungs in the wagon, can cause
cough, the coughing-coffee, and hemoptysis, depicted by the red mop and the
sinner character coughing up blood. The upper airways are also classically
involved and can lead to chronic sinusitis, portrayed by the sinner with large
nose, and otitis media, oats in the ear. Chronic inflammation of the nose and
sinuses can lead to a saddle nose deformity, shown by the grandma sitting on the
saddle placed on the nose, as well as perforation of the nasal septum,
illustrated by the large nose-ring on the sinusitis sinner. The kidneys are also
classically involves and can cause glomerulonephritis, the glowing mare, with
Wegeners granulomatosis
Picmonic Summary
Wegeners granulomatosis, more recently termed granulomatosis with
polyangiitis, is a small and medium vessel necrotizing vasculitis that typically
affects the nose, lungs, and kidneys. Wegeners is characterized by granulomatous
inflammation against a nonspecific inflammatory background thought to be
caused by the presence of C-ANCA or cytoplasmic anti-neutrophil cytoplasmic
antibodies. These antibodies react with proteinase 3, an enzyme within neutrophil
granulocytes. The lungs and upper airways are classically involved and can cause
chronic sinusitis, otitis media, perforation of the nasal septum, and saddle nose
deformity. Individuals also commonly complain of cough and hemoptysis. The
kidneys are also classically involved and can cause glomerulonephritis with
hematuria. Cyclophosphamide and corticosteroids can be used as immune
suppressants in the treatment of granulomatosis with polyangiitis.
Educational Transcript
Wegeners granulomatosis, shown by the wagon with the granny and the llama,
is a small and medium vessel vasculitis more recently termed granulomatosis
with polyangiitis, portrayed by the granny llama with poly the parrot angel for
polyangiitis. This vasculitis, which is portrayed by the vessels on the wagon, is
commonly described as a necrotizing vasculitis, the necrosis crow grabbing at
the vessels. Wegeners granulomatosis is characterized by the presence of C anca
antibodies, shown by the C shaped anchor, which is thought to play a role in the
pathophysiology of the disease. The lungs and upper airways, shown by the
lungs and airways in the wagon, are classically involved as well as the kidneys,
which can lead to crescentic glomerulonephritis, portrayed by the crescent
Microscopic Polyangiitis;
Picmonic Summary
Microscopic Polyangiitis is an autoimmune small vessel vasculitis affecting
multiple organs in the body. Common causes of microscopic polyangiitis include
autoimmune disorders, systemic lupus erythematosus, streptococcus infections
and penicillin use. These conditions, infections and medications act as triggers to
cause microscopic polyangiitis in patients who are genetically susceptible. The
small vessel inflammation leads to disease manifestation in the brain, lungs,
intestines and kidneys. Due to inflammation in the vessels of these organs,
patients present with neurological defects, pulmonary symptoms, abdominal pain
and possibly renal failure. A unique finding in this disease is that the vessels
affecting the various organs occur at the same stage during the disease process.
The skin manifestation is called a palpable purpura which are lesions that appear
as red or purple discolorations on the skin that do not blanch on applying
pressure. This disease can be detected by the presence of perinuclear anti
neutrophilic cytoplasmic antibodies (P-ANCA) which are antibodies against
myeloperoxidase in cells.
Educational Transcript
Microscopic polyangiitis, depicted by the microscope Polly-angel, is a
necrotizing small vessel vasculitis, which is demonstrated by the necrosiscrow with the small vessels-on-fire. Common causes of microscopic polyangiitis
include infections like streptococci, drugs like penicillin and autoimmune
disorders like lupus. Now, with this disorder, the lungs, kidneys and skin are
commonly affected, depicted as the lungs, kidney, and skin-suit-man. Moreover,
on the skin, patients with microscopic polyangiitis get palpable purpura, the
Picmonic Summary
Churg Strauss Syndrome is a small and medium vessel autoimmune vasculitis.
Diagnostic markers include eosinophilic granulomas and p-ANCA. Churg Strauss
typically presents in 3 stages. The first stage of disease involves the sinuses and
the onset or worsening of pre-existing allergies. The second stage involves the
onset of acute asthma. The third stage involves various organ systems including
vessels of the lungs, GI tract, and peripheral nerves. Churg Strauss can also affect
the heart and kidneys. Often the disease will cause severe nerve pain or
peripheral neuropathy.
Educational Transcript
Churg strauss syndrome, portrayed by the church of straws, is a
granulomatous vasculitis, illustrated by the granny llama grabbing vessels. It
commonly presents with sinusitis, shown as the sinner with a large nose, skin
lesions, the skin leeches, and peripheral neuropathy, the purple wavy neuron
arms. Asthma, depicted by the inhaler, is also a common presentation with
abundance of eosinophils, the red eagle, in the blood. Organs involved include
the GI tract, heart, and kidneys. 70% of patients demonstrate a positive P-anca,
the pancakes, on lab findings.
Story Transcript
The church of straws serves as a refuge for those trying to resist the sinus sinner.
And he should know by now that he isn't winning anyone over with those skin
leeches. The sinner attacked with his wavy peripheral when granny llama arrived
to get pancakes. But he really only wants their inhaler for his burning lungs. The
granny really put him in his place with her vessels as soon as she returned. The
kidney, heart, and G.I. guy should stop being so happy about pancakes and take a
moment to help granny though, because there's an eagle who wants those
pancakes just as bad.