7.3 Arteriosclerosis

Question 1

hyperplastic arteriolosclerosis

-appearance on histology

Answer 1

onion skin appearance

-growth of smooth m layers

Question 2

Hyaline arteriolosclerosis

• what is it caused by? (2)
• mech of each

Answer 2

• benign HTN and diabetes cause proteins to leak into vessel wall
  1. Benign HTN: increased pressure pushes proteins into wall
  2. Diabetes: Glucose weakens vessel wall (non-enzymatic glycosylation of basement membrane), allowing proteins to leak into wall

Question 3

arteriosclerosis

• 3 types?
• what vessels affected by each

Answer 3

1. atherosclerosis–large/med size arteries
2. arteriolosclerosis–arterioles
3. Monckeberg medial calcific sclerosis–med arteries

Question 3

hyperplastic arteriolosclerosis

-classic complication

Answer 3

• acute renal failure with “flea-bitten” kidney
• fibrinoid necrosis of vessel walls with hemorrhage

Question 4

hylaine arteriolosclerosis

-the classic complication

Answer 4

arteriolonephrosclerosis (glomerular scarring)

• chronic renal failure
• glomerulus ischemia causes scarring of glomerulus

Question 5

Atherosclerosis:

-progression of vessel damage

Answer 5

1. Endothelial damage
   - endothelium causes lipids to leak into intima
2. Fatty Streak
   - Lipids are oxidized and consumed by macrophages, resulting in foam cells
3. Plaque
   - inflammation and healing lead to deposition of ECM and proliferation of smooth m.

Question 6

atherosclerosis

-the Big 4 modifiable risk factors

Answer 6

1. HTN
2. Hypercholesterolemia
3. Smoking
4. Diabetes

Question 8

atherosclerosis

-what do you see in cross section of vessel wall

Answer 8

1. necrotic lipid core (mostly cholesterol)
2. fibromuscular cap

Question 9

hylaine arteriolosclerosis

-appearance on histology

Answer 9

• vessel wall is pink from presence of hyaline.
• thickening of vessel wall

Question 9

Monckeburg medial calcific sclerosis

-how is it related to breast cancer?

Answer 9

• mammograms look for calcifications in breast tissue
• you may see Monckeburg calcification in mammograms

Question 10

what population is hormonally protected from atherosclerosis?

Answer 10

premenopausal women are protected by estrogen.

Question 11

what layer of vessel does atherosclerosis affect?

Answer 11

Tunica intima

Question 12

atherosclerosis

-4 important complications to know

Answer 12

1. Ischemia
   - can lead to peripheral vascular disease, angina, ischemic bowel disease
2. Thrombosis
   - Plaque rupture exposes lipid core, leading to thrombus formation. (MI, stroke)
3. Embolism
   - thrombus can embolize
4. Aneurysm
   - vessel wall weakened b/c poor O2 transfer through thick wall

Question 13

types of Arteriolosclerosis

Answer 13

1. Hyaline–proteins leak into vessel wall
2. Hyperplastic–hyperplasia of smooth m.

Question 15

Monckeburg medial calcific sclerosis

• what happens
• appearance on histology

Answer 15

• calcification of media in med-sized arteries
• nonobstructive, not clinically significant
• you can see calcifications in media on histology

Question 16

Fatty streak

Answer 16

the appearance of foam cells, which are macrophages that eat oxidized lipids that entered the intima through endothelial damage.

Question 17

hyperplastic arteriolosclerosis

• main cause
• mech

Answer 17

• caused by Malignant HTN
• in response, vessel grows extra layers of smooth m.

(onion skin appearance)

Question 18

what is the hallmark of atherosclerotic emboli on histology?

Answer 18

-presence of cholesterol crystals in embolus

Question 19

what percentage of stenosis is required in artery before complications appear?

Answer 19

-must be over 70% stenosis before you get complications