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CV II Exam 2 > Blood vessels Day 2 continued > Flashcards

Blood vessels Day 2 continued Flashcards

1
Q

If you are experiencing hypothermia and these guys shows up to help, what should you do and why?

A
  1. Pet the dogs because they are awesome
  2. If you have a shot at living… do not drink the beer, ETOH causes vasodilation which accelerates body temperature decreases.
  3. If you are totally screwed, get hammered to both hasten and make death more tolerable.
  4. Or go all Han Solo on them and curl up inside them to wait out the storm. (see attached image)
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2
Q

What are the direct and indirect effects of hypothermia?

A

•Direct effects: Physical disruptions and high salt concentrations within cells due to crystallization of the intra- and extracellular water

  • Indirect effects: Circulatory changes
  • Vasoconstriction and increased

permeability (leading to edema)

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3
Q

What is frostnip?

A

Vasoconstriction involving nose, ears, hands and feet

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4
Q

What is this?

A

Chilblain (Perniones/Perniosis)

Nonfreezing temps and damp conditions

Chronic recurrent vasculitis with red raised leasions

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5
Q

This persons feet have been wet but not freezing cold. What is going on here? What does this lead to?

What does it produce?

A

Immersion (trench) foot

  • May not heal, leads to chronic pain, edema and blotchy discoloration
  • Often produces a superficial, moist, liquefaction gangrene
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6
Q

This person was exposed to sudden sharp drop in temp. that persisted. What happened here?

A

Frostbite with…

  • Vasoconstriction and increased viscosity of the blood
  • Hyperemia and edema, large, clear blisters, vesicles filled with hemorrhagic fluid to complete gangrene
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7
Q

What is shown here?

What are the two types?

A

Raynaud phenomenon

Primary Raynaud Phenomenon (disease)

Secondary Raynaud phenomenon

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8
Q

What induces the vasoconstriction in primary raynauds?

A

Cold or emotion induced vasoconstriction

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9
Q

What causes secondary raynaud phenomenon?

A

Arterial insufficiency caused by various conditions such as SLE, scleroderma, atherosclerosis or Buerger disease

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10
Q

What is this? What can this develop into?

A

Varicose veins - can develop into stasis dermatitis (brawny induration)

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11
Q

What are some other varicosities to be aware of?

A

Hemorrhoids

Esophageal varices

Caput medusa

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12
Q

What is phlebesclerosis?

A

elastic tissue degeneration and spotty calcifications within the media

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13
Q

Where do thrombophlebitis and phlebothrombosis mostly occur?

A

90% in deep leg veins

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14
Q

What are some predisposing factors for thrombophlebitis and phlebothrombosis?

Two bolded, a bunch of others

A
  • Cardiac failure
  • Pregnancy
  • Obesity
  • Postoperative state
  • Prolonged bed rest or immobilization
  • Estrogen therapy (2X)
  • Oral contraceptives (3-6X)
  • Genetic hypercoagulability syndromes
  • Neoplasia, particularly adenocarcinomas of the pancreas, colon, or lung, (paraneoplastic syndrome)
  • Migratory Thrombophlebitis (Trousseau syndrome/sign)- thrombi disappear in one site and appear in a new site

(do not confuse with Trousseau phenomenon/sign from hypocalcemia)

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15
Q

Trousseau syndrome is associated with?

A

Neoplasia and prothrombotic states

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16
Q

What are the two vena caval syndromes?

A

Superior Vena Cava syndrome

Inferior Vena Cava Syndrome

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17
Q

What happens in superior vena cava syndrome?

A

Usually a neoplasm compresses or invades, with cyanosis and dilation of the veins of the head, neck and arms. If pulmonary vessels also compressed, will have respiratory distress.

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18
Q

What happens in inferior vena cava syndrome?

A
  • Neoplasm compresses or penetrates (renal, hepatic or adrenal cortex carcinomas) or a thrombus propagates upward with leg edema, distention of lower abdomen superficial collateral veins
  • With renal vein involvement massive proteinuria
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19
Q

What is this?

A

Superior vena cava syndrome

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20
Q

What is this?

What are three types of neoplasms that are likely candidates for this?

What else might cause this?

A

Inferior Vena cava syndrome

  1. Renal Cell carcinoma
  2. Hepatocellular carcinoma
  3. Occasionally adrenocortical carcinomas

Also can be caused by a large thrombus that keeps growing.

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21
Q

What is lymphangitis?

What is an organism known for causing this?

A

Infections involving lymphatics with red streaks.

Group A beta hemolytic strep

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22
Q

red streaks with painful enlarged regional lymph nodes… describes what?

A

Acute lymphadenitis

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23
Q

What are the types of secondary lymphedema?

A

Obstructive lymphedema…

  • malignant tumors obstructing lymphatic channels or lymph nodes
  • removal of regional groups of lymph nodes
  • postirradiation fibrosis
  • filariasis
  • postinflammatory thrombosis and scarring
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24
Q

Patient is aged 25 years, female, and has had edema that began in the feet at age 10, and slowly accumulated over time. Her extremities are shown in the attached image. What is this?

What causes it?

A

Lymphedema Paecox

Cause is unknown

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25
Q

What are Chylous ascites, chylothorax, and chylopericardium, caused by?

A

caused by rupture of obstructed, dilated lymphatics into the peritoneum, pleural cavity, or pericardium

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26
Q

What are vascular ectasias?

A

localized dilation of pre-existing vessels

27
Q

What is telangiectasia?

What is it composed of?

A

congenital anomaly or acquired permanent exaggeration of preformed vessels

•composed of prominent capillaries, venules, and arterioles

28
Q

What does two face here have?

What should you be worried about?

A

Port-wine stain. If on the face, need to be worried about Sturge-Weber syndrome.

29
Q

Sturge-Weber syndrome is an uncommon congenital disorder, with angiomatous masses in the?

There will be ipsilateral port-wine nevi with distribution of what?

A

Angiomatous masses in the leptomeninges.

Ipsilateral port-wine nevi with trigeminal nerve distribution.

30
Q

What is sturge-weber syndrome often associated with?

A
  1. mental retardation
  2. seizures
  3. hemiplegia
  4. radioopacities in skull
31
Q

What is this? Who is it most frequent in?

A

Spider telangiectasia (arterial spider)

Most frequent in pregnant women and in cirrhosis

32
Q

The shown congenital malformations consist of dilated capillaries and veins and are distributed widely over the skin and mucous membranes of the oral cavity, lips, respiratory, GI and GU tracts.

What is this condition?

What is the inheritance pattern?

Where is the mutation?

A
  1. Hereditary Hemorrhagic Telangiectasia (Osler-weber-rendu disease (he used the eponym when talking about this… for what that is worth))
  2. Autosomal dominant
  3. TGF-β signaling pathway genes
33
Q

Your AIDs patient presents with the lesions shown in the attached images. What organisms cause this?

What is the condition? Benign or malignant?

What is a closely related vascular lesion in the liver and or spleen?

A

Bacillary Angiomatosis - Benign

B. Henslea - domestic cat res and flea vector (also causes cat scratch disease)

B. Quintana - human res with body louse vector (also causes trench fever)

Bacillary Peliosis

34
Q

What is angiomatosis?

A

A hemangioma that involves a large segment of the body, such as an entire extremity

35
Q

What are the five subtypes of hemangiomas?

A

capillary hemangioma

Juvenile hemangioma

Pyogenic granuloma

Cavernous hemangioma

hemangioblastomas

36
Q

Condition?

Tx?

A

Juvenile hemangioma

no Tx, will typically resolve

aka strawberry type hemangioma

37
Q

The lesion shown developed after trauma, what is this?

What would you call this if it happened in a pregnant female?

A

Pyogenic granuloma (lobular capillary hemangioma.

Granuloma gravidarum in pregnant patient

38
Q

This hemangioma is larger and less circumscribed, also it involved deep structures. What is the danger with this? Will it regress?

A

Cavernous hemangioma

Does not regress

•Hemangiomas of the brain threatening since cause pressure symptoms or rupture

39
Q

This hemangioblastoma was obtained from the patient’s eye. There is evidence on imaging of similar lesions in the cerebellum, and brainstem. What is the condition?

What is the disease associated with this?

Where else will you find characteristic lesions?

A

Hemangioblastoma (maybe cavernous, maybe not) in von hipple-lindau disease.

Also see cystic neoplasms in the pancreas and liver

40
Q

While appearing like a hemangioma there is no evidence of RBCs in the leasion. What is this?

What should you think if you see this?

What is this a type of?

A

Cystic hygroma of the neck (may also show in the axilla or retroperitoneun uncommonly)

Think chromosomal abnormality - typically turner syndrome.

A type of lymphangioma

41
Q

These lesions were present on the skin of an AIDs patient. High levels of VEGF are detected in the lesions.

Whaat is this?

What organism caused this?

What are the symptoms you would expect to see with this?

What are the key findings you see in the histology?

A

Kaposi sarcoma

KKV-8 (KS-associated herpesvirus KSHV)

Most will be asymptomatic

Histology reveals hyalin globules in cells

42
Q

What stage kaposi sarcoma is this?

A

pPatch stage: ink to purple solitary or multiple macules

•Dilated angulated blood vessels and chronic inflammatory cells (lesions difficult to distinguish from granulation tissue)

43
Q

What will early stage Kaposi sarcoma lesions be, cellularly?

What happens later on?

A

Reactive polyclonal lesion with only a few infected cells.

Eventually you get a monoclonal proliferation that is neoplastic

44
Q

What stage kaposi sarcoma is shown here?

A

Nodular stage – raised nodular lesions

  • often accompanied by involvement of lymph nodes and of viscera
  • sheets of spindle cells with mitotic figures and slit-like spaces that often contain rows of red cells
45
Q

We covered patch and nodular stages of kaposi sarcoma, what is the other stage?

A

Plaque stage- larger, violaceous dermal jagged vascular channels lined by plump spindle cells with occasional mitoses with RBC extravasation

46
Q

What does the nodular stage of KS resemble?

A

Bacillary angiomatosis

47
Q

What are the types of kaposi sarcoma? (4)

A

Chronic (european or classic)

Lymphadenopathic (african or endemic)

Transplant associated (immunosuppression associated)

AIDS assoiated KS

48
Q

Chronic KS is most common in Older men of Eastern European (especially Ashkenazi Jews) or Mediterranean descent. What is the Tx?

A

Resect

Radiation

Chemo

49
Q

Lymphadenopathic KS is most common in Young Bantu children or adults <40 y/o of South Africa. Tx?

A

Chemo or radiotherapy

50
Q

Transplant-associated (immunosuppression -associated) occurs Months to few years post-organ transplant with high doses of immunosuppressive therapy. Tx?

A

Withdraw or reduce immunosuppresion.

51
Q

How do you treat AID associated KS?

A

Antiretroviral therapy for HIV. Chemo and rad

52
Q

This vascular tumor occurred around a medium/large vein in an adult patients soft tissue. The histologic features and clinical behavior is between hemangiomas and angiosarcomas. What is this?

Describe what you see.

A

Epitheliod hemangioendothelioma

  • vascular tumor occurring around medium and large veins in the soft tissue of adults
  • inconspicuous well-defined vascular channels and tumor cells are plump and often cuboidal
53
Q

Hemangioendothelioma can be cured by excision… but….

A
  • 40% recur
  • 20% to 30% metastasize
  • 15% die from metastases
54
Q

Angiosarcomas are highly malignant… what can induce them?

A

Radiation or foreign material left in body

55
Q

How do we ID angiosarcoma?

A

Immunohistochem - CD31, vWF, CD34, factor VIII

56
Q

What are the three types of angiosarcoma we talked about?

A

Cutaneous angiosarcoma

hepatic angiosarcoma

lymphangiosarcoma

57
Q

What is associated with hepatic angiosarcomas?

A

Arsenic

Thorotrast

Vinyl Chloride

58
Q

In what conditions does lymphangiosarcoma arise?

A

Chronic lymphedema (10 yrs post radical mastectomy)

59
Q

On autopsy evaluation of the heart the attached image is found, the image at right shows staining + for CD31. What is this tumor?

A

Angiosarcoma

60
Q

Your patient presents with this lesion under their fingernail. They complain that pressure on the nail bed causes pain.

What did this tumor arise from?

What cells do you see arranged around the vessels?

Benign or malignant?

A

Glomus Tumor (glomangioma)

Arose from modified cells of the glomus body

specialized glomus cells

61
Q

What are the complications associated with balloon angioplasty?

A
  • Abrupt reclosure (extensive circumferential or longitudinal dissection, thrombosis)
  • Proliferative in-stent restenosis (intimal thickening in 30% to 50% of patients within the first 4 to 6 months)
62
Q

What are the complications of vascular stents?

A
  • Early - thrombosis
  • use platelet antagonists)
  • Late - intimal thickening
  • use antiproliferative drugs, e.g. paclitaxel or

sirolimus

63
Q

What is shown here?

A

Restenosis after angioplasty and stenting

Gross - new tan-white concentric intimal lesion in the plaque.

Micro - thickened neointima seperating and overlying the stent wires

64
Q

Endothelialization of clinical grafts is unusual, but can happen. What do we see in these cases?

A
  • neointima in a 12- to 15-mm zone near the anastomosis
  • pseudointima with thrombus or cells other than endothelial cells lining remainder of graft

CV II Exam 2 (8 decks)

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