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Cardio - Gupta > Blood Vessels - The Basics > Flashcards

Blood Vessels - The Basics Flashcards

1
Q

T or F: maintanace of a non-thrombotic state is dependent on laminar flow

A

True, Laminar Flow is required to prevent thrombosis

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2
Q

What are some basic relaxing and contracting factors secreted from the endothelial lining of vessels?

A

Relaxing - Nitric Oxide

Contracting - Endothelin

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3
Q

In what conditions might tight junctions become more permeable?

• how are large amounts of solutes moved?

A
  • Vasoactive Agents Secreted or High Blood Pressure will increase the tight junction permeability
  • Large Amount of Solute moved by Trancytosis
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4
Q

What are the Two Mechanisms of Vascular Pathology?

A
  1. Narrowing or Obstruction
  2. Weaking (resulting in aneurysm
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5
Q

What vascular pathology has happened here?

A

Dissecting Aneurysm

• Media has been split in half

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6
Q

What vascular pathology has happened here?

What time frame did it happen in and how do you know?

A

Acute Narrowing/Obstruction of a vessel

• You can see lines of Zahn indicating that it is a thrombus, clefts of cholesterol indicating that Hypercholesterolemia could be etiology

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7
Q

What vascular pathology has happened here?

• what has caused it, time frame?

A

Narrowing of Vessel Lumen as a result of intimal thickening can be seen

• More progressive than just acute, resultin from high LDL over a long period of time

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8
Q

What has happened here?

A

Atherosclerotic aneurysm from Weakening of BVs

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9
Q

What is Glycation?

• Diseases where it is common?

A

Glycation - non-enzymatic reaction between reducing sugars such as glucose and proteins, lipids, or nucleic acids

**Common in Diabetes, we use Hbg A1C**

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10
Q

What is glycoxidation?

A

When OXIDATIVE steps are involved ine Glycoxidation

**ROS accelerate this processes

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11
Q

What is a time when you might not want to measure Hbg A1C in a patient?

A

People who don’t have much Hbg A1 such as Sickle Cell patients or Pts. with alpha thalessemia

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12
Q

In what 3 ways do Advanced Glycation End products (AGEs) contribute to vascular disease?

A
  1. Collage Crosslinking promoted
  2. Glycation of LDL
  3. Binding to RAGE
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13
Q

How does promotion of collagen cross-linking lead to increased cardiovascular disease?

A
  • Collagen Crosslinking causing Stiffening of Vascular Walls
  • Crosslinking also causes entrapment of LDL in the artery walls
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14
Q

How does glycation of LDL promote CV disease?

A
  • Glycation of LDL makes it more prone to get oxidized
  • Oxidation of LDL is a MAJOR risk factor of Atherosclerosis
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15
Q

How does binding to RAGE (receptor for advanced glycation end products) lead to CV disease?

A
  • Binding to RAGE promotes Oxidative Stress on the Endothelium
  • Also activates Inflammatory Pathways in the endothelial cells
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16
Q

What 3 congenital Anomalies do we need to know for vessels?

A
  • Berry Aneurysms
  • Arteriovenous (AV) fistulas
  • Fibromuscular Dysplasia
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17
Q

Berry Aneurysms

  • What are they?
  • Where are they found?
  • Why does it happen?
  • Dangers?
A

What/Where:

• Thin-walled arterial outpouching in cerebral vessels specifically at Branch Points

Why:

• Media is CONGENITALLY too thin (attenuated)

Danger:

• Rupture

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18
Q

What is the major complaint of someone experienceing a Berry Aneurysm?

A

“The worst headache I’ve Ever had”

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19
Q

****What is this?

• What do you think this person complained of when they came to the ED?

A

Berry Aneurysm - caused by a congenitally thin media

• Probably Said it was the worst headache they’ve ever had

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20
Q

What is an Arteriovenous (AV) fistula?

• Whats a major problem that may result?

A

• CONGENITAL Abnormal connection between an Artery and a Vein (they don’t go all the way down to capillaries, they just connect)

Major Problem: Susecptible to Hemorrhage and Hypoxia even without Hemorrhage from decreased Surface area of vessel being exposed

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21
Q

*****What has happened here?

A

AV Fistula - caused by direct connection between an artery and a vein

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22
Q

Fibromuscular Dysplasia

  • What is it?
  • Type of Vessels Affected?
  • Who is it found in?
A
  • Congenital disease causing alternating thickened and thinned arterial walls usually from thickening of the Media
  • small to medium sized vessels are affected
  • Found in younger women
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23
Q

A young fit woman comes in with hypertension as a result of Fibromuscular Dysplasia.

  • What is the most likely cause of the HTN?
  • Other risk factors of the disease?
  • APPEARANCE?
A

Cause - hypertension can be caused in patient with Fibromuscular Dysplasia via renal artery constrictions

Other Disease Complications: 10% experience medial dissections

Beads on a String Appearance in affected vessels

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24
Q

****T or F: thickening in this vessel was caused by either an inflammatory or atherosclerotic process.

A

False, this is from a patient with fibromuscular dysplasia - these patients experience non-inflammatory, non-atherosclerotic thickening of the media

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25
T or F: PRIMARY vascular tumors of large vessels are fairly comon and are often carcinomas
FALSE, they are EXTREMELY RARE and are usually SARCOMAS
26
What are vascular tumors that arise from the endothelium called? • what about ones from support cells?
Hemangiomas or Angiosarcomas Support Cells = Glomus Tumor
27
Compare Benign and Malignant Tumors with respect to: * Organization * Cellularity
Benign: * Obvious Vascular Channel with Blood * Lined by **monolayer** of **normal** appearing cells Malignant: * **poor orgnaization** of vessels * **more cellular** with **cytologic atypia**
28
What markers can you use to confirm that the tissue you're looking at is in fact vascular?
* CD31 * CD34 * D2-40
29
What is a vascular ectasia?
• Local Dilation of a Blood Vessel
30
What are the 3 **benign** vascular ectasias?
* Nevus Flammeus * Spider Telangectasias * Hereditary Hemorrhagic Telangectasia
31
What is a Telangiectasia? • where is it usually found?
* Telangiectasia - **permanent** dialation of **small BVs** * Typically occurs in **mucous membranes and skin**
32
**T or F: Vascular ectasias are very benign neoplasms**
FALS, these are NOT TRUE NEOPLASMAS
33
**Nevous Fammeus** * Typical Appearance * Progression * Life impact
aka **port wine** Appearance • Large Flat patch of purple or dark red skin with well defined borders Progression • Starts off flat at birth but become **more bumpy and unsighly over time and DOES NOT REGRESS** Life Impact: • Not any real health impact but the psychosocial element may be huge
34
\*\*\*\*What is this? • What is the Px?
Nevus Flammus • No real health impact, BUT they should expect that this will be a long term condition with a high probability of having a psychosocial impact
35
**Salmon Patch** * Typical Appearance and Location * Progression * Life Impact
Appearance: • typically on **back of neck** (stork bite) or **between eyes** (angels kiss) Progression: • Unlike nevus flammeus **will regress over 1st year of life** Life Impact: • **prolly none**
36
\*\*\*\*What condition is this? • What is the Px?
Condition - Naevus Simplex aka **salmon patch** • will regress in the **1st year of life**
37
**Sturge-Webber Syndrome** * Physical appearance? * Effects on Brain?
Physical Appearance: • **port wine** in the **trigeminal distribution** Brain Effects: * **ipsilateral venous angiomas in the leptomeninges** * ^ causes - **mental retardation, seizures and hemiplegia**
38
\*\*\*\*What condition does this baby likely have? • What is the Px?
**Sturge-Weber Syndrome** - because the port wine stain follows the trigeminal distribution Px: Poor - this often causes Ipsilateral Hemangiomas on the leptomeninges that can result in **mental retardation, hemiplagia, and siezures**
39
\*\*\*\*What benign Vascular Ectasia may have caused this appearance on CT?
**Sturge-Weber Syndrome** - hemangiomas in the meninges causes asymmetry and blood on the brain as seen on the right side of the picture (left frontal lobe)
40
\*\*\*\*What is this? •what are some possible risk factors?
**Spider Telangectasias** Risk factors: HYPERestrogen states - Pregnancy, or Cirrhosis (alcoholics)
41
\*\*\*\*What is this condition? • What is the most likely cause?
**Erythemia ab igne (EAI)** caused by Infrared Radiation in the form of heat \*Think about a kid who has been sitting next to a heater or sitting with your laptop on your legs for too long
42
\*\*\*What is this?
Classic **basal cell carcinoma**
43
**Hereditary Hemorrhagic Telangiectasia** * Inheritance? * Mutation? * Most common symptom?
Inheritance: • Autosomal **Dominant** Mutation: • Most commonly in the **TGF-beta** gene Symptoms: • **Recurrent nosebleeds**, GI bleeds can also be problematic
44
\*\*\*\*\*What condition is this? • Treatment?
**Hereditary Hemorrhagic Telangiectasia** • Only treated symptomatically - G.I. bleed etc.
45
Lymphangitis • What is it?
Infection uses vasculature (lymph, veins, etc.) to travel into the body
46
\*\*\*\*What condition does this patient have?
**lymphangitis**
47
How common is Nevus Flammus compared to Salmon Patch?
Salmon Patch is much more common
48
**Hemangiomas** * How common? * Composition? * Benign or Malignant?
* Very Commmon * Composed of Blood-Filled Vessels * BENIGN - only a low chance of becoming malignant
49
\*\*\*\*What is this?
Hemangioma
50
What 4 types of Hemangioma are there? • Which is most common?
* Capillary Hemangioma * Juvenile Hemangioma (aka Strawberry Hemangioma) * Pyogenic Granulomas * Cavernous Hemangioma
51
**Capillary Hemangioma** * Frequency? * Location? * Histological Features?
Most Common Hemangioma Found in **Skin and SubQ, Mucous Membrane,** may occasionally be in Liver, spleen, or kidney Histo: Thin Walled, Scant Stroma \*\*\*Note: this is more likely a transformation than a neoplasm
52
\*\*\*\*What condition is this? • What histological features are you looking for?
**capillary hemangioma** Thin walled with Scant Stroma, Endothelial Lining with NO MITOSIS
53
**Juvenile Hemangiomas (strawberry hemangiomas)** * Number typically present? * Who are they usually seen on? * Px?
* Can be one or multiple present * Seen on **newborns** * **rapid growth** for 1 to 3 years followed by **regression by age 7**
54
Histological Features of Juvenile Hemangiomas
* Endothelial Cells that line vascular spaces. These have **small lumens** (hard to see) * **mitotic figures** are common (may be multiple) * **Mast Cells** are present
55
\*\*\*\*What condition is this? • Px?
Juvenile (strawberry) Hemangioma • Tumor will grow years 1-3 then regress by age 7
56
\*\*\*\*What condition is this?
Strawberry Hemangioma * Endothelial Cells that line vascular spaces. These have **small lumens** (hard to see) * **mitotic figures** are common (may be multiple) * **Mast Cells** are present
57
**Pyogenic Granulomas** * Appearance (gross and histological) * Location/onset * Pain
Appearance/Location * **Pedunculated** appearance often in **areas of trauma** and common during **pregnancy** * Histologically looks like **granulation tissue** Pain: • Often Painless
58
\*\*\*\*What is this?
Pyogenic Granulomas • Appears like granulation tissue, small slits correspond to capillaries
59
\*\*\*\*What is this?
Pyogenic Granulomas (type of capillary hemangioma)
60
**Cavernous Hemangioma** **•** ability to infiltrate? • Regression?
Infiltration: • More likely to infiltrate than the other capillary hemangiomas Regression: • **Does not regress**
61
\*\*\*What is this?
Cavernous Hemangioma • **scant stroma** **• Tons of Blood**
62
\*\*\*What is this? • Px?
Cavernous Hemangioma will **not regress**
63
What syndrome is associated with Cavernous Hemangiomas?
Von Hippel-Lindau Syndrome
64
**Simple Lymphangioma** **•** commonly found where? • Histological Characterisitics
* Found most commonly in head neck and axilla * **NO RBCs** in histological section * Typically 1-2 cm
65
**Cavernous Lymphangioma (cystic hygroma)** * Location * Disease associations
* Located on Neck or in Axilla * Presents as more of a **cystic mass** than simple lymphangiomas * Associated with **Turner syndrome**
66
\*\*\*\*\*What is this?
Lymphangioma \*must use Hx to determine if its simple capillary lymphangioma or a cavernous lymphangioma
67
\*\*\*\*What is this?
Cavernous Lymphangioma (cystic Hygroma)
68
* What are some characteristics of Turner Syndrome? * Genetic defect?
* Webbed Neck * Far Spread Nipples \*\*Caused by XO chromosome
69
**Glomus** **•** Cell type responsible? * Benign or Malignant? * Location? * Pain?
* Cell type = **glomus body cells that are needed for thermoregulation** (specialized smooth muscle) * **Benign** tumor found **under the nail** * These are often **very painful**
70
\*\*\*\*What tumor type is this? • benign or malignant?
Gloumus - Benign \*looks like endothelial cells are spiralling off the vessel
71
\*\*\*\*what tumor is this likely to be?
Glomus but melanoma should be in your differential
72
**Bacillary Angiomastosis** **•** what is it? * organism responsible * tissue type involved
What is it? • Vascular Proliferation Tissue: • Skin, Bone, Brain, other - Pretty much any type Organisms Responsible: * Bartonella henselae - found on cats * Bartonella quintana - transmitted by body lice
73
How do bacteria cause Bacillary Angiomatosis?
• They induce **HIF-1alpha** \*\*\*note: these are gram negative bacteria
74
\*\*\*\*What is this?
Bacillary Angiomatosis
75
**Kaposi's Sarcoma** * How does HHV-8 induce cancer? * Stages of Kaposi's
• HHV-8 prevents apoptosis by inhibiting **p53** Stages: * Patches - pink, red or purple typically on distal leg * Plaque - larger, raised * Nodular - may involve viscera
76
\*\*\*What is this?
Patch phase of Kaposi's Sarcoma
77
\*\*\*What is this?
• Plaque Phase of Kaposi's Sarcoma
78
\*\*\*What is this?
Nodular Phase of Kaposi's Sarcoma
79
**Angiosarcoma** **•** Most commonly seen in? * Seen where? * Px?
* Most commonly seen in **older people**, but younger people who get diagnosed have a better px * Most commonly seen in **Skin, Soft Tissue, Breast and Liver** but others are possible * on **30% 5 year survival rate**
80
\*\*\*\*What is this?
Lymphangiosarcoma
81
\*\*\*\*What is this?
Angiosarcoma
82
\*\*\*\*what is this?
Angiosarcoma of the breast
83
**What causes angiosarcomas of the liver?**
**PVC (polyvinyl chloride)** **Thorotrast (radioactive contrast dye)** **Arsenic Pesticides**
84
What type of women often present with angiosarcoma of the breast?
• Women who undergo **radiation chemo treatment** **•** If **long term indwelling foreign bodies** are in the breast
85
\*\*\*What is this?
Stasis Dermatitis

Cardio - Gupta (12 decks)

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