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Pathology > Chapter 9 - Blood Vessels > Flashcards

Chapter 9 - Blood Vessels Flashcards

1
Q

Hypertensive Vascular Disease

A 
Normal 120/80
Prehypertension: 120/80 to 139/89
Hypertension: 140/90 or greater
Stage I: <160/100
Stage 2: >160/100
Hypertensive "urgency": 180/110
Hypertensive "emergency": 220/140

Pathogenesis: interaction of genetic, environmental and demographic factors

Causes: essential (idiopathic) - majority, secondary - 5%

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2
Q

Essential (idiopathic) hypertension mechanism

A

complex, multifactorial disorder

environmental factors affect variables controlling blood pressure in a genetically predisposed individual

increased blood volume and increased peripheral resistance contribute to elevated BP

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3
Q

Secondary Hypertension causes

A

Renal: Acute glomerulonephritis, chronic renal disease, polycystic disease (kidney has cysts), renal artery stenosis, renal vasculitis, renin-producing tumors

Endocrine: adrenocortical hypofunction, pheochromocytoma, acromegaly, hypothyroidism, hyperthryoidism, pregnancy-induced

Cardiovascular: cortication of aorta, polyarteritis nodosa, increased intravascular volume, increased cardiac output, rigidity of aorta

Neurologic: psychogenic, increased intracranial pressure, sleep apnea, acute stress

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4
Q

Hyaline arteriolosclerosis

A

hyaline accumulates in the wall of small arteries and arterioles, producing the thickening of their walls and narrowing of the lumen.

major morphology of benign nephrosclerosis - glomerular arterioles damage and renal impairment

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5
Q

Hyperplastic Arteriosclerosis

A

thickened concentric smooth muscle cell layer and thickened, duplicated basement membrane

most prominent in the kidney and can lead to ischemia and acute renal failure

“onion-skin”

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6
Q

Aneurysm

A

localized abnormal dilation of a blood vessel or heart

atherosclerotic aneurysms most common in abdominal aorta

Smokers over 60 years old particularly at risk

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7
Q

Aortic dissection

A

separation of the layers within the aortic wall

tears in the intimal layer result in the propagation of dissection secondary to blood entering the intima-media space

Mortality is high and risk factors include arterial hypertension (major cause) and connective tissue disorder (Marfan’s predisposing factor)

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8
Q

Vasculitis

A

inflammation of the walls of vessels and may involve any artery or vein

caused by direct invasion of walls by infectious pathogens, immune-mediated (immune complex) inflammation

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9
Q

Direct Infection vasculitis

A

Bacterial - Neisseria meningitidis
Rickettsial - Rocky Mountain Spotted fever
Fungal
Viral

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10
Q

Immune-mediated vasculitis

A

drug hypersensitivity - antigen-antibody complex deposition

viral infections - hepatitis B (antigen-antibody deposition)

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11
Q

Blood Vessel Vasculitis

A
  1. Giant cell arteritis
  2. Polymyalgia rheumatica
  3. Takayasu arteritis
  4. Kawasaki disease
  5. Granulomatosis with polyangiitis
  6. Thromboangiitis obliterans
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12
Q

Giant cell (temporal) arteritis

A

most common of vasculitides

involves small and larger arteries principally of head (temporal, vertebral, ophthalmic and other extracranial arteries)

nodular thickenings of vessels with reduction of lumen, may be granulomatous, etiology unknown

Symptoms: fever, fatigue, masseter muscle claudication common, lingual musculature claudication, transient to complete vision loss (opthalmic artery involvement and retinal ischemia)

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13
Q

Polymyalgia Rheumatica

A

closely related to giant cell arteritis

pain, weakness, stiffness more pronounced in neck and shoulders, spreading to hips

50% of pts with GCA also have this
15-20% of pts with PR develop GCA

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14
Q

Takayasu Arteritis “Aortic Arch Syndrome”

A

common in females <40 (asians)
Granulomatous vasculitis involving proximal aorta and branches

markedly weak pulse in arms (pulseless disease of females)

blindness may result and substantial morbidity with unknown etiology

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15
Q

Kawasaki Disease

A

acute, febrile illness of infancy & childhood (80% < 4 yrs) (common in asians)

arteritis involving vessels of all sizes, Coronary artery involvement is most significant feature (Leading cause of ACQUIRED heart disease in children)

red, racked lips; strawberry tongue; palatal erosions; oral erythema; cervical lymph node enlargement; mucocutaneous lymph node syndrome

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16
Q

Granulomatosis with Polyangiitis (Wegener Granulomatosis)

A

Autoimmune necrotizing vasculitis, acute necrotizing granulomatous vasculitis of upper respiratory tract and/or lungs, renal disease (glomerulonephritis)

PR3-ANCA (antiprotinase-3 Anti Neutrophil Cytoplasmic Antibodies) positive in about 95% of patients

Males more than females, 40 yrs is average age, 80% die in 1 year, PR3 ANCA levels used to monitor response to therapy

17
Q

Thromboangiitis Obliterans (Buerger Disease)

A

Arteritis mainly involving the tibial and radial arteris, onset <35 yrs, ischemic changes in fingers and toes, in-step claudication, severely painful, heavy cigarette smokers

not autoimmune

18
Q

Primary Raynaud Phenomenon

A

paroxysmal pallor/cyanosis of fingers, toes, tip of nose/ears cased by intense vasospasm of small arteries or arterioles

exaggeration of normal central and local vasomotor response to cold or emotion

usually young women

19
Q

Secondary Raynaud Phenomenon

A

Arterial insufficiency of extremities secondary to other conditions (SLE, scleroderma, Buerger disease)

reversible arterial vasospasm, may cause ischemic necrosis of fingertips or change in nails

20
Q

Monckeberg Medial Calcification

A

Usually not clinically significant (minimal narrowing of arterial lumen)
Older individuals, increased incidence in diabetics, incidental finding on radiograph

21
Q

Atherosclerosis

A

disease of the arteries
characterized by the deposition of plaques of fatty material on inner walls

Fibrofatty intimal plaques called “atheromas”
fibrous cap, necrotic center

Risk Factors: advancing age, genetic derangements in lipid metabolism, hyperlipidemia, hypertension, diabetes mellitus, cigarette smoking, inflammation, hyperhomocystinemia, Lipoprotein A

22
Q

Theory of Atherosclerotic Plaque Development

A
  1. endothelial injury
  2. endothelial dysfunction, monocyte adhesion and emigration
  3. smooth muscle emigration from media to intima and macrophage activation
  4. macrophages and smooth muscle cells engulf lipid
  5. smooth muscle proliferation, collagen and other ECM deposition, extracellular lipid
23
Q

Evolution of atherosclerosis

A

“Response to injury” theory

-oxidized LDL cholesterol, toxins as foundi n cigarette smoke, hyperglycemia, flow turbulence (Virchow’s triad), Homocystinuria (inc homocysteine level)

24
Q

Role of LDL cholesterol

A

“BAD”

circulating LDL accumulated beneath the endothelium in the intima where it undergoes oxidation via “free radicals”

  • activated macrophages (foam cells formed)
  • cytotoxic to endothelial cells (inc apoptosis)
  • activated macrophages secrete “free radical” compounds as well as cytokines and growth factors
  • Decreased nitric oxide production by endothelial cells
25
Q

Role of HDL Cholesterol

A

“GOOD”

“scavenger” function for LDL-C
Inhibits endothelial damage
- recycles LDL-C to liver
- levels of HDL-C <40 mg/dL associated w/ increased cardiovascular events

26
Q

Clinical Complications of Atherosclerosis

A

myocardial infarction, gangrene (diabetics), ischemic stroke

27
Q

Varicose veins

A

abnormally dilated tortuous veins

produced by prolonged, increased intravenous pressure with loss of vessel wall support 15-20%,
familial tendency

Clinical Problems: edema, pain and thrombosis, persistent edema leads to poor oxygenation resulting in stasis dermatitis, ulcerations of skin, poor wound healing

28
Q

Thrombophlebitis/Phlebothrombosis

A

Thrombophlebitis: Vein inflammation (phlebitis) related to a blood clot (thrombus)

Phlebothrombosis: occurs when a blood clot (thrombosis) in a vein forms independently from the presence of inflammation in the vein

90% occur in deep leg veins

predisposing factors: congestive heart failure, malignant neoplasia, pregnancy, obesity

*First sign of phlebothrombosis may be a pulmonary embolus (bedridden pts)

29
Q

Lymphangitis

A

inflammation or infection of lymphatic channels that occur as result of infection at a site distal to channel

most common cause in humans is Streptococcus pyogenes (Group A strep)

caused by fungus Sporothrix schenckii as well

30
Q

Hemangioma

A

Benign vascular neoplasm, most common in skin, oral hemangiomas uncommon, but not rare

31
Q

Capillary hemangioma

A

composed of small, capillary-sized vessels

32
Q

Cavernous hemangioma

A

composed of larger, more “cavernous” vascular

usually do not regress, may be locally destructive

33
Q

Lymphangioma

A

composed of benign lymphatic channels

“Cystic hygroma” (neck) - cavernous, lymphangioma, usually neck and axilla of children, Turner syndrome common

34
Q

Osler-Weber-Rendu Disease (Hereditary Hemorrhagic Telangiectasia

A

rare AD genetic disorder, affects bv throughout body, failure of normal capillaries to develop and results in a tendency of bleeding, dilation of pre-existing capillaries and veins, widely distributed (severe epistaxis)

35
Q

Kaposi Sarcoma

A

Neoplasm of border line or low-grade malignancy

Caused by HHV8 in combo with altered T-cell immunity

“Epidemic form” seen with AIDS

36
Q

Angiosarcoma

A 
Sarcoma of malignant endothelial cells,
Most often in skin (can occur in soft tissue, breast &amp;  liver and bone)
Poor outlook - agressive neoplasm
older person if skin primary
5 year survival about 30%
Different from Kaposi sarcoma

Pathology (13 decks)

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