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MHD 1 > L39 Vascular Disease > Flashcards

L39 Vascular Disease Flashcards

1
Q

What makes up the intima of blood vessels?

A
  1. Endothelium (simple squamous epithelial cells)

2. Small subendothelial component

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2
Q

What makes up the media of blood vessels?

A

Smooth muscle; surrounded by internal elastic lamina and external elastic lamina on either side

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3
Q

What makes up the adventitia of blood vessels?

A

Connective tissue, collagen, vasovasorum

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4
Q

How can we distinguish the aorta from other high caliber blood vessels with a lot of smooth muscle in the media?

A

The aorta has a lot of elastic tissue, which stains black

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5
Q

Describe the intimal response to vascular injury.

A

When a vessel is injured:

  1. Recruitment of smooth muscles cells (and their precursors) to the intima from the media
  2. Smooth muscle cell mitosis (proliferation)
  3. Elaboration of ECM (intima thickens and expands)
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6
Q

What is arteriosclerosis, broadly?

A

Hardening of the arteries (arterial wall thickening and loss of elasticity)

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7
Q

What are the four major types of arteriosclerosis?

A
  1. Atherosclerosis
  2. Monckeberg’s medial calcific sclerosis
  3. Fibromuscular intimal hyperplasia
  4. Arteriolosclerosis
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8
Q

What kind of blood vessels are affected by atherosclerosis?

A
  1. Large elastic arteries (aorta, carotid, iliac)

2. Muscular arteries (coronary, popliteal, renal, mesenteric)

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9
Q

Describe the “response to injury” hypothesis of atherosclerosis.

A

Atherosclerosis is a chronic inflammatory response of the arterial wall to endothelial injury. The lesion progression involves interaction of lipoproteins, monocyte-derived macrophages, T-cells, and the cellular constituents of the arterial wall.

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10
Q

What is an atheroma?

A

The basic pathological entity that drives atherosclerosis; it is composed of a necrotic center filled with cell debris, cholesterol crystals, foam cells and calcium, as well as a fibrous cap filled with smooth muscle cells, macrophages, foam cells, lymphocytes, collagen, elastin, proteoglycans, and neovascularization.

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11
Q

True or false - atherosclerosis tends to affect the thoracic aorta more than the abdominal aorta.

A

False - it affects the abdominal aorta more than the thoracic aorta.

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12
Q

What are some possible outcomes of complicated plaques?

A
  1. Rupture/ulceration/erosion
  2. Emboli
  3. Hemorrhage
  4. Weakening of the media and aneurysm formation
  5. Calcification, growth, and lumen occlusion
  6. Thrombosis
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13
Q

Why is rupture a bad thing?

A

Rupture leads to exposure of the sub-endothelium to platelets and ultimately to thrombus formation

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14
Q

What are the spindle-like structures seen in histological slides of plaques?

A

Cholesterol clefts

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15
Q

Why can hemorrhage occur in plaques?

A

Because the atheroma gets neovascularized with new blood vessels

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16
Q

What is an aneurysm?

A

An outpouching of the blood vessel

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17
Q

What leads to an aneurysm?

A

Invasion of the atheroma into the media, loss of smooth muscle cells/strength

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18
Q

What are the important complications that stem from atherosclerosis?

A
  1. Myocardial ischemia (angina, infarction, sudden death)
  2. Cerebral ischemia (stroke, transient ischemic attack)
  3. Peripheral vascular disease (claudication, gangrene)
  4. Aneurysms (rupture)
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19
Q

What is Monckeberg’s medial calcific sclerosis?

A

Non-obstructive calcific deposits found in medium sized muscular arteries; centered on internal elastic lamina and media; appear chunky and purple on H&E stain

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20
Q

What is fibromuscular intimal hyperplasia?

A

Form of arteriosclerosis that affects muscular arteries larger than arterioles; involves a marked intimal thickening caused by smooth muscle cell proliferation and increased ECM

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21
Q

What are the etiologies of fibromuscular intimal hyperplasia?

A
  1. Vascular injury (particularly from stents and angioplasties)
  2. Inflammation (healed arteritis, transplant-associated arteriopathy)
22
Q

What are the two types of hypertension induced arteriolosclerosis?

A
  1. Hyaline

2. Hyperplastic

23
Q

What is hyaline arteriolosclerosis?

A

Arteriosclerosis seen in the arterioles and caused by hemodynamic stress (long standing high blood pressure); the endothelium is injured, plasma proteins leak out, ECM and smooth muscle cells increase; this all leads to a homogenous pink hyaline thickening of the media of the arterioles and a narrowing of the lumen

24
Q

What is hyperplastic arteriolosclerosis?

A

Arteriosclerosis seen in patients with chronic severe hypertension or an abrupt increase in BP (malignant hypertension); processes of stress and repair lead to concentric thickening of smooth muscle cells and a progressive lumenal narrowing

25
Q

How does hyperplastic arteriolosclerosis appear on H&E stain?

A

Onion skin

26
Q

What is an aneurysm?

A

Localized abnormal dilatation of a blood vessel

27
Q

What is the difference between a true aneurysm and a false aneurysm?

A

True: the entire vessel wall itself forms an out-pouching
False: a hematoma forms under the vessel

They look the same

28
Q

What is the difference between a saccular and fusiform true aneurysm?

A

Saccular: portion of the wall outpouches
Fusiform: whole wall is dilated

29
Q

What are the three broad causes of aneurysms?

A
  1. Abnormal connective tissue synthesis
  2. Excessive tissue degradation
  3. Loss of smooth muscle cells
30
Q

What are two causes of abnormal connective tissue synthesis?

A
  1. Marfan syndrome (defective fibrillin synthesis and loss of elastic tissue)
  2. Ehlers Danlos (defective type III collagen)
31
Q

What is one cause of excessive tissue degradation?

A

Increased matrix metalloprotease (released from macrophages)

32
Q

What is one cause of loss of smooth muscle cells?

A

Ischemia (as a result of atherosclerotic thickening of the intima or narrowing of the vasovasorum)

33
Q

What is cystic medial degeneration?

A

Elastin fragmentation and loss of smooth muscle cells lead to areas resembling cystic spaces filled with proteoglycans; sometimes seen in patients with aneurysms

34
Q

What are 5 major causes of aneurysms?

A
  1. Atherosclerosis
  2. Hypertension
  3. Congenital defects (berry aneurysm)
  4. Inflammation (infections and vasculitis)
  5. Trauma
35
Q

What is the etiology and pathogenesis of an aneurysm of the abdominal aorta?

A

ECM degradation mediated by MMPs released from inflammatory infiltrates leads to compression of the media and compromised nutrient and waste diffusion from the vascular lumen into the arterial wall; the media undergoes degeneration and necrosis and the arterial wall weakens and thins

36
Q

What is the characteristic location of an abdominal aortic aneurysm?

A

Infrarenal (below the renal bifurcation) and above the aortic bifurcation

37
Q

Abdominal aortic aneurysms are commonly seen in which populations?

A

Men, smokers, people over 50

38
Q

What can be felt on a physical exam vis a vis an abdominal aortic aneurysm?

A

Pulsatile abdominal mass

39
Q

What are the possible complications of AAA?

A

Compression, obstruction, and embolism

40
Q

What is an aortic dissection?

A

Tear in the intima; occurs when blood splays apart laminar planes of the media to form a blood filled channel within the aortic wall (usually happens in the thoracic aorta)

41
Q

What are the etiologies of aortic dissections?

A
  1. Hypertension (pressure related mechanical or ischemic injury - medial hypertrophy of vasovasorum and degenerative changes of media/loss of SMC)
  2. People with connective tissue disorder (abnormal vascular ECM)
  3. Bicuspid aortic valves
42
Q

What is the difference between Type A and B dissections?

A

Type A: involve proximal aorta

Type B: do not involve proximal aorta

43
Q

What is a major symptom of aortic dissection?

A

Sudden onset ripping chest pain radiating to the back

44
Q

What are the complications of aortic dissection?

A

Rupture or extension

45
Q

How is aortic dissection treated?

A

Blood pressure control and surgery

46
Q

What is an angiosarcoma?

A

Cancer of endothelial cell origin; can involve any body site (common in skin, soft tissue, breast), highly malignant

47
Q

What type of stain is used for angiosarcoma?

A

Immunohistochemical for endothelial maker CD31 and VW factor

48
Q

Hepatic angiosarcoma is often caused by exposure to carcinogens, such as…

A

…arsenic (pesticides), thorotrast (formerly used radioactive contrast agent), polyvinyl chloride (plastic)

49
Q

What is the connection between lymphedema of the arm and angiosarcoma?

A

Radical mastectomy and lymph node dissection is sometimes correlated with development of angiosarcoma

50
Q

What are hemangiomas?

A

Common benign neoplasms of blood vessels, often seen in children

MHD 1 (58 decks)

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