Lecture 10 - Blood Vessels

Question 1

Arteriosclerosis

Answer 1

• “hardening of arteries”

- deposits of foreign materials that react and inflame leading to the thickening of the wall and loss of elasticity

Question 2

Arteriolosclerosis

Answer 2

• type of Arteriosclerosis
• affects small arteries and arterioles (hits kidneys hard).
• most often associated with hypertension and diabetes mellitus
• blood vessel narrows and causes microscopic areas of necrosis

Question 3

Mönckeberg Calcific Medial Sclerosis

Answer 3

• type of Arteriosclerosis
• calcium deposits in the wall of muscular arteries
• doesn’t narrow lumen, so it doesn’t effect blood flow
• walls are harder and less elastic
• typically in patients over 50 yo
• do not usually have clinically significant lesions

Question 4

Atherosclerosis

Answer 4

• type of Arteriosclerosis
• effects coronary arteries (carotid and aorta)
• atheroma = raised lesions that narrow the lumen, has a core of cholesterol and fibrous cap
• calcium makes atheroma hard = plaques
• plaques weaken vessel walls by eroding into media
• rupture of plaques can lead to thrombosis

Question 5

Aneurysm

Answer 5

• localized abnormal dilation of a blood vessel or the heart (only affects arteries)

Question 6

True aneurysm

Answer 6

• involves all three layers of the vessel wall (intima, media, and adventia) or wall of the heart
• can be atherosclerotic, syphilitic, congenital, or ventricular (heart)

Question 7

False (pseudo-) aneurysm

Answer 7

• defect in wall of vessel with extravascular hematoma that communicates with the lumen
• pulsating hematoma

Question 8

Abdominal aorta

Answer 8

• most common location of atherosclerotic aneurysm
• located between renal arteries and bifurcation of iliacs
• can be mycotic abdominal aorta aneurysm (AAA) = which indicates a secondary microbial infection of the aneurysm

Question 9

Dissection

Answer 9

• hemorrhage into the walls of an artery (through planes dividing layers
• aortic dissection is an area of significance
• slight tear of intima precedes dissection

Question 10

Type A Dissection

Answer 10

• proximal/ascending aorta = from the heart up
• cardia tamponade seen in type A specifically, leads to intense pericardium
• DeBakey I and II

Question 11

Type B Dissection

Answer 11

• distal to or after subclavian artery = descending aorta
• aortic insufficiency, mitochondrial infarction, and extension of dissection to great arteries* are more typically seen in type B

Question 12

Vasculitis

Answer 12

• inflammation in blood vessels caused by immune system or microorganisms

Question 13

Giant - Cell (Temporal) Arteritis

Answer 13

• most common type of vasculitis
• example of immune mediated
• chronic granulomatous inflammation
• affects vessels of the heart most commonly (ophthalmic artery), may lead to permanent and sudden blindness
• symptoms: fever, fatigue, weight loss, facial pain, headache along temporal artery

Question 14

Thromboangitis / Thromboarteritis Obliterans (Buerger disease)

Answer 14

• segmental, thrombosing acute and chronic inflammation - medium and small arteries
• most commonly - tibial and radial arteries ( vessels of extremities)
• effects heavy smokers possibly due to toxins = loose their digits due to ischemia

Question 15

Raynaud Phenomenon

Answer 15

• functional defect of vessel, exaggerated vasoconstriction of digital arteries/arterioles (finger/toes)
• proximal vasodilation = red
• central vasoconstriction = white
• distal cyanosis = blue
• primary disease: exaggerated central/local vasomotor response; benign course (ex. cold brings it on but back to normal with warmth)
• secondary disease: more severe; due to other vascular diseases (ex. Buerger disease)

Question 16

Varicose veins

Answer 16

• dilated, twisted veins due to quality of the valves

- Risk factors: obesity, pregnancy, and heredity ( put pressure on veins so valves are pulled apart)

Question 17

Esophageal varices

Answer 17

• severe form of varices (dilated veins seen as small red spots on the skin)
• caused by portal systemic shunts in patients with cirrhosis
• leads to rupture in which bleeding can be severe

Question 18

Hemorrhoids

Answer 18

• swollen, inflamed veins due to increased pressure
• internal = located in the rectum
• external = located in the anus

Question 19

Thrombophlebitis

Answer 19

• phlebitis = inflammation of vein that makes the walls jagged and can cause a clot to form
• deep leg veins are most commonly affected because blood flow is the slowest

Question 20

Hemangioma

Answer 20

• benign tumor
• 7% of tumors in infants
• most present from birth and are localized
• types: Capillary (skin, subcutaneous tissue ; regress by age 7) and Cavernous (involves deep structures; don’t typically regress)

Question 21

Lymphangioma

Answer 21

• Simple = occurs in head, neck, and axillary subcutaneous tissue; slightly elevated, sometimes pedunculated
• Cavernous (cystic hygroma) neck or axillia of children, common in Turner Syndrome

Question 22

Kaposi Sarcoma

Answer 22

• malignant tumor (intermediate grade) due to underlying viral etiology (human herpes virus 8 or KS - associated herpes virus)
  4 types: Chronic (classic), lymphadenopathic, transplant associated, AIDS associated

Question 23

Types of Kaposi Sarcoma Explained:

Answer 23

Chronic (classic) = effects older men, remains localized to the skin (behaves benignly)

Lymphadenopathic = aggressive course; presents in lymph nodes or viscera

Transplant associated = aggressive; occurs with solid organ transplant

AIDS associated (epidemic) = disseminates; rare with current anti-viral therapies

Question 24

Angiosarcoma

Answer 24

• malignant blood vessel tumor
• commonly affects older adults
• occurs in hepatic sites (liver) - associated with toxin exposures
• also associated with previous radiation (ex. breast)
• degree of differentiation varies