Lecture 3+4+DLA Flashcards
Hyaline arteriolosclerosis
seen in benign chronic hypertension
CBH is asymptomatic
chronic hypertension = hemodynamic stress
plasma protein leakage and SM matrix production
deposition of hyaline in the vessel wall
impairment of blood supply by narrowing
Hyperplastic arteriolosclerosis
seen in chronic hypertension
chronic hypertension = >200/120 and commonly with advanced bilateral retinopathy (cotton wool spots)
sudden and severe changes in BP
thickened and reduplicated BM and SM hyperplasia
thickening (Onion skin) and narrowing of vessel
will have fibroid necrosis
Pulmonary hypertension
seen in left heart failure, congenital heart disease, valvular disorders, lung diseases\
heart changes due to HTN
left ventricular hypertrophy
kidney changes due to HTN
hyaline:
benign nephrosclerosis
Hyperplastic arteriolosclerosis-
Malignant nephrosclerosis
brain changes due to HTN
both hyaline and hyperplastic arteriolosclerosis seen →
can cause hypertensive intraparenchymal hemorrhages
abdominal aortic aneurysm
aneurysms occurring as a consequence of atherosclerosis seen most commonly in the abdominal aorta and common iliac arteries
seen in older above 50; more common in males
associations: smokers
most cases are asymptomatic (discovered by accident)
abdominal aortic aneurysm is most likely where?
most are distal to renal arteries and proximal to the bifurcation
usually fusiform
Majority are lined by raised, ulcerated and calcified
(complicated) atherosclerotic lesions
histology of abdominal aortic aneurysm
Reveals destruction of the normal arterial wall and its replacement by fibrous tissue
Thickened and focally inflamed adventitia
syphilitic aneurysm
patho?
aortitis in thoracic aorta seen in the tertiary stage of syphilis
Inflammatory response to the spirochete → obliterative
endarteritis of the vasa vasorum of the aorta
Narrowing of their lumen → Ischemic injury of the elastic tunica media in the aorta (Medial destruction and weakening)
chronic inflammation and scaring
syphilitic aneurysm morphology
Fibrosis of the vascular wall “tree bark appearance”
wrinkling of the aortic intima due to secondary atherosclerosis (may narrow coronary ostia)
Aortic valve ring dilation (valvular insufficiency)
Aortic valvular insufficiency → massive hypertrophy of left ventricle
mycotic aneurysm
aneurysms resulting from the weakening of the vessel wall by a microbial infection
sites of involvement:
aorta, cerebral vessels, mesenteric, renal, and splenic
arteries
Etiopathogenesis:
At the site of sticking of a dislodged septic embolus within a vessel, usually as a complication of infective endocarditis
As an extension of adjacent suppurative process like tuberculous infection or a bacterial abscess.
By circulating organisms directly infecting the arterial wall.
marfan syndrome: aneurysms
considered a congenital aneurysm
autosomal dominant; fibrillin-1 gene mutation
etiopathology:
fribillin-1 is needed for normal elastic tissue development; the mutation leads to the elastic fibers not being able to resist normal stress = aneurysm
berry aneurysms
site? shape? patho?
developmental thin-walled aneurysms in the circle of
Willis
site: anterior cerebral A. branches
shape: small and saccular
patho:
develop over time because the arterial media is congenitally attenuated
Rupture at any time but often during increased intracranial pressure = subarachnoid hemorrhage
association:
autosomal dominant polycystic kidney disease
aortic dissection
blood separating the laminar planes of the media to form a blood-filled channel within the aortic wall
epi:
men aged 40 to 60 wit HTN
younger patients with genetic disorders
etiopathology: HTN genetic abnormality complication of arterial cannulation pregnancy induced
