Pathologies of Blood Vessels Flashcards
What are two non-inflammatory vascular disorders?
- Monkeberg medial sclerosis
- Raynaud phenomenon
What is Monkeberg medial sclerosis?
A degenerative calcification of the tunica media of large and medium sized muscular arteries
What age does Monkeberg medial sclerosis typically present?
Older individuals
Where does Monkeberg medial sclerosis most often occur?
Arteries of upper and lower extremities (may cause posterior knee pain)
How is Monkeberg medial sclerosis distinct from atherosclerosis?
Ordinarily does not lead to a clinical presentation
No luminal narrowing
What is the etiology of Monkeberg medial sclerosis?
Etiology unknown
What is Raynaud phenomenon?
Paroxysmal pallor or cyanosis of the digits of hand or feet typically due to cold induced vasoconstriction
How do fingers change color with Raynaud phenomenon?
White to blue to red
What is the mechanism of Raynaud phenomenon?
Reflects an exaggeration of normal central and vasomotor responses to cold or emotion
Is Raynaud phenomenon primary or secondary?
Can be either
What is the prognosis for Raynaud phenomenon?
Usually benign, however long-standing cases may show signs of atrophy of skin, subcutaneous tissue, and muscles
Ulceration and gangrene are rare
Inflammatory vasculitides refers to…
inflammation of the walls of vessels (all sizes and types)
What are possible etiologies of vasculitis?
- Infection
- Immunologic
- Unknown
Clinical presentation of vasculitis is often a result of…
vessel lumen narrowing/ obliteration/ dilation/ thrombosis
Many vasculitides are responsive to…
steroid/immunosuppressive therapy
What is ESR?
What does an elevation of ESR indicate?
Erythrocyte sedimentation rate
Non-specific indicator of inflammation when elevated
What is CRP?
What does an elevation of CRP indicate?
C-reactive protein
Non-specific indicator of inflammation when elevated
What is RF?
What does RF assess for?
Rheumatoid factor
Assesses for inflammatory joint disease
What is ANA?
What condition involves ANA?
Antinuclear antibody
Found in lupus
What is ANCA?
Antineutrophilic cytoplasmic antibodies
What is the demographic of those most prone to Takayasu arteritis?
Females under 40 years of age
Which structure is affected by Takayasu arteritis?
Aortic arch, maybe its branches as well
If a patient has a weaking of peripheral pulses and near obliteration of distal portions of aortic branches, what disease is suspected?
Takayasu arteritis
What is polyarteritis nodosa?
Necrotizing vasculitis of small and medium sized visceral arteries (no lung involvement)
Where is presentation of polyarteritis nodosa most common?
Kidney, liver
What is the demographic of those most prone to polyarteritis nodosa?
Young males
If a patient presents with necrotizing of the vessel wall (fibrinoid necrosis), what disease is suspected?
Polyarteritis nodosa
What are the three phases of polyarteritis nodosa?
Acute, healing, scarred (may copresent)
What are complications of polyarteritis nodosa?
Aneurysm, thrombosis, infarct
Polyarteritis nodosa is ___ responsive
corticosteroid
What is the demographic of those most prone to allergic granulomatosis and angitis (Churg-Strauss)?
Young individuals with asthma
Two-thirds of patients with allergic granulomatosis and angitis (Churg-Strauss) have…
C-ANCA or P-ANCA
What structures are affected by allergic granulomatosis and angitis (Churg-Strauss)?
Small and medium-sized arteries and arterioles of the lungs, spleen, kidney, heart, CNS, and others
What is the morphology of a typical lesion demonstrating a pattern of fibrinoid necrosis caused by allergic granulomatosis and angitis (Churg-Strauss)?
Intense eosinophilic infiltrate
What is the demographic of those most prone to giant cell arteritis (temporal arteritis)?
Patients over 50 years of age
Giant cell arteritis (temporal arteritis) is a ___ form of vasculitis in adults
MC systemic form
Is giant cell arteritis (temporal arteritis) chronic or acute in form?
Both acute and chronic
What structures are affected by giant cell arteritis (temporal arteritis)?
Large and small arteries, particularly in the head
Especially temporal arteries but also vertebral and ophthalmic
What is a possible consequence of ophthalmic artery involvement in giant cell arteritis (temporal arteritis)?
Sudden permanent blindess
Pathogenesis of giant cell arteritis (temporal arteritis) suggests that ___ is generated towards components of the vascular wall
immune reaction
___ nature of giant cell arteritis (temporal arteritis) suggests T-cell mediated mechanism and antigen driven injury
Granulomatous
Granulomatous nature of giant cell arteritis (temporal arteritis) suggests…
T-cell mediated mechanism and antigen driven injury
What are clinical features of giant cell arteritis (temporal arteritis)?
- Facial pain, intense upon palpation
- Ocular symptoms mild to severe
- May lead to permanent blindness
Giant cell arteritis (temporal arteritis) is treated with…
anti-inflammatory
If a patient presents with pain and stiffness in neck, shoulder, and hip with extreme exhaustion, what is suspected?
Polymyalgia rheumatica
50% of patients with polymyalgia rheumatica also have…
temporal arteritis (giant cell arteritis)
What occurs systemically with polymyalgia rheumatica?
WBCs attack joints of the body
What is the etiology of Kawasaki disease?
Unknown etiology
What is Kawasaki disease?
Disease of the coronary arteries affecting young children under 4 years of age
Kawasaki disease is associated with…
mucocutaneous lymph node syndrome (acute self-limiting fever, rash, erythema, desquamation, and lymphadenopathy)
About 20% of children with Kawasaki disease develop…
cardiac sequellae leading to aneurysmal formation
What are the clinical consequences of Kawasaki disease in order of increasing severity?
- Asymptomatic vasculitis
- Coronary artery ectasia
- Coronary artery aneurysm
- Thrombosis
- Myocardial infarction
- Sudden death
What is the treatment for Kawasaki disease?
Aspirin and intravenous gammaglobulin (decrease immune response)
Wegener’s granulomatosis is a necrotizing vasculitis characterized by:
- Acute necrotizing granulomas of upper respiratory tract
- Necrotizing granulomatosis of small to medium sized vessels
- Renal disease in the form of focal glomerulitis
90% of those with Wegener’s granulomatosis present with ___
75% is ___
90% ANCA
75% C-ANCA
Pathogenesis of Wegener’s granulomatosis suggests…
hypersensitivity reaction
What is the result of Wegener’s granulomatosis if not treated?
Rapidly fatal
What is the treatment for Wegener’s granulomatosis?
Cyclophosphamide (chemotherapy)
Thromboangitis obliterans (Buerger’s disease) is a distinctive disease leading to…
vascular insufficiency
What characterizes thromboangitis obliterans (Buerger’s disease)?
Segmental acute and chronic thrombosing of small and medium arteries
Where does thromboangitis obliterans (Buerger’s disease) principally present?
Tibial and radial arteries
Thromboangitis obliterans (Buerger’s disease) previously occurred almost exclusively in…
heavy cigarette smoking men
What type of inflammation is found in thromboangitis obliterans (Buerger’s disease)?
Microabscesses/ granulomatous inflammation
What are some symptoms of thromboangitis obliterans (Buerger’s disease)?
Claudication; maybe cold intolerance/ Raynaud’s
Behcet mainly involves…
mucous membranes
If a patient presents with oral apthous ulcers, genital ulceration, ocular inflammation, and lesions in CNS, cardiovascular, and GI, what is suspected?
Behcet
What is the cause of Behcet?
Unknown, however immune basis
What are varicose veins?
Enlarged tortuous blood vessels
What is the etiology of varicose veins?
Increased intraluminal pressure
What are some risk factors for varicose veins?
Female sex, familial predisposition, obesity
Describe the vessel walls of varicose veins?
May be thinned due to dilation or thickened due to hypertrophy
What are some results of varicose veins?
Stasis dermatitis and secondary ulceration
What is the term for varicosity of rectum and anus?
Hemorrhoids
What is the term for varicosity of esophagus?
Esophageal varices
What is the term for varicosity of scrotum?
Varicocele
What is thrombophlebitis?
Blood clot blocking one or more veins with inflammation, often in legs
What is phlebothrombosis?
Blood clot in a vein without inflammation
Deep vein thrombosis is associated with…
prolonged bed rest, reduced cardiac output, surgery
Deep vein thrombosis is a major threat to life; there can be sudden death following…
post-op ambulation
What is the cause of death associated with deep vein thrombosis?
Pulmonary embolus resulting in cor pulmonale
What is cor pulmonale?
Enlarged right ventricle due to lung condition (ie. pulmonary embolus)
If a patient presents with a general swelling in the calf, ankle, foot, or thigh, increased warmth of the leg, redness, leg pain, night leg cramps, and bluish discoloration of skin on leg or toes, what is suspected?
Deep vein thrombosis
