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Pathology > Pathology Tute 1. Aneurysms and Vasculitis > Flashcards

Pathology Tute 1. Aneurysms and Vasculitis Flashcards

1
Q

What are the complications of dissecting aneurysms?

A

Rupture into surrounding issues
Dissect proximally - haemopericardium, tamponade.
Dissect distally - causing disruption of aortic branches (carotids, vertebral, renal arteries)

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2
Q

What is a cardiac aneurysm?

A

Develops at site of MI; bulge outwards.
Lumen often filled with laminated blood clot (e.g. emboli risk).
Usually not a site of ventricular rupture.

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3
Q

What are berry aneurysms

A

Occur at branch point in Circle of Willis.
Sites of congenital weakness.
Aneurysm not present at birth.
Risk of rupture related to size and location.

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4
Q

What are the causes of aneurysms?

A

Atherosclerosis
Vasculitis
Congenital or acquired weakness
Hypertension

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5
Q

What are Charcot Bouchard aneurysms?

A

xxxx

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6
Q

What are the symptoms of AAA?

A

Usually asymptomatic if intact.
If ruptured: back/abdominal mass, shock, pulsatile abdominal mass, reduced lower limb pulses.
Investigated with Contrast CT.

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7
Q

What are the implications and causes of proximal aortic aneurysms?

A

Aortic root dilation with aortic valve regurgitation. Usually secondary to atherosclerosis or Marfan’s syndrome.

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8
Q

What is vasculitis?

A

Inflammation of blood vessels.

Acute or chronic inflammation that results in structural damage to the vessel wall.

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9
Q

What are the classifications of vasculitis?

A
  • Infectious
  • Immunologic
  • Immune complex mediated: Henoch-Schoanlein purport, cryoglobulinaemic vasculitis, serum sickness, CT disease.
  • Cell mediated
  • ANCA Mediated
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10
Q

What are the classifications of vasculitis?

A
  • Infectious
  • Immunologic
  • Immune complex mediated: Henoch-Schoanlein purport, cryoglobulinaemic vasculitis, serum sickness, CT disease.
  • Cell mediated
  • ANCA Mediated
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11
Q

What should trigger clinical suspicion of vasculitis?

A
  • Unexplained multiple organ ischaemia

- Systemic illness with no evidence of malignancy or infection

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12
Q

What lab results should arouse suspicion of vasculitis?

A

Non specific: anemia, increased WBC and ESR, abnormal urinalysis

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13
Q

How should suspected vasculitis be Ix?

A

Biopsy if tissue accessible.

Angiography if vessel inaccessible.

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14
Q

How does vasculitis appear microscopically.

A

+/- thrombus
Fibrinoid necrosis (wall dead, fibrin accumulates).
Surrounding inflammation
Blood leakage around
May have immunoglobulins (further testing)
Leukotyoclasis (neutrophils chopped up dead around).

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15
Q

What is the general pathological process of vasculitis?

A

Infiltrate of neutrophils –> vessel injury
Fibrin deposition (in lumen or vessel wall)
Leakage of blood cells
Lymphocytes and Macrophages to help vessel repair
xxxxxxx

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16
Q

What is the Churg Strauss Triad?

A

Allergic rhinitis and asthma
Eosniophilic infiltrative disease resembling pneumonia
Systemic vasculitis

17
Q

What is the renal manifestation of vasculitis?

A

Nephritis: usually a necrotising and crescentic GN.

18
Q

What are the pulmonary manifestations of vasculitis?

A

Pulmonary haemorrhage: haemorhagic alveolar capillaritis. Heals as interstitial fibrosis.

19
Q

What is pulmonary-renal syndrome?

A

Microscopic polyangitis and Goodpasture’s syndrome.

xxxxxxxxxx

20
Q

What are the skin manifestations of vasculitis?

A

Purpura

Non-blanching. Generally rapid onset.

21
Q

What are the GIT manifestations of vasculitis?

A

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22
Q

What is microscopic polyangitis?

A

Small vessel vasculitis.
Necrotising systemic vasculitis; affects arterioles, capillaries and venues.
Can sometimes involved S - M sized arteries.
Characterised by few or no immune deposits.

23
Q

What is the epidemiology of microscopic polyangitis?

A

1 per 100,000
Slight M>F predominance
Mean patient age of 50 years.

24
Q

What is microscopic polyangitis?

A

Small vessel vasculitis.
Necrotising systemic vasculitis; affects arterioles, capillaries and venues.
Can sometimes involved S - M sized arteries.
Characterised by few or no immune deposits.

25
Q

What is the epidemiology of microscopic polyangitis?

A

1 per 100,000
Slight M>F predominance
Mean patient age of 50 years.

26
Q

What is the pathology of microscopic polyangitis?

A

Segmental vascular necrosis.
Infiltrate of neutrophils and monocytes.
May have leukocytoclasis, fibrin and haemorrhage.
Thrombosis in small arteries causing infarction.
Healing with fibrosis
Pseudoaneurysms do occur in M arteries.

27
Q

How do ANCA levels vary?

A

Highest in untreated disease

Decline with treatment and disease quiescence.

28
Q

What is Wegener’s granulomatosis?

A

Granulomatous inflammation of vessels of respiratory tract and kidneys, initially
have URTI symptoms, most common in middle age
-Granulomatous inflammation, necrosis and vasculitis predominantly affecting respiratory tract.
-Variable renal involvement.
-Predominately C-ANCA positive (75%).

29
Q

What is Churg-Strauss syndrome?

A

Granulomatous inflammation of vessels with hypereosinophilia and eosinophilic tissue infiltration, frequent lung involvement (asthma, allergic rhinitis), can be associated with p-ANCA or c-ANCA, other manifestations include coronary arteritis, myocarditis and neuropathy, average age 40s

30
Q

What is Henoch-SChonlein purport?

A

Vascular deposition of lgA causing systemic vasculitis (skin, Gl, renal), usually se~-limiting, most common in childhood

31
Q

What is polyarteritis nods?

A 
Segmental non-granulomatous necrotizing inflammation
Unknown etiology in most cases (sometimes Hep B/C), 
any age (average 40-50s), M > F
32
Q

What is polyarteritis nods?

A 
Segmental non-granulomatous necrotizing inflammation
Unknown etiology in most cases (sometimes Hep B/C), 
any age (average 40-50s), M > F
33
Q

What is giant cell arteritis?

A

Inflammation predominantly of the aorta and arteries originating from it (head and neck arteries = vertebral, retinal, temporal and coronaries)
Over 50yrsofage, F>M

34
Q

How does giant cell arteritis present?

A

Headache, vessel tenderness, jaw claudication, fever, raised ESR.

35
Q

Why is giant cell arteritis an emergency?

A

May result in blindness.

Treat with steroids and obtain temporal artery biopsy.

36
Q

Why is giant cell arteritis an emergency?

A

May result in blindness.

Treat with steroids and obtain temporal artery biopsy.

37
Q

How are vasculitides Dx?

A

Clinical Features:
Serology: ANCA, cryoglobulins, Hep B and C, Complement, ANAs, Rheumatoid factor.
Pathology: Bx if possible

Pathology (11 decks)

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