Pathoma - HTN, Arteriosclerosis, Vascular tumors Flashcards
What are the effects of ATII
(1) Promoting adrenal release of aldosterone
(2) Contracting arteriolar smooth muscle
What is fibromuscular dysplasia and what population does it usually occur in?
Developmental defect of the blood vessel wall, resulting in irregular thickening of large- and medium-sized arteries, especially the renal artery
Is an important cause of stenosis in young female vs. atherosclerosis as a cause of stenosis in elderly males
What are the 3 types of arteriosclerosis and describe them
(1) Atherosclerosis (intimal thickening in large vessels)
(2) Arteriolosclerosis (small vessels)
(3) Monckeberg medial calcific sclerosis (thickening of media)
Describe the plaques of atherosclerosis
Necrotic lipid core (mostly cholesterol) with a fibromuscular cap
What are the 4 most common arteries involved in athersclerosis?
Abdominal aorta
Coronary artery
Popliteal artery
Internal carotid artery
What are the modifiable risks of atherosclerosis?
Smoking, HTN, diabetes, hypercholesterolemia
Describe the components of a fatty streak
Collection of macrophages containing oxidized lipids (foam cells)
What are the 4 consequences of atherosclerosis?
(1) Stenosis
(2) Plaque rupture with thrombosis
(3) Plaque rupture with embolization
(4) Aneurysm (due to plaque blocking blood flow to wall)
What are the 2 types of arteriolosclerosis
(1) Hyaline arteriolosclerosis
(2) Hyperplastic arteriolosclerosis
Describe hyaline arteriolosclerosis and the two causes
Vascular thickening due to proteins leaking into the vessel wall
Caused by:
(1) Benign HTN (high BP pushes protein into wall)
(2) Diabetes (non-ezymatic glycosylation of the basement membrane makes the wall leaky)
Describe hyperplastic arteriolosclerosis and its cause
Thickening of vessel wall by hyperplasia of the smooth muscle (“onion-skin”)
Causes by malignant HTN
What is Monckeberg medial calcific sclerosis and its clinical presentation
Calcification of the media of muscular (medium-sized) arteries
Is clinically insignificant (no luminal narrowing)
Seen as incidental findings on X-ray or mammography
Describe the layers of the aorta affected by aortic dissection
Intimal tear with dissection of blood through the media
What are the 2 necessary criteria for a dissection to occur?
High stress & pre-existing weakness of the media (e.g. Marfan’s or Ehlers-Danlos)
Describe the defect and presentation of Marfan’s syndrome
Defect in fibrillin (scaffold for elastin)
Arachnodactyly, lens dislocation (upward), aortic dissection, hyperflexible joints
Describe the defect and presentation of Ehler’s Danlos syndrome
Classical type (joint and skin) caused by defeciency in Type V collagen
Vascular type caused by deficiency in Type III collagen
Hyperextensible skin, hypermobile joints, tendency to bleed
Describe the mechanism behind HTN as a risk factor for aortic dissection
HTN results in hyaline arteriolosclerosis of the vasa vasorum (blood supply running through the adventitia)
Decreased flow leads to atrophy and weakening of the media, which increases risk for dissection
What is the classic disease associated with thoracic aneurysm?
Tertiary syphilis
Endartertitis of the vaso vasorum results in luminal narrowing, decreased flow, and atrophy of the vessel wall
Fibrosis secondary to inflammation results in a “tree bark” appearance of aorta
Where along the aorta does an abdominal aneurysm usually occur?
Below the renal arteries but above the aortic bifurcation
Major cause of abd aortic aneurysm
Atherosclerosis (increases the diffusion barrier to get O2 to the media)
Triad of presentation in abd aortic rupture?
Hypotension
Pulsatile abd mass
Flank pain
Hemangioma (benign/malignant; areas involved; treatment)
Benign tumor comprised of blood vessels (blanchable)
Most often involves skin and liver
Often regresses during childhood
Angiosarcoma (benign/malignant; areas involved; risk exposures)
Malignant proliferation of endothelial cells
Common sites: skin, breast, and liver
