peripheral vascular disease Flashcards
common infectious causes of aneurysm
Mycotic aneurysm (mucormycosis)
Syphillis (Treponema pallidum)
treatment giant cell / temporal arteritis
high dose steroids
histology Microscopic polyangiitis (leukocytoclastic vasculitis)
fibrinoid necrosis,
neutrophils
nuclear dust (Karyorrhexis)
clinical features of thoracic aortic aneurysm
mediastinum encroachment: tracheal/esophogeal compression,
bone erosion,
cough (larygneal nerve)
Heart failure due to insuficient aortic valve, aortic rupture
Pressentation, pathogensis, vessels
Takayasu Arteritis
Pulseless disease (UE)
ocular disturbances
Japanese women
granulomatous inflammation of aortic arch+ branches
pulmonary, coronary, renal artery pos.
autoimmune etiology
presentation, pathogenesis, vessels Churg Strauss
palpable purpura, GI bleeding, Renal impairment, Cardiomyapthy, MPO ANCA +
possible hyper-response to allergic stim
Small Vessel vasculitis associated with - asthma, allergic rhinitis, peripheral eosinophilia, necrotizing granulomas
presentation aotic dissection
stabbing or tearing anterior chest pain radiating to back
most common location of aortic dissection
ascending aorta
aortic disection = ____ tear within 10 cm of ___
intimal tear within 10 cm of aortic valve
(dissection palce between middle and outer thirds of wall in media0
ehlers dalos vs marfans
ehlers danlos - type iII collagen
marfans- fibrillin
presentation, pathogenesis, vessels
Microscopic Polyangiitis (Leukocytoclastic Vasculitis)
Clinical depends on vascular bed (hemoptysis, hematuria, protinuria, abd pain and muscle pain or bleeding, cutaneous purpura)
Arterioles, cappillaries, venules of Skin, mucous membranes, **lungs, kidneys **brain, heart, GIT, muscles
Thromboangiitis Obliterans (Buerger)
smokers,
Painful ischemia, gangrene of limbs
inflammation and thrombosis of medium-small muscular arteries and secondarily, nerves and veins. Tibial and radial artery esp.
Raynaud phenom
prosymall pallor or cyanosis of fingers, toes, nose, easrs
healthy young woman
recurrent vasospasm, no strucutral changes in arterial wall until late.
(can be secondary to arterial insufficiency due to SLE, SS, atheroscloriss, beurger)
presentation, pathogenesis, vessels
wegner granulomatosis
PR3-ANCA positive
40yo Pneumonitis, Sinusitis, Nasopharyngeal ulcerations, Renal Dease
necrotizing vasculitis > granulomas of lung or UR+ENT (likely cell mediated hypersensitivitiy)
vasculitis of small-medium in lung and UR tract
Glomerulonephritis
histology Kawaski’s
necrosis and inflammation
savular vs fusiform anyeurism
sacular buldges out one side, unilateral
fusiform: uniform expansion of the vessel
histology Takayasu ateritis
lymphocytes, giant cells
collagenous fibrosis
most common location of aortic anyeurism
abdominal aorta
presentation abdominal aortoci aneurysm
pulsatile abdominal mass
histology Polyarteritis nodosa
Necrosis with karorrhexis
transmural, full thickness inflammation
Presentation, pathogenesis, vessels
Polyarteritis nodosa
Young aadults (30% Hep B ag)
No ANCA
Aneurysms
Rapidly accel HTN, abdominal pain + blood stool
peripheral nephritis
Renal and viceral arteries (spares lungs)
systemic transmular necrotizing inflammation of small or med muscular arteries
histology of giant cell arteritis
granulomatous inflammation of inner half of media around internal elastic lamina
destruction of internal elastic lamina
multinucleated giant cells
Presentation, pathogenesis, vessels
Polyarteritis nodosa
Young aadults (30% Hep B ag)
No ANCA
Aneurysms
Rapidly accel HTN, abdominal pain + blood stool
peripheral nephritis
Renal and viceral arteries (spares lungs)
systemic transmular necrotizing inflammation of small or med muscular arteries
ANCA
two main patters
auto-antibodies agasint granule enzymes of neutrophils
PR3-ANCA - Wegner granulomatosis
MPO-ANCO - microscopic polyangitis and Churg Strauss syndrome
presentation, pathogenesis, vessels Churg Strauss
palpable purpura, GI bleeding, Renal impairment, Cardiomyapthy, MPO ANCA +
possible hyper-response to allergic stim
Small Vessel vasculitis associated with - asthma, allergic rhinitis, peripheral eosinophilia, necrotizing granulomas
underlying excessive connective tissue degradations often due to
increased MMP
decreased inhibitors of MMP (TIMP)
polymorphisms off MMP or TIMP in the presence of inflammation predispose
Presentation, pathogenesis, vessels
Kawasaki’s
mucocutenous lymph node syndrome, mucous membrane inflam.
anyeurisms (resembles PAN)
Large medium and small arteries
**Often coronary **with aneurysm formation
hemopericardium in aortic dissection
blood disects thouhg media, proximally, filling pericardial sac
(may also rupture into pleural or peritoneal cavities)
in aortic dissection secondary to marfan syndrome, _____ causes connective tissue weakness, appearing as pools of blue mucinous ground substance disrupting elastic fibers
cystic medial necrosis
pathogenesis of immune complex mediated vasculitis
SLE (DNA and anti-DNA complexes)
Drug Hypersensitivity
HBsAg and anti HBSsAg
layer impact aneurysm
loss of SMCs
thickening of intima due to atherosclerosis > ischemia of inner media
systemic HTN > narrows vasa vasorum leading to ischemia of outer layers
morpolohy of aortic aneurysm
thinning and destruction of media
mural thrombus
saccular or fusiform
inflammatory or mycotic
Atheroscleorsis likely to impact -____ for anyeurism
while HTN is more likely to impact ____
Atherosclerosis - abdominal aorta
HTN - ascending aorta
presentation, pathogenesis, vessels
wegner granulomatosis
PR3-ANCA positive
40yo Pneumonitis, Sinusitis, Nasopharyngeal ulcerations, Renal Dease
necrotizing vasculitis > granulomas of lung or UR+ENT (likely cell mediated hypersensitivitiy)
vasculitis of small-medium in lung and UR tract
Glomerulonephritis
presentation, pathogenesis, vessels
Microscopic Polyangiitis (Leukocytoclastic Vasculitis)
Clinical depends on vascular bed (hemoptysis, hematuria, protinuria, abd pain and muscle pain or bleeding, cutaneous purpura)
Arterioles, cappillaries, venules of Skin, mucous membranes, **lungs, kidneys **brain, heart, GIT, muscles
Pressentation, pathogensis, vessels
Takayasu Arteritis
Pulseless disease (UE)
ocular disturbances
Japanese women
granulomatous inflammation of aortic arch+ branches
pulmonary, coronary, renal artery pos.
autoimmune etiology
Presentation, pathogenesis, vessels
Kawasaki’s
mucocutenous lymph node syndrome, mucous membrane inflam.
anyeurisms (resembles PAN)
Large medium and small arteries
**Often coronary **with aneurysm formation
other mechanism of vasculitis pathogenesis
antibodies to endothelial cells (Kawaski’s)
Thromboangiitis Obliterans (Buerger)
smokers,
Painful ischemia, gangrene of limbs
inflammation and thrombosis of medium-small muscular arteries and secondarily, nerves and veins. Tibial and radial artery esp.
Pathogensis, vessels, and presentation
Giant Cell / Temporal Arteritis
most common form
Aorta+branches, esp Temp and vertebral
50yo, painful Temporal artery
diplopia, vision loss
headache
increased ESR
Pathogensis, vessels, and presentation
Giant Cell / Temporal Arteritis
most common form
Aorta+branches, esp Temp and vertebral
50yo, painful Temporal artery
diplopia, vision loss
headache
increased ESR
