Robbin's 11: Blood Vessels Flashcards
What is the most common vasculature to be invaded by a malignancy for hematogenous spread?
Veins and lymphatics If in the head, however, veins bc there are no lymphatics in the cranium.
Fibromuscular dysplasia typically involves what arteries?
Fibromuscular dysplasia (FMD) typically involves renal and carotid arteries. Renal arterial stenosis activates the renin-angiotensin system, leading to hypertension. On angiography, FMD appears as a “string of beads” caused by focal medial hyperplasia with thickened fibromuscular ridges adjacent to less involved areas of the arterial wall. This is a surgically correctible cause for hypertension.
Necrotizing vasculitis occurs in pulmonary vasculature in association with:
Necrotizing vasculitis occurs in pulmonary vasculature in association with anti–neutrophil cytoplasmic autoantibody (ANCA)–associated granulomatous vasculitis.
Symmetrically smaller than normal kidneys can be caused by:
diabetes mellitus; systemic hypertension (hyaline arteriosclerosis) Hyaline arteriolosclerosis is seen with long-standing essential hypertension of moderate severity. These lesions give rise to benign nephrosclerosis. The affected kidneys become symmetrically shrunken and granular because of progressive loss of renal parenchyma and consequent fine scarring.
A 45-year-old man has had poorly controlled hypertension ranging from 150/90 mm Hg to 160/95 mm Hg for the past 11 years. Over the past 3 months, his blood pressure has increased to 250/125 mm Hg. On physical examination, his temperature is 36.9° C. His lungs are clear on auscultation, and his heart rate is regular. There is no abdominal pain on palpation. A chest radiograph shows a prominent border on the left side of the heart. Laboratory studies show that his serum creatinine level has increased during this time from 1.7 mg/dL to 3.8 mg/dL. What vascular lesions is most likely to be found in this patient’s kidneys?
Necrotizing arteriolitis Malignant hypertension can suddenly complicate and be superimposed on less severe, benign essential hypertension. The arterioles undergo concentric thickening and luminal narrowing with malignant hypertension, called hyperplastic arteriolosclerosis, and fibrinoid necrosis is a prominent feature.
What is Mockeberg arteriosclerosis?
a benign process that is a form of arteriosclerosis, often with no serious sequelae. The distal extremities, pelvis, thyroid, and breast regions are the most common locations.
An experiment studies early atheroma development. Lipid streaks on arterial walls are examined microscopically and biochemically to determine their cellular and chemical constituents and the factors promoting their formation. Early lesions show increased attachment of monocytes to endothelium. The monocytes migrate subendothelially and become macrophages; these macrophages transform themselves into foam cells. What substance is most likely to be responsible for the transformation of macrophages?
Oxidized LDL –can be taken up by a special “scavenger” pathway in macrophages; it also promotes monocyte chemotaxis and adherence. Macrophages taking up the lipid become foam cells that begin to form the fatty streak. Smoking, diabetes mellitus, and hypertension all promote free radical formation, and free radicals increase degradation of LDL to its oxidized form. About one third of LDL is degraded to the oxidized form; a higher LDL level increases the amount of oxidized LDL available for uptake into macrophages.
_______ are present early in the pathogenesis of atherosclerotic lesions and are believed to activate monocytes, endothelial cells, and smooth muscle cells by secreting cytokines.
T-cells T cells are present early in the pathogenesis of atherosclerotic lesions and are believed to activate monocytes, endothelial cells, and smooth muscle cells by secreting cytokines. T cells adhere to VCAM-1 on activated endothelial cells and migrate into the vessel wall. These T cells, activated by some unknown mechanism, secrete various proinflammatory molecules that recruit and activate monocytes and smooth muscle cells and perpetuate chronic inflammation of the vessel wall.
Syphilis (positive VDRL test result) produces endarteritis obliterans of the:
Syphilis (positive VDRL test result) produces endarteritis obliterans of the aortic vasa vasorum, which weakens the wall and predisposes to aortic aneurysm formation.
Classic polyarteritis nodosa (PAN) can produce small microaneurysms in small arteries, most often where?
Classic polyarteritis nodosa (PAN) can produce small microaneurysms in small arteries, most often renal and mesenteric. –segmental involvement of medium-sized arteries with aneurysmal dilation in the renal and mesenteric vascular beds (e.g., abdominal pain, melena). PAN can affect many organs at different times. Although the cause of PAN is unknown, about 30% of patients have hepatitis B surface antigen that presumably forms immune complexes that damage vascular walls. In contrast to microscopic polyangiitis, PAN has less of an association with anti–neutrophil cytoplasmic autoantibody (ANCA).
__________ is a rare condition in which muscular arteries become occluded in the lower extremities in smokers.
Thromboangiitis obliterans (Buerger disease) is a rare condition in which muscular arteries become occluded in the lower extremities in smokers.
Marfan syndrome is a risk for aortic dissection starting in what area of the aorta?
Marfan syndrome is a risk for aortic dissection starting in a dilated ascending aorta.
_________ is seen mainly in children and involves the aorta (particularly the arch) and branches such as the coronary and renal arteries, causing granulomatous inflammation, aneurysm formation, and dissection.
Takayasu arteritis is seen mainly in children and involves the aorta (particularly the arch) and branches such as the coronary and renal arteries, causing granulomatous inflammation, aneurysm formation, and dissection. Takayasu arteritis leads to “pulseless disease,” because of involvement of the aorta (particularly the arch) and branches such as coronary, carotid, and renal arteries, which results in granulomatous inflammation, aneurysm formation, and dissection. Fibrosis is a late finding, and the pulmonary arteries also can be involved.
A 3-year-old child from Osaka, Japan, has developed a fever and a rash and swelling of her hands and feet over the past 2 days. On physical examination, her temperature is 37.8° C. There is a desquamative skin rash, oral erythema, erythema of the palms and soles, edema of the hands and feet, and cervical lymphadenopathy. The child improves after a course of intravenous immunoglobulin therapy. What is most likely to be a complication of this child’s disease if it is untreated?
Mucocutaneous lymph node syndrome, or Kawasaki disease, involves large, medium-sized, and small arteries. Cardiovascular complications occur in 20% of cases and include thrombosis, ectasia, and aneurysm formation of coronary arteries.
A 50-year-old man has had a chronic cough for the past 18 months. Physical examination shows nasopharyngeal ulcers, and the lungs have diffuse crackles bilaterally on auscultation. Laboratory studies include a serum urea nitrogen level of 75 mg/dL and a creatinine concentration of 6.7 mg/dL. Urinalysis shows 50 RBCs per high-power field and RBC casts. His serologic titer for C-ANCA (proteinase 3) is elevated. A chest radiograph shows multiple, small, bilateral pulmonary nodules. A transbronchial lung biopsy specimen shows a necrotizing inflammatory process involving the small peripheral pulmonary arteries and arterioles. What is the most likely diagnosis?
GPA, Granulomatosis with polyangiitis Anti–neutrophil cytoplasmic autoantibody (ANCA)–associated vasculitis (granulomatosis with polyangiitis) is a form of hypersensitivity reaction to an unknown antigen characterized by necrotizing granulomatous inflammation that typically involves small to medium-sized vessels, although many organ sites may be affected. Pulmonary and renal involvement can be life-threatening. C-ANCAs (antibodies mainly directed against neutrophil proteinase 3) are found in more than 90% of cases.
