Vascular Flashcards
1
Q
A
2
Q
Berry aneurysm congenital defect of the
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tunica intima and tunica media are congenitally absent allowing an outpocketing of the tunica adventitia
3
Q
Average age of berry aneurysm
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20-40
4
Q
Berry aneurysm location
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Circle of Willis
5
Q
Arteriovenous fistulas congenital defect
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abnormal communications between arterial and venous blood vessels
6
Q
Arteriovenous fistulas may be secondary to
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to infection, trauma, blood vessel rupture or previous surgical intervention.
7
Q
Arteriovenous fistulas may contribute to
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right-sided congestive heart failure by increasing venous return to the heart
8
Q
Temporal Arteritis definition
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granulomatous inflammation and breakdown if the internal elastic membrane of branches of carotid artery
9
Q
Temporal Arteritis Treatment
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corticosteroids
10
Q
Takayasu Arteritis definition
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granulomatous inflammation of aortic arch, young asian female
11
Q
Takayasu Arteritis symptoms
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ocular disturbances, weak/absent pulses in UE
12
Q
Polyarteritis Nodosa
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young, adult males w/ nodular inflammation of vessels
13
Q
Polyarteritis Nodosa affects which organs
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all organs except the LUNG
14
Q
Polyarteritis Nodosa acute pathology
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fibrinoid necrosis w/ neutrophils, eosinophils, monocytes
15
Q
Polyarteritis Nodosa healing lesion pathology
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fibroblastic proliferation w/ macrophages and plasma cells
16
Q
Kawasaki Disease symptoms
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fever, conjunctivitis, erythematous rash of palms and soles, enlarged cervical lymph nodes
17
Q
Complication of Kawasaki Disease
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coronary aneurysm
18
Q
Kawasaki Disease patient population
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young asian children/infants
19
Q
Buerger Disease patient population
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male, heavy smokers,
20
Q
Buerger Disease Symptoms
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gangrene, pain mostly in fingers and toes, Raynaud Phenomenon
21
Q
Treatment for Kawasaki Disease
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ASA
22
Q
Treatment for Buerger Disease
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smoking cessation
23
Q
Wegener Granulomatosis definition
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necrotizing granulomatosis of the nasopharynx, lung, kidney
24
Q
Wegener Granulomatosis Symptoms
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chronic sinusitis, nasopharynx ulcerations, hemoptysis, pneumonitis, necrotizing glomerulitis
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Test for Wegener Granulomatosis
C-ANCA
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Wegener Granulomatosis patient pop
male, 50+
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Microscopic Polyangitis definition
arterioles, venules, capillaries of the skin, mucus membranes, lung, heart, GIT, kidney, etc
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Test for Microscopic Polyangitis
P-ANCA
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Churg-Strauss Syndrome is associated w/
asthma and eosinophilia
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Test for Churg-Strauss Syndrome
P-ANCA
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Infectious vasculitis
direct extension of organism into wall or hematogenous embolization
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vaso vasora
found in the tunica adventitia
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Atherosclerosis commonly occurs in the
abdominal aorta, coronary arteries, elastic arteries, muscular arteries and cerebral arteries
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atherosclerotic plaque is composed what cells
smooth muscle cells, macrophages and leukocytes
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atherosclerotic plaque is composed what CT
collagen, elastic fibers, proteoglycans
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Simple atheromatous plaque is composed of
composed of a fibrous cap and central lipid core
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The fibrous cap is composed of
macrophages, foam cells, lymphocytes, collagen, elastin, and proteoglycans
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The inner core is a necrotic center composed of
lipid, cholesterol, cellular debris, foam cells, and calcium
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Simple atheromatous plaques occur b/w
tunica intima and tunica media
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Complicated atheromatous plaque is associated w/
Either: 1.) calcification 2) surface ulceration 3) thrombosis 4) hemorrhage into the plaque causing hematoma. 5) aneurysmal dilation
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fatty streaks
earliest sign of atherosclerotic plaque
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Fatty streaks are characterized by
proliferation of smooth muscle with intracytoplasmic lipid accumulation
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fatty streaks tend to occur as
intimal cushion pads occurring at the bifurcation of arteries
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intimal cushion pads HOWEVER are
smooth muscle cells with collagen however, they usually lack lipid
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atheroma formation is initiated by
damage to endothelium lining arterial blood vessels
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Damage causes
adherence of platelets and monocytes, attraction of SM cells and collagen production, w/ monocyte/macrophage phagocytosis of lipids deposited in the injury site
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Monckeberg
ring-like calcifications of the tunica media arranged in a concentric fashion throughout the length of an artery - give rise to bone
48
Monckeberg sites most commonly affected
femoral, tibial, radial, ulnar, and arterial supplies of the genital tracts in both sexes
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Arteriolosclerosis
thickening of arterial walls due to HTN
50
Hyaline arteriolosclerosis occurs in
hypertensive and diabetics
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Hyaline arteriolosclerosis appears as
accumulation of pink homogenous hyaline material within the blood vessel wall -\> narrowing of intima
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Benign nephrosclerosis and/or ischemic necrosis and gangrene in the lower extremities of diabetics is due to
Hyaline arteriolosclerosis
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Hyperplastic arteriolosclerosis
malignant hypertensive
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Hyperplastic arteriolosclerosis characteristic finding
onionskin layering due to an increase of smooth muscle cells within the tunica media
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Hyperplastic arteriolosclerosis most commonly affects
abdominal and thoracic viscera are very commonly affected
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headache, temporal tenderness, visual loss or facial pain.
Temporal arteritis
57
Polyarteritis Nodosa most commonly affects
arterial bifurcations
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Polyarteritis Nodosa Sx
fever of unknown origin, weight loss, hematuria, albuminuria, renal failure, hypertension, abdominal pain, melena myalgia and neuritis
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acute form of Polyarteritis Nodosa
fibrinoid necrosis of the blood vessel wall with infiltrates of neutrophils, eosinophils and monocytes
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Healing form of Polyarteritis Nodosa
fibroblastic proliferation with an infiltrate of macrophages and plasma cells
61
Healed form of Polyarteritis Nodosa
fibrotic thickening of the blood vessel wall with a loss of the internal elastic membrane.
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Churg-Strauss Syndrome
allergic granulomatosis of Polyarteritis Nodosa
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Churg-Strauss Syndrome key findings
bronchial asthma, marked eosinophilia
64
Wegener granulomatosis
necrotizing granulomas, upper airway and lungs, glomerulitis
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Wegener granulomatosis occurs at age
50+
66
Treatment of Wegener granulomatosis
if not fatal in 5 mo
67
Buerger Disease patients
heavy smokers under the age of 35
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Buerger Disease Sx
Raynaud phenomenon, instep claudication, pain with gangrene
69
mycotic aneurysm
weakening of the vessel wall due to infectious vasculitis
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Raynaud Disease definition
intense vasospasm of small arteries and arterioles of
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Raynaud Disease pathology
no identifiable changes in the arterial walls except in the late form in which there may be intimal proliferation
72
Raynaud phenomenon definition
arterial insufficiency from a direct underlying cause
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Underlying causes of Raynaud phenomenon
SLE, scleroderma, atherosclerosis, Buerger
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The most common cause of aortic aneurysms is
atherosclerosis
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Aneurysm pathogenesis
cystic medial necrosis with degeneration of the tunica media and subsequent weakening of the wall
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Atherosclerotic aneurysms pt pop
hypertensive males, abdominal aorta, may rupture
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Complications of Atherosclerotic aneurysms
mural thrombi/emboli, rupture into peritoneum
78
Syphilitic (luetic) aneurysms common site
ascending thoracic aorta and arch
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Syphilitic (luetic) aneurysms characteristic shape
fusiform
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Syphilitic (luetic) aneurysms appearance of vessel
endothelium undergoes “tree-barking”, caused by linear destruction and inflammation of the tunica intima
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Syphilitic (luetic) aneurysms pathology
lymphocytes and plasma cells, medial necrosis and destruction
82
Aortic Dissection
tear of the tunica intima into the tunica media with separation and dissection along the tunica media
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Aortic Dissection fate
spontaneously reenter the aortic lumen or may end as a blind pouch
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Aortic Dissection pathology
cystic medial necrosis with fragmentation of the elastic membrane
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Aortic Dissection Type A1
begins in the ascending aorta and extends over the arch and down along the entire descending aorta
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Aortic Dissection Type A2
begins at and involves only ascending aorta
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Aortic Dissection Type B
distal to the aortic arch and involves the entire descending aorta
88
Venous varicosities are caused by
destruction of venous valves with subsequent venous insufficiency
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Venous varicosities Sx
progression of marked dilation and tortuosity of veins
90
Venous varicosities pt pop
genetic predisposition, non-mobile upright occupations
91
Venous varicosities of the Lower extremities
superficial veins, dilated tortuousities, prone to thrombi
92
Venous varicosities - Hemorrhoids caused by
increased abdominal pressure (obesity, tumor, scarring secondary to previous surgery or trauma, pregnancy)
93
Venous varicosities - Esophageal varices
lower plexus of the esophagus, cirrhosis, chronic alcoholics and prone to rupture
94
Venous varicosities - Varicocele
pampiniform plexus of the spermatic cord, “bag of worms"
95
Phlebothrombosis and Thrombophlebitis
inflammation with thrombosis - inflammatory processes of the veins associated with the formation of venous thrombi
96
Causes for Phlebothrombosis
cardiac failure, neoplasia, pregnancy, obesity, post operative state, infection, prolonged bed rest or immobilization and hypercoagulable states
97
Trousseau sign
paraneoplastic syndrome of malignany is migratory thrombophlebitis
98
Phlebothrombosis locations
DVT, periprostatic venous plexus, large veins of the skull
99
first manifestation of Phlebothrombosis may be
PE
100
Lymphangitis causes
bacterial - group A beta hemolytic streptococci
101
Lymphangitis pathogenesis
dilated and filled with acute inflammatory exudate -\> break through causing cellulitis and abscess
102
Clinically lymphangitis is diagnosed by
development of streaks along extremities spreading towards the trunk from the distal area proximally
103
The most common causes of lymph edema include
1. metastasis + obstruction in the lymphatic vessels 2) surgery 3) radiation 4) filariasis 5) post inflammatory thrombosis with scarring of lymphatic channels.
104
chylous ascites, chylothorax or chylopericardium
Lymph edema in the abdominal and thoracic cavities
105
Capillary hemangioma
small, benign, neoplasm of capillaries in the skin, mucus membrane, viscera
106
strawberry hemangioma
large capillary hemangioma on the skin of infants
107
strawberry hemangioma fate
usually fade at approximately 3 years of, regress by 5
108
Cavernous hemangiomas
small, benign, neoplasm of dilated vascular spaces of the head and neck, mucus membranes, viscera, brain
109
von Hippel-Lindau
condition in which cavernous hemangiomas occur in the cerebellum or brain stem and eye grounds, pancreas, liver, etc
110
Granuloma Pyogenicum
polypoid form of hemangioma, with surface inflammation and ulceration or the skin, gingiva, and oral mucosa
111
Granuloma Pyogenicum pathology
distinct collarette at base w/ granulation-looking stroma
112
33% of Granuloma Pyogenicum are due to
trauma
113
granuloma gravidarum
tumor on the gingiva and spontaneously regresses after delivery
114
Glomus Tumor definition
benign, painful tumor of the nerve receptor sensitive to temperature variation and regulating arterial flow
115
Glomus Tumor commonly found
distal extremities, especially beneath the nails
116
Pathology of Glomus Tumor
Vascular channels split by CT Aggregated nests of gloms cells
117
Vascular Ectasias
Nevus flammeus, Spider telangiectasis, Hereditary hemorrhagic telangiectasia
118
Hemangioendothelioma
endothelial cells growing in vascular lumina
119
Hemangioendothelioma is intermediate b/w
hemangioma and angiosarcoma
120
Hemangioendothelioma is most common in the
skin but also the spleen and liver
121
Hemangioendothelioma pathology
spindle shaped cells with occasional mitotic figures and pleomorphism
122
Angiosarcoma
anaplastic endothelial cells with frequent mitotic figures
123
Angiosarcoma is most common in the
skin, breast, soft tissue and liver
124
Angiosarcoma symptoms
small red well-demarcated masses -\> bulky and fleshy with central areas of hemorrhage and poorly defined borders
125
Hepativ variants of Angiosarcoma involve exposure to
arsenic, Thorotrast and PVC
126
Hemangiopericytoma
lower extremities and retroperitoneum, these rare tumors arise from pericytes
127
Hemangiopericytoma pahtology
spindle-shaped cells
128
Hemangiopericytoma risk of metastatsis
50% may metastasize to the lungs, bone and liver.
129
Classic Kaposi Sarcoma pt pop
older men of Eastern European and Mediterranean,
130
Classic Kaposi Sarcoma Sx
multiple purple red skin plaques or nodules usually arising on the lower extremities and spreading proximally
131
African Kaposi Sarcoma pt pop
children and younger men
132
African Kaposi Sarcoma accounts for 10% of
All tumors in Africa, regional lymph node involvement
133
Transplant Associated Kaposi pt pop
transplant recipients + immunosuppressants
134
Transplant Associated Kaposi Sx
localized or metastasized, regresses w/ discontinuation of immunosuppressants
135
AIDS-associated Kaposi pt pop
33% of all AIDS pts
136
AIDS-associated Kaposi Sx
wide dissemination, skin, membranes, viscera and typically develop another malignancy
137
Appearance of all kaposi lesions
red to blue coalescing plaques and nodules composed of spindle cells around angulated blood filled vascular spaces with occasional mitoses
138
Lymphangioma
benign, subcutaneous tissues of the head, neck and axilla
139
Lymphangioma pathology
identical to capillary hemangioma but absence of blood from the vascular spaces
140
Lymphangiosarcoma
malignant, after prolonged lymph obstruction w/ lymphedema
141
Lymphangiosarcoma is most common in
mastectomy pt
142
Lymphangiosarcoma Sx
small subcutaneous nodules, which later coalesce to form a large mass
