Vascular Pathology Flashcards
Most cases of vasculitis are
Not infectious
Large vessel vasculitis include
Temporal giant cell arteritis
Takayasu arteritis
Temporal giant cell arteritis
Most common form of vasculitis in older adults (>50) , usually affect females
Temporal giant cell arteritis symptoms with
Carotid artery branches affection
Headache (temporal) Visual disturbance (ophthalmic ) Jaw Claudication Flu-like symptoms ESR is elevated
Temporal giant cell arteritis treatment
Corticosteroids
There is high risk of blindness without treatment of
Temporal giant cell arteritis
Takayasu arteritis present in
Adults <50 years old
Takayasu arteritis symptoms with affection aortic arch at branch point
Visual and neurologic symptoms
Weak or absent pulse in upper extremity “pulseless disease”
ESR is elevated
Polyarteritis nodosa
Necrotizing vasculitis
Involve most organs
***Lungs are spared
Polyarteritis nodosa present in young adults with symptoms of
Hypertension (renal artery)
Abdominal pain and melena (mesentric artery )
Neurologic disturbance
Skin lesions
Polyarteritis nodosa associated with
Serum HBsAg
In polyarteritis nodosa , lesions of varying stage are present result in
*****String of pearls appearance on imaging
Kawasaki disease classically affects
Asian children <4 years
Coronary artery involvement is common with
Kawasaki disease
Thrombosis with MI , aneurysm with rupture
Kawasaki disease present with
Fever
Conjunctivitis
Erythematous rash of palms and soles
Enlarged cervical lymph nodes
Buerger disease highly associated with
Smoking
Buerger disease
.Necrotizing vasculitis involving digits
.Present with ulceration , gangrene and autoamputation of fingers and toes
.Ranaud phenomenon often present
Medium vessel vasculitis include
Polyarteritis nodosa
Kawasaki disease
Buerger disease
Takayasu arteritis treatment
Corticosteroids
Wegener granulomatosis
Necrotizing granulomatous vasculitis involving nasopharynx ,lungs and kidney
Wegener granulomatosis present with
Sinusitis and nasopharyngeal ulceration
Hemoptysis and bilateral nodular lung infeltrate
Hematuria due RPGN
Serum c-ANCA correlate with disease activity
WG present in
Middle aged males
Microscopic polyangiitis similar to WG but ……………. and ……………. are absent
Nasopharyngeal involvement , granuloma
Serum p-ANCA level correlate with
Microscopic polyangiitis activity and churg Strauss syndrome
Churg Strauss syndrome
Necrotizing ***granulomatous vasculitis with eosinophils
Present with **Asthma and **peripheral eosinophilia
HSP
Vasculitis due to IgA immune complex deposition
Most common vasculitis in children is
HSP
HSP present with
Palpable purpura on buttock and legs
**Hematuria (IgA nephrolathy)
HSP usually occur after
Upper respiratory tract infection
Systemic hypertension defined as
> 140/90 mmHg
Primary HTN due to
Unknown etiology (95% of cases)
Primary HTN risk factors
Age Race Obesity Stress Lack of physical exercise High salt diet
In Renal artery stenosis there is
Increased plasma renin
Unilateral atrophy of affected kidney
Important causes of renal artery stenosis
- Ahtherosclerosis (in elderly males)
2. Fibromuscular dysplasia ( in young females)
Benign HTN
Mild or moderate elevation in blood pressure
Classically silent , vessels and organs are damaged over time
Malignant HTN definition
Severe elevation in BP (>200/120)
May arise from preexisting benign HTN or de novo
Malignant HTN present with acute organ damage as :
.Acute renal failure , headache and papilledema
.Medical emergency
Three pathological pattern of arteriosclerosis
Atherosclerosis
Arteriolosclerosis
Monckeyberg medial sclerosis
Atherosclerosis is
Intimate plaque that obstruct the blood flow
Modifiable risk factors of atherosclerosis
HTN
Hypercholesterolemia
Smoking
Diabetes
Nonmodifiable risk factors of atherosclerosis
Age
Gender
Genetics
Complications of stenosis medium sized vessels
Peripheral vascular disease (popliteal a.)
Angina (coronary a.)
Ischemic bowel disease (mesenteric a.)
Complication of plaque raputure with thrombosis
MI (coronary a.)
Stroke (middle cerebral a.)
Complications of atherosclerosis
Stenosis
Plaque raputure with thrombosis
Plaque raputure with embolisation
Weaking of vessel wall (aneurysm )
Arteriolosclerosis types
Hyaline and hyperplastic
Hyaline arteriolosclerosis caused by
Leakage of protein into the vessel wall
*****Hyaline arteriolosclerosis seen in
Benign HTN
Diabetes
Hyaline arteriolosclerosis classically produce
Glomerular scaring (arteriolonephrosclerosis) Progress to chronic renal failure
Hyperplastic arteriolosclerosis show
Onion skin appearance
Hyperplastic arteriolosclerosis seen with
Malignant HTN
Hyperplastic arteriolosclerosis classically causes
Acute renal failure with flea bitten appearance
May lead to fibrinoid necrosis of the vessel wall
Hyperplastic arteriolosclerosis
Monckeyberg medial calcific sclerosis
Classification of the media , non-obstructive
Aortic dissection definition
Intimal tear with dissection of blood through the media of aortic wall
Aortic dissection occurs in
The proximal 10cm of the aorta with preexisting weakness of the media
Causes of Aortic dissection
HTN (most common cause)
Inherited defects of connective tissue
Aortic dissection present with
Sharp tearing chest pain radiate to the back
Aortic dissection complication is
Pericardial tamponade (most common cause of death)
Thoracic aneurysm is
Ballon-like dilation of the thoracic aorta
Due to weakness in the aortic wall
Thoracic aneurysm classically seen in
Tertiary syphilis (result in tree-bark appearance of aorta)
Complications of thoracic aneurysm
- Dilation of aortic valve root result in aortic insufficiency
- Compression of mediastinal structures
- Thrombosis/embolism
AAA (Abdominal aortic aneurysm) usually occur at
***** below the renal arteries but above the aortic bifurcation
AAA primarily due to
Atherosclerosis (classically seen in male smokers >60yrs old with HTN)
AAA presentation
.Pulsatile abdominal mass
.Grows with time
Major complication of AAA is
Rupture , especially when >5cm in diameter
AAA rupture present with triad of
Hypotension , pulsatile abdominal mass and flank pain
