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vascular Pathology Flashcards

0
Q

Response of vascular smooth muscle to injury (minor and major)

A
  • in minor injuries: adjacent endothelial cells migrate to restor luminal surface
  • in major injuries: smooth muscle is stimulated to migrate to intima (bad) and create collagen (worse)
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1
Q

Review:

  • inter-endothelial attachment protein
  • expressed in HEVs for niece Tcell attachment
  • binds integrins for stable adhesion
A
  • CD31
  • CD34
  • CD54
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2
Q

Stenosis outcomes

A
  • chronic ischemia
  • rupture -> thrombus
  • complete progressive occlusion
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3
Q

5 leading Causes of death in 2010

A 
1 heart disease 
2 malignant neoplasms 
3 chronic lower resp diseases
4 Cerebrovascular disease 
5 accidents
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4
Q

Clinically significant stages of atherosclerosis

A
  • fiberoatheroma (lipid core with fibrotic layer): stage IV

- complicated lesion with surface defect and adherent hematoma or thrombosis: stage V

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5
Q

Plaque structure

A
  • cells (smooth muscle cells, foam cells, lymphocytes)
  • matrix
  • lipid (in necrotic core)
  • neovascularization
  • important: media is thinned at base of plaque: rupture/ulceration significant risk
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6
Q

Preclinical stage

A
  • Generally 40-50 yearsish. Silent until age related comorbidities show up
  • exception: familial hypercholesterolemia and TIIDM
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7
Q

Diagnosis of atherosclerosis

A
  • angiography is gold standard

- one clear artery doesn’t guarantee another (patchy)

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8
Q

Tissue ischemia in atherosclerosis

A
  • may be direct occlusion
  • may also be decreased Plat in collateral vessels
  • lower ext gangrenous ulcers and bowel ischemia are common presentations of mesenteries and LEx atherosclerosis
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9
Q

Risk factors for MandM in atherosclerosis

A
  • synergistic

- HTN, cholesterol LDL/HDL ratio, smoking male, genetics

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10
Q

Heterozygous familial hypercholesterolemia

A
  • LDL receptor mutation: LDL>220 Mg/dL

- 1:500

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11
Q

Familial defective apoprotein B

A
  • Apo B 100

- 1:700

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12
Q

Familial combined hyperlipidemia

A
  • unknown etiology
  • LDL and trigs elevated
  • HD! Suppressed
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13
Q

Inflammatory conditions effecting development if atherosclerosis

A
  • high CRP
  • homocysteine (B12 deficiency)
  • lipoprotein LPa
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14
Q

Berry aneurysm

- incidence, location, rupture risk, clinical sequela

A
  • 2 %
  • 90% are in MCA/ACA near branch points
  • Marfan and Ehlers danlos at increased risk for rupture
  • results in subarachnoid hemorrhage
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15
Q

Fibromuscular dysplasia

A
  • Segmental lesions affecting renal, carotid, splanchnic, vertebral
  • renovascular HTN: decreased afferent pressure -> JG cells -> renin release
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16
Q

Etiology of HTN

A
  • 90% essential: unknown
  • secondary: renal lesions most common (glomerulonephritis, renal artery stenosis et al)
    > CV: coarctation of aorta, poly arteritis nodosa
    > endocrine
    > Neuro: increased ICP
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17
Q

Hyaline arteriolesclerosis

A
  • thickening of media and intima by hyaline material in HTN

- sequelae: diffuse renal ischemia, worsening HTN

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18
Q

True vs. false aneurysm

A
  • true aneurysm has all three walls dilated

- false aneurysm has had the media and the intima separated

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19
Q

Cystic media degeneration

A
  • ischemic degeneration of medial layer of aorta due to stenosis of vaso vasorum
  • risk factor for AAA
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20
Q

Thoracic aortic aneurysm etiology and sequelae

A
  • rare
  • most are HTN in origin
  • infectious etiology: syphillis
  • sequelae: encroachment on esophagus, lungs, mediastinum, bones; aortic valvular insufficiency with LVH, coronary artery obstruction, rupture (uncommon)
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21
Q

Aortic aneurysms

A

Class A: surgical emergency
- proximal to descending aorta
Class B: distal to arch

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22
Q

Raynaud’s phenom vs disease

A
  • disease is primary, less severe, presents younger and essentially an exaggerated vasomotor response
  • phenomena is typically secondary to disease process (arterial stenosis) presents in more variable age group,
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23
Q

Vasculitis

A
  • rarely infectious, typically immune mediated
  • large: GTA (giant cell, takayasu’s, the other one)
  • medium: PK (polyarteritis nodosa, kawasakis)
  • small: Good Small White CHurch (goodpastures, SLE vasc, Wegeners, Churg-Strauss)
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24
Polyarteritis nodosa
- NO LUNG involvement (pan no pulm) - obliterated arterial lumen, trans mural neutrophils - transmural necrotizing inflammation of muscular arteries (sans lung) - on continuous inflammation (esp bifurcations) - microaneurysms, ischemia with ulceration, hemorrhage with necrosis and infarct
25
Kawasakis disease
- aka mucocutanious lymphnode syndrome - PAN-like arteritis of medium vessels in young kids > mucocutaneous erythema, palmar and pedal erythema, desquamation - autoantibodies against smooth muscle - cardiac sequelae most significant pathology (rare)
26
Cardiac sequelae of Kawasakis etiology and treatment
- coronary vasculitis - coronary aneurysms (large) - fatal in ~ 1% - epidemic in Japan and Hawaii, but #1 acquired heart diseas in kids in us - Aspirin and IVIG
27
Wegeners granulomatosis (it's a klr)
- classic triad: upper resp lesions, lung lesions (necrotizing capsulitis) kidney lesions - all three together are uncommon presentation clinically
28
Infectious arteritis
- bacteria or fungi esp. Aspergillus and mu or (angioinvasive) - infarction and aneurysm rupture
29
Varicose veins
- pathenogenesis: venous stasis - can be painful, unsightly - pulmonary emboli rare (only 1 of three in virchows) - varices in esophagus and anorectal junction due to portal HTN
30
Phlebothrmbitis (thrombophlebitis)
- not an inflammatory state, thrombosis within vein - immobilization with inactivity - Vircows triad: venous stasis, endothelial injury, hypercoagulable state - most originate in deep leg veins
31
Clinical manifestations of thrombophlebitis
- few signs of early disease - first symptom often embolus - leg edema, redness, pain - Homan sign: pain in popliteus upon abrupt dorsiflexion
32
Pulmonary thromboembolus
- # 1 cause of sudden death in post op PTs - lines of Zahn in antemortem clots - can be visualized in ventilation/perfusion scan
33
SVC/ IVC syndrome
- 90% neoplasm, 10% thrombosis - facial edema, dilated head/neck veins (SVC) - leg edema, distention of superficial abdomen, if renal veins effected massive proteinuria > hepatocellular and renal cell CA
34
Lymphangiitis
- typically GAStrep - inflammation along lymphatic drainage pathway - bacteremia -> sepsis; monitor closely
35
Lymphadema
- primary is rare, defects in lymph drainage, or agenesis | - secondary much more common: inflammation or cancer
36
Weird complication of large hemangioma
- high output cardiac failure | - don't remove heagioma unless necessary
37
Vascular ectasias
- talengectasia | - osler-weber-rendu disease: talengectasias of mouth and tongue; risk of lethal intestinal bleed
38
Bacillary angiomatosis
- opportunistic infection presenting as vascular proliferations of blood vessels - Infection typically GNBac (often Bartonella)
39
Vascular tumors: intermediate grade and malignant
``` - intermediate: > kaposis sarcoma (assoc with HIV and HHV8) coalescing patches and plaques > hemagioendothelioma - malignant: > angiosarcoma > hemangiopericericytoma ```
40
Arterioloslerosis
- similar to atherosclerosis but generally localized t heart and kidneys
41
Boot shaped heart with | - overriding aorta, VSD, pulmonary stenosis r vent hypertrophy
- tetralogy of fallot - untreated 30 year survival is ~ 10% - right to left shunting
42
Neonat with lower body cyanosis
- coarctation of the aorta
43
Pulmonary atresia/stenosis
- results in post-stenotic pulmonary dilation
44
Circumferential infarct
- subendocardial infarction | > can be due to global hypoperfusion in presence of reduced atherosclerotic vessels
45
Kerley B lines on roentgenogram
- represent pulmonary edema (vascular and interstitial) | - especially in interlobar speta
46
Panners don't mine for gold so polyart nod doesn't involve lung. Wegener is the coal miner
,
47
Osler-Weber-Rendu disease
Oropharyngeal Talengectasias | - potentially lethal GI bleeds
48
C-ANCA/P-ANCA
- C-ANCA: Wegeners | - P-ANCA: microscopic polyangiitis, Churg-Strauss
49
Anti-endothelial cell Abs
Associated with kawasakis
50
Pulseless (weakened pulse in UEX), similar to giant cell arteritis except pathology in aorta
Takayasu's | - more common in japanese
51
Hypersensitivity type as units of small/medium blood vessels, hemoptysis, hematuria, muscle pain/weakness, palpable cutaneous purpura
Microscopic polyangiitis | - fragmenting neutrophils: leukocytoklastic vasculitis
52
Allergic symptoms with eosinophilic rhinitis
- Churg- Strauss | - ANCAs probably responsible for vascular manifestation
53
Beurgers disease (thromboangiitis obliterans)
- smokers - cold sensitivity, raynauds, chronic ulcers in fingers toes, feet - stop smoking
54
Most common infectious vasculitis
- mucor/aspergillus
55
Most common vascular tumor
- hemangioma (capillary variant)
56
Pedunclulated rapidly growing hemangioma
- pyogenic granulomas | - can occur in pregnant women
57
Exquisitly painful benign tumor typically under finger nail bed
Glomus tumor | - excision is curative
58
Large facial vasicular lesion in presence of mental deficiency
- Sturge-Weber syndrome
59
kaposis sarcoma variants (4)
- KS preceded by HHV8 (requires a cofactor to progress as a tumor) - chronic: Eastern European men, NOT assoc with HIV - Lymph: African variant NOT assoc with HIV - transplant assoc is aggressive: not assoc with HIV (immunosuppressive) - AIDS assoc IS assoc with AIDS
60
Malignant tumor arising due to exposure to arsenic, radiation or PVC
- angiosarcoma
61
Fragmented neutrophils
- microscopic angiitis
62
Munkeyburg phenomena
- benign calcification of media of arteries not constricting flow. Show up on x ray

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