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pathoma > Vascular Pathology > Flashcards

Vascular Pathology Flashcards

1
Q

Arterial wall structure

A
  1. intima (innermost - endothelial on a basement membrane)
  2. Media - smooth muscle
  3. Adventita - CT
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2
Q

Large vessel vaculitis involve what?

A

Aorta and it’s branches

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3
Q

Temporal (Giant cell artertis)

A

> 50, carotid
females
granulomatous

HA - temporal
Visual disturbances (ophthalmic)
Jaw claudication
Flu like symptoms (joint/muscle pain) - aka polymyalgia rheumatica

ERS elevated

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4
Q

Biopsy of Temporal arteritis

A

inflammed vessel wall w/ giant cells & intimal fibrosis

Granulomatous vasculitis - firbosis narrows lumen and increases distance between intima and media

Lesions are segmental

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5
Q

Takayasu Arteritis

A
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6
Q

Large vessel vasculitis

A

Temporal arteritis

Takayasu arteritis

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7
Q

Medium vessel vasculitis

A

involve muscular arteries that supply organs

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8
Q

Polyarteritis nodosa

A

Necrotizing vasculitis - young adult
Spares Lungs
Involves most organs

HTN - renal a
Abd pain w/ melena (mesenteric a)
Neurologic disturbances
Skin lesions
**Associated with serum HBsAg** - HB surface antigen
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9
Q

What does the vessel look like in Polyarteritis nodosa?

A

Lesions in varying stage - “string of pearls” from fibriniod necrosis

alternating aneurysm and fibrosis

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10
Q

Tx of Polyarteritis nodosa

A

Corticosteroids and cyclophosphamide

Fatal if not treated!

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11
Q

Kawasaki Dz

A

Asian children

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12
Q

TX of Kawasaki DZ

A

ASA & IVIG

ASA blocks COX - so no TXA2 - preventing thombosis

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13
Q

Buerger DZ

A

SMOKING!
Necrotizing vasculitis involving digits
Ulceration, gangrene - autoamputation of fingers/toes
Raynaud often present

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14
Q

Small vessel vasculitis

A

Arterioles, capillaries, venules

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15
Q

Wegener granulomatosis

A

Necrotizing granulomatous vasculitis
Nasopharynx, lungs, kidney

“wecener” - Man with C going through him - nose, lungs, kidney
c-ANCA
Key tx: cyclophosphamide

Sinusitis, nasopharyngeal ulceration
Hemoptysis w/ bilateral nodular lung infiltrates
Hematuria d/t RPGN

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16
Q

Microscopic polyangiitis

A

Necrotizing vasculitis - multiple organs - espc lung/kidney
No nasopharyngeal/granulomas
p-ANCA

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17
Q

Microscopic polyangiitis tx

A

corticosteroids and cyclophosphamide

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18
Q

Churg Strauss Syndrome

A

Necrotizing granulomatous vasculitis w/ eosinophils
Multiple organs - espc lungs/heart
Asthma & peripheral eosinophilia
p-ANCA

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19
Q

HSP - Henoch Schonlein Purpura

A

Vasculitis d/t IgA immune complex deposition
Most common vasculitis in children

Palpaple purpura on buttocks/legs
GI pain/bleeding
Hematuria (IgA nephropathy - IgA in mesagnium)
After URI (develop IgA)

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20
Q

HSP - Henoch Schonlein Purpura Tx

A

Steroids

21
Q

Common cause of secondary HTN:

A

renal artery stenosis - decreases blood flow to glomerulus - JGA secretes renin … ATII contracts arteriolar SM increase TPR and promotes adrenal release of aldosterone

22
Q

2 causes renal artery stenosis
Men
Women

A

Old men: atherosclerosis

Young women: fibromuscular dysplasia - irregular thickening of BV wall

23
Q

Malignant HTN

A

> 180/120
May arise from pre-existing benign HTN or de novo

Acute end organ damage: acute renal failure, HA, papilledema

24
Q

Three patterns of arteriosclerosis

A

Atherosclerosis (Intima thickening - medium/large vessels)
Arteriolosclerosis - small vessels - hyaline/hyperplastic
Monckenberg medial sclerosis - media of muscular (medium sized arteries - calcification)

25
Q

Atherosclerosis

A

Intimal plaque - most on necrotic lipid core with fibromuscular core
Commonly calcified

26
Q

Atherosclerosis pathogenesis

A

Damage to endotheiium allows lipids to leak into intima
Lipids oxidized and consumed by macrophages (foam cells)
Inflammation/healing = deposition of ECM and proliferation of SM

27
Q

Common complications of atherosclerosis: impaired blood flow & ischemia

A

Peripheral vascular DZ
Angina (coronary artery)
Ischemic bowel Dz (mesenteric a)

28
Q

Common complications of atherosclerosis: plaque rupture with thombosis

A

MI

Stroke (MCA)

29
Q

Common complications of atherosclerosis: plaque rupture with emobolization

A

atherosclerotic emboli

- characterized by cholesterol clefts

30
Q

Common complications of atherosclerosis: weakening of vessel wall

A

Aneurysm

Wall becomes weak/atrophic - so allows ballooning of wall

31
Q

Arteriolosclerosis

A

Narrowing of small arterioles

Hyaline and Hyperplastic types

32
Q

Arteriolosclerosis: hyaline

A

Protein leak into vessel wall - vacular thicking
Pink Hyaline on microscopy

  1. Benign HTN
  2. Diabetics (nonenzyme glycosylation)

End organ ischemia

  1. glomerular scarring
  2. progresses to CRF
33
Q

Arteriolosclerosis: hyperplastic

A

thickening of vessel wall by hyperplasia of SM
“onion skin”
reduce lumen

  1. Malignant hypertension

Results in end organ ischemia
May lead to fibrinoid necrosis of vessel wall

Acute renal failure w/ flea bitten appearance

34
Q

Monckenberg Medial Calcific Sclerosis

A

Calcification of media
Non-obstructive
Incidental finding
Doesn’t alter lumenal caliber

35
Q

Aortic dissection

A

intimal tear w/ dissection of blood thru media and aortic wall

36
Q

Aortic dissection requires 2 things

A

Lots of stress - proximal 10 cm of the aorta (right off the heart)
Pre-existing weakness of media - HTN

Also associated with CT defects

37
Q

Proximal 10 cm of aorta - very thick - so O2 diffusion not sufficient - what supplies adventita

A

Vaso vasorum

HTN - hyaline arteriolosclerosis - decreasing blood flow to the adventita - so atrophy SM allowing weaking of media so dissection can occur

38
Q

Major complication of aortic dissection

A

Pericardial tamponade

39
Q

Aneurysm:

A

balloon like dilation of blood vessel wall

  1. thorax
  2. abdomen

Only way to get one: need weakness in aortic wall

40
Q

Thoracic aneurysm

A

Tertiary syphilis

Tree bark appearance of aorta - endarteritis of vaso vasorum

41
Q

Complication of Thoracic aneurysm

A

dilation of aortic valve root w/ insufficiency - results in aortic insufficiency

Compression of mediastinal structures
Thrombosis/embolism

42
Q

Abdominal aortic aneurysm

A

Below renal arteries but above aortic bifurcation

Male smokers >60 w/ HTN
Weakness d/t atherosclerosis

Atrophy of wall leading to weakness d/t lack of O2 diffusion blocked by atherosclerosis

43
Q

Presentation of AAA

A

pulsatile abd mass

Grows with time

44
Q

Major comlication of AAA

A

rupture >5 cm

Triad: Hypotension, pulsatile abd mass, flank pain

45
Q

Hemangioma

A

Benign tumor of BV
Often regresses during childhood

Skin/liver

46
Q

Angiosarcoma

A

Malignant proliferation of endothelial cells (line BV), highly aggressive

Liver angiosarcoma associated with PVC, arsenic, throrotrast

47
Q

Kaposi sarcoma

A

HHV-8

Low grade malignant proliferation of endothelial cells
Purple patches, plaques, nodules on skin

48
Q

Kaposi sarcoma seen in

A
  1. Older eastern european males
  2. AIDS
  3. transplant recipients

pathoma (12 decks)

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