Vascular Pathology Flashcards by Camelita Thrift

Consequences of hyperplastic arteriolsclerosis

Reduced vessel caliber with end organ ischemia

Fibrinoid necrosis of the vessel wall with hemorrhage

Acute renal failure with a characteristic ‘flea-bitten appearance

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When does an abdominal aortic aneurysm classically rupture?

When >5cm in diameter

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Why is artherosclerosis not common in pre-menopausal females?

Estrogen is protective

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Granulomatous vasculitis that classically involves the aortic arch at branch points

Takayasu Arteritis

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What is the classical appearance of the thoracic aneurysm?

“Tree bark” appearance

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What is the most common cause of aortic dissection?

Hypertension

*Also associated with inherited defects of connective tissue in younger individuals

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Complications of thoracic aneurysm

Dilation of the aortic valve root, resulting aortic valve insufficiency (major)

Compression of mediastinal structures

Thrombosis/embolism

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Complications of atherosclerosis

Impaired blood flow and ischemia:
- Peripheral vascular disease
- Angina
- Ischemic bowel disease
Plaque rupture with thrombosis results in MI and stroke
Plaque rupture with embolization results in artherosclerotic emboli
Weaking of vessel wall results in aneurysm

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Necrotizing granulomatous vasculities involving nasopharynx, lungs, and kidneys

Wegener Granulomatosis

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What is an angiosarcoma?

Malignant proliferation of endothelial cells; highly agressive

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Classic demographic for takayasu arteritis

<50

young asian females

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Necrotizing granulomatous inflammation with eosinophils involving multiple organs, especially lungs and heart

Chrug-Strauss Syndrome

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What is the pathology by which hypertension leads to aortic dissection?

Hypertension results in hyaline arteriolosclerosis of the vasa vasorum. Decreased flow causes atrophy of the media

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How does polyarteritis nodosa present?

Hypertension

Abdominal pain with melena

Neurologic disturbances

Skin lesions

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Takayasu Arteritis treatment

Corticosteriods

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You have to have greater than _________ stenosis before you see complications.

70%

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Low-grade malignant proliferation of endothelial cells

Kaposi Sarcoma

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How does takayau arteritis present?

Visual and neurologic symptoms with a weak or absent pulse in the upper extremity

ESR is elevated

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How does temporal arteritis present?

Headache (due to temporal artery involvement)

jaw claudication

Visual disturbances (due to opthalmic artery)

Flu-symptoms with joint and muscle pain (polymyaligia rheumatica)

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Initimal plaque that obstructs blood flow

Atherosclerosis

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__________ hypertension is due to an unknown etiology, while ________ hypertension is due to an identifiable etiolgy.

Primary; secondary

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Causes of renal artery stenosis

Artherosclerosis (elderly males)

Fibromuscular dysplasis (young females)

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Intimal tear with dissection of blood through media of the aortic wall

Aortic dissection

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Pathogenesis of thoracic aneurysm

Endarteritis of the vasa vasurum results in luminal narrowing, decreased flow, and atrophy of the vessel

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Classic demographic of abdominal aortic dissection

Male smokers \>60 yrs with HTN

In conditions is thoracic aneurysm classically seen?

Tertiary syphillis

How is Wegener Granulomatosis treated?

Cyclophosphamide Steroids

How does an abdominal aortic aneurysm present?

Pulsatile abdominal mass that grows with time

Which artery is involved in kawasaki disease?

Coronary artery, which leads to risk for thrombosis with MI and aneurysm rupture

Hyperpastic arteriolosclerosis is a consequence of \_\_\_\_\_\_\_\_\_\_.

Malignant hypertension

Modificable risk factors for artherosclerosis

HTN Hypercholesterolemia (LDL increase, HDL decreases) Smoking Diabetes

Which vasculitis is associated with serum HBsAg?

Polyarteritis nodosa

3 pathologic patterns of arteriosclerosis

Atherosclerosis Arteriolosclerosis Monckeberg medial calcific sclerosis

Demographic for kawasaki disease

Asian children \<4 yrs

Hyaline arteriolosclerosis is the consequence of ...

Long standing benign hypertension or diabetes

What is the hematuria seen in Wegener granulomatosis due to?

Rapidly progressive glomerulonephritis

String of pearls

Polyarteritis nodosa

Henoch-Schonlein Purpura is a vasculitis due to ____ immune complex deposition.

Henoch Schonlein Purpura

Complications of aortic dissection

* Pericardial tamponade * Rupture with fatal hemorrhage * Obstruction of branching arteries with resultant end-organ ischemia

Pathogenesis of artherosclerosis

* Damage to endothelium allows lipids to leak into the intima * Lipids are oxidized and then consumed by macrophages via scavenger receptors , resulting in foam cells * Inflammation and healing leads to deposition of extracellular matrix and proliferation of smooth muscle

What is the cause of the hematuria seen in Henoch-Schonlein Purpura?

IgA nephropathy

What is the characteristic appearance of acute renal failure due to hyperplastic arteriolosclerosis?

Flea-bitten

When does Henoch-Schonlein purpura typically occur?

Following an upper respiratory tract infection

Most common organs impacted by hemangioma

Skin and liver

Where does an abdominal aortic aneurysm usually arise?

Below the renal arteries, but above the aortic bifurcation

How does Henoch-Schonlein Purpura presnt?

Palpable purpura on buttocks and legs GI pain and bleeding Hematuria

Ballon-like dilation of the thoracic aorta

Thoracic aneurysm

How does malignant hypertension present?

Acute end-organ damage

Necrotizing vasculitis involving multiple organs

Polyarteritis nodosa

Which arteries are usually affected by artherosclerosis?

Large and medium sized arteries * Abdominal aorta * Coronary artery * Popliteal artery * Internal carotid artery

\_\_\_\_\_\_\_\_\_\_\_\_\_\_ arteriolosclerosis involves thickening of vessel wall by hyperplasia of smooth muscle.

Hyperplastic

Histo of polyarteritis nodosa?

Early * Transmural inflammation with fibrinoid necrosis Late * Healing results in fibrosis producing a "string of pearls" apperance on imaging

Pathology by atherosclerosis results in abdominal aortic aneurysm

Athreosclerosis increases the diffusion barrier to the media, resulting in atrophy and weakness of the vessel wall

Necrotizing vasculitis involving the digits?

Buerger Disease

Complications of abdominal aortic aneurysm

Rupture Compression of local structures Thrombosis/embolism

Where does an aortic dissection typically occur?

In the proximal 10 cm of the aorta with pre-existing weakness of the media

Which arteries are involved in polyarteritis nodosa?

Renal Abdominal

How is temporal arteritis treated?

Corticosteroids \*High risk of blindness if not treated

Morphologic stages of atherosclerosis

* begins as fatty streaks (fatty yellow lesions of the intima consisting of lipid-laden macrophages * Progresses to atherosclerotic plaque

Which organs are spared in polyarteritis nodosa?

Lungs

Why does a negative biopsy not exculde temporal arteritis?

Lesions are segment. Diagnosis requires biopsy of a long segment of vessel.

Characteristic of atherosclerotic emboli

Cholesterol crystals with in the embolus

Liver angiosarcoma is associated with exposure to what substances?

Polyvinyl chloride Arsenic Thorortrast

Common sites of angiosarcoma

Skin, breat, and liver

Treatment for Buerger Disease

Smoking cessation

How does a ruptured abdominal aortic aneurysm present?

Hypotension Pulsatile abdominal mass Flank pain

Components of intimal plaque seen in atherosclerosis

Consists of a necrotic lipid core (mostly cholesterol) with a fibromuscular cap \*often undergoes dystrophic calcification

Consquences of hylaine arteriolosclerosis

Reduced vessel caliber with end-organ ischemia Glomerular scarring that slowly progresses to chronic renal failure

What genetics conditions are related to aortic dissection and by what mechanism?

Marfan syndrome and Ehlers-Danlos syndrome classically lead to weakness of the connective tissue in the media (cystic medial necrosis)

How does Wegener Granulomatosis presnt?

* Middle aged male with sinusitis or nasopharyngeal ulceration * Hemoptysis with bilateral nodular lung inflitrates * Hematuria

Abdominal aortic aneurysm is primary due to \_\_\_\_\_\_\_\_\_\_\_\_\_.

Artherosclerosis

How does buerger disease present?

Ulceration Gangrene Autoamputation of fingers and toes Raynaud phenomenon

Microscopic polyangiitis presents similar to wegener granulomatosis. How does it differ?

No nasopharyngeal involvement Granulomas are absent p-ANCA

Most common vasculitis in children

Henoch-Schonlein Purpura

What lung condition is often associated with churg-strauss syndrome?

Asthma

How is Henoch-Scholein Purpura treated?

Disease is self-limited, but may recur; treated with steroids, if severe

Common demographic for temporal arteritis

Females \>50

How does renal artery stenosis result in secondary HTN?

1. Stenosis decreases blood flow to glomerulus 2. Juxtaglomerular apparatus responds by secreting renin, which converts angiotension to angiotension II 3. ATII raised blood pressure by contracting smooth musclem increasing total peripheral resistance and promting adrenal release of aldosterone, which increases resorption of sodium in the distal convuluted tubule (expanding plasma volume)

Temporal (giant cell) arteritis is a granulomatous vasculitis that classically involves branches of the _______ artery.

Carotid

How does aortic dissection present?

Presents as sharp, tearing chest pain that radiates to the back

How is polyarteritis nodosa treated?

Cyclophosphamide Corticosteriods

\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is a developmental defect of the blood vessel wall, resulting in irregular thickening of large and emdium-sized arteries, especially the renal artery.

Fibromucular dysplasia

How is Kawasaki treated?

Aspirin and IVIG

Calcification of the media of muscular arteries; non obstructive

Monkerberg Medial Calcific Sclerosis

Cause of hyaline arteriolosclerosis

Proteins leaking into the vessel wall, producing vascular thickening