Vascular Pathology Part 1 - Dr. Hillard Flashcards
3 types of arteries
- Large Elastic
- Medium muscular
- small arterioles
vessel resistance is proportional to and inversely proportional to
proportional : L of vessel and Viscosity (n)
inverse proportional : radius^4
what vessel regulates BP
all the way down to arterioles
arteries vs veins made up of
arteries: thick muscular media and elastic (to hold high pressure
Veins : thin media and not that elastic + valves
Capillaries : no media
Arteriovenous malformation (AVM) what
abnormal connection from thick A to abnormal thick V
Arteriovenous malformation (AVM) location and look like
- head and neck usually
2. tangle of worm like vascular channels shunting blood away from A = increase heart pumping
Arteriovenous malformation (AVM) can cause
heart cant always keep up with extra pumping high CO = Cardiac failure
Arteriovenous malformation (AVM) result from and prevalence
congenital or trauma, or by surgery if chemo/hemodialysis access needed
= males, childhood or early adult . later in life
Arteriovenous malformation (AVM) SX
- GI bleed, pulm hemorrhage, hematuria, seizure, intracerebral hemorrhage
Berry Aneurysm (saccular) location
= circle of willis usually at anterior cerebral artery + anterior communicating A branch point
Berry Aneurysm (saccular) risks
HTN, smoking
Berry Aneurysm (saccular) associated with that
= AD polycyctic kidney disease
= CT disease like Marfans + Ehlers Danlos
Berry Aneurysm (saccular) sx
- severe worst headache of life, = (after rupure)
2. neck pain, double vision, loss of consciousness , V
most common cause of subarachnoid hemorrhage
Berry Aneurysm
Berry Aneurysm rupture associated with
straining during stools, sexual orgasms
Mycotic Aneurysm is what
dilation to A from infection damaging vessel wall
Mycotic Aneurysm from what
infection from usually :
= septic emboli (infective endocarditis)
= bacteria circulating , fungus
Fibromuscular Dysplasia is what
hyperplasia of muscular media and intima
= irregular thickening A , this causes outpouching of vascular not as thick areas
Fibromuscular Dysplasia imaging
angiography : beads on string
Fibromuscular Dysplasia prevalence
young women
Fibromuscular Dysplasia effects what locations
kidney renal arteries = renal artery stenosis = low BF = activated renin angiotensin
Fibromuscular Dysplasia ascultation
bruits from renal arteries
= heard on epigastric area to upper Qs and back
= from renal stenosis
BP =
BP = CO x Peripheral Resistance
CO =
CO = HR x SV
renin is released when 2
- low BP in afferent arterioles
2. low Na and distal convoluted tubules
ANP
released from myocytes in A and V = reduce BP
renin is released from
Afferent arterioles by juxtaglomerular cells
normal BP
120/ less then 80
3 things to prevent high BP
- exercise
- low salt intake
- lower weight
primary HTN prevalence
most common type and high in AA
secondary HTN 3 causes
- Cardiovasualr : coarctation of aorta
- Kidney : renal artery stenosis (fibromuscular dysplasia), polycystic kidney D)
- Endocrine : primary aldosteronism (Cushing, Phenochromocytoma)
primary hyperaldosteronism common sx
- high BP
2. muscle cramps, weakness, visual problems (low K+)
Cushing Syndrome happens from
high cortisol production from adrenal gland
= ACTH production (AP tumor) primary tumor
= or from lung tumor secreting ACTH
primary hyperaldosteronism what happens
- adenoma of the adrenal gland
- just hyperactive adrenal gland
= more aldosterone
Cushing Syndrome sx
- HTN
- round face, posterior neck and back and abd fat + hair
- abd striae and stretch marks
Pheochromocytoma is what
tumor of chromaffin cells in adrenal medulla (secreting catecholamines NE and Epi)
= peripheral vasoconstriction (a1 activation) and higher CO (B1 activation)
Pheochromocytoma sx
- HTN
- Tachy, pounding headache, tremor, diaphoresis
- paroxysms of high BP (random sudden)
- sleep problems
Pheochromocytoma mutation and looks like
MEN2
= golden brown tumor color
renal artery stenosis causes what and 2 causes of this
HTN due to high renin release from low renal BF
- fibromuscular dysplasia
- atherosclerosis
renal artery stenosis can cause what besides htn
= ischemia in kidney
= CKD
= increase Cr
coarctation of aorta does what and prevalence and association
- upper body HTN, lower body hypotension weak pulse
- is PDA = you have cyanosis in lower extr.
- bicuspid aorta , males
coarctation of aorta auscultation
bruits over back on occasion heard
other kidney diseases that can cause htn besides renal stenosis
- polycystic kidney
- pyelonephritis
= both can cause ischemia –> renin
HTN effect on heart and aorta
- LV hypertrophy (can also back up to lungs)
- CHF
- ischemic HD, MI (atherosclerosis)
- Aortic Dissection
= 1/2 of htn pts die from this
HTN on brain and eye
- dementia
- cerebrovascular hemorrhage/ stroke
- increased intracrainal P, papilledema
- Rentinopathy
Hyaline Arteriolosclerosis is what
changes in small arterioles = mild to moderate htn
Hyaline Arteriolosclerosis looks like
vessels contain prominent pink eosinophilic hyaline material
= trapped in SM matrix of BVs small
Hyaline Arteriolosclerosis happens due to what cause
- drugs like calcineurin inhibitors (T-cell immunosuppressor)
Hyaline Arteriolosclerosis can cause what eventually
ischemia : nephrosclerosis —-> ischemic glomerulosclerosis + htn
Hyaline Arteriolosclerosis hyaline material is made of what
precipitated plasma proteins (usually C3 complement)
Hypertensive Crisis / Malignant HTN is what
fast high HTN
= 180-200 / over 120
Hypertensive Crisis / Malignant HTN causes from and causes
- organ failure
- papilledema
necrotizing arteriolitis, renal failure, Acute MI
Hyperplastic arteriolosclerosis happens due to what
severe htn = thickening of the walls BM
Hyperplastic arteriolosclerosis looks like what
SM form concentric lamellations “onion skinning”
mild to moderate htn in asymptomatic pt : over years what happens to kidney
- hyaline arteriosclerosis : cortical scarring + thinning, shrinking kidney (PINK changes)
- later becomes end-stage organ damage = sx present
mild to moderate htn in asymptomatic pt : over years what happens to kidney
- hyaline arteriosclerosis** : cortical scarring + thinning, shrinking kidney (PINK changes)
- later becomes end-stage organ damage = sx present
severe htn / malignant htn changes in kidney effects
- petechial hemorrhages in kidney
2. hyperplastic arteriosclerosis** (onion skinning)
Myocardial vessel vasospasm is what
cardial Raynaud’s phenomenon
= can lead to MI from vasospasm
Myocardial vessel vasospasm causes 5
- cocaine (vascular contraction, vasospasm –> MI
- high catecholamines
- high thyroid (more catecholamine sensitivity)
- systemic scleroderma ABs
- Takotsubo cardiomyopathy (broken heart syndrome), elderly women
Varicose Veins are what
abnormal dilated, twisted veins, from prolonged high intraluminal P
= incompetence of venous valves + dilation of veins
Varicose Veins risks
stasis, edema, thrombosis (Rare)
= stasis dematitis (brown yellow shiny skin)
= pruritis
= infection, poor healing wounds
Portal htn from what causes
- venous htn
- cirrhosis
- hepatic V thrombosis or obstruction
Portal htn can lead to what
1 esophageal varices
- Splenomegaly
- Hemorrhoids
- Distended superficial epigastric veins (caput medusae)
Superior Vena Cava Syndrome caused by what
obstruction / compression of SVC usually by intrathoracic tumor
- bronchogenic lung carcinoma
- lymphoma (Hodgkins)
Superior Vena Cava Syndrome SX
- face, neck swelling
- SOB (pulm vessels compressed)
- WORSE with bending forward or laying down
- distended veins on neck or chest
- confusion / headaches
Inferior Vena Cava Syndrome happens from what
compression / obstruction of IVC
- HCC
- Renal cell carcinoma
Inferior Vena Cava Syndrome sx
- Lower EXR edema
2. distention of superficial collateral veins or lower abd
Thrombophlebitis is what
venous thrombosis from inflammation from clot formation
3 causes of paradoxical embolism
- ASD / VSD
- AVM
- PDA
risks DVT
- immobilization ** most high risk
2. hypercoagulation
hypercoagulation causes that increases thrombosis
- Factor V Leiden mutation
- Prothrombin mutation
- Mucin producing adenocarcinoma = procoag
- tumor procoag that appears at random and disappears then appears at different place = TROUSSEAU SIGN of Malignancy (pancreatic + lung carcinoma)
Lymphangitis is what
lymphatic channel inflammation from Group A B-hemolytic streptococcus
Lymphangitis looks like
red painful subQ streaks on skin
lymphadenopathy
= can pregress to cellulitis + Abscess with fever
Lymphedema is what
swelling from fluid buildup due to blocked lymphatics
Lymphedema cause
Primary : Milroy disease (Lymph agenesis)
Secondary : blockage (tumor, surgery, mastectomy, post radiation fibrosis), Peau d’orange = dimpling texture of skin when lymph drain will with tumor in breast cancer
Vascular Ectasias - Nevus Simplex
Birth mark in infants on forehead and eyelid, nose, upper lip, = regresses with time (ecstatic vessels)
Port wine stains
Nevus flammus , progressive ectasia
Persists into adulthood
More uncommon
Sturge Weber syndrome
Trigeminal nerve facial port wine nevi
= glaucoma, intellectual disability later,
= seizures , large facial talengetaia
= BV maturation, somatic tissue to not heritable
Spider Telangiectasia is what and location
Dilation of small BVs and caps,
= permanent
= lesion forming (red papule with red radial lines
= neck, face, upper chest
Spider Telangiectasia risks
High Estrogen (dilates BVs) = pregnancy and liver disease
Hereditary Hemorrhagic Telangiectasia other name and what is it
Osler- Weber - Rendu Disease
1. Abnormal BV formation causing Telangiectasia and AVM on skin, brain , bladder, GI (tongue, lips, face)
Osler- Weber - Rendu Disease mutation
TGF-B signaling pathway mutation
Hemangiomas is what and location
Being common child vascular tumor (increased BV proliferation)
= head and neck
= usually superficial
Congenital Hemangiomas other name and what is it
Strawberry Hemangiomas
= at birth
= capillary Hemangiomas, raised plaque, lobular well demarcated lobular BV collection
= grow fast few months then regress by 7yo
Internal Hemangiomas usually involve
Liver
Cavernous Hemangiomas is what
Large dial aged BVs
= deep tissues like Von Hippel - Lindau Disease , vascular lesions in brain, pancreas, liver, cerebellum, retina
=clotting blood looking, large cave like spaces full of blood
Pyogenic Granuloma other name and is what
Lobular Capillary hemangioma = fast BV proliferation = oral mucosa lips, mouth, fingers = can ulcerate SEEN IN PREGNANCY **** = lobulated proliferation of BV
Glomus Tumor from what and the function of this
Mesenchymal tumor of SM from glomus body (dermal structure taking blood away from skin surface when cold to prevent heat loss)
= thermoregulation
Glomus Tumor what happens and what it does sx
From SM origin benign
Under finger nail
Bluish tumor
Painful by tactile stimulation and temp changes
Lymphangioma simple is what
Capillary dilation with no Blood
Lymph benign neoplasm
Cavernous Lymphangioma is what
Neck or axillary , congenital malformation when lymphatics dont communicate with n=venous system
= large neck masses (up to 15cm) HUGE DILATED lymph spaces
= cystic hygroma (other name)
Cavernous Lymphangioma associated with
Turner syndrome and other development problems like trisomy 21, Klinefelter
Cavernous Lymphangioma tx
Surgery respect if possible
Bacillary Angiomatosis is what
Vascular proliferation from gram - BARTONELLA BACILLI
Bacillary Angiomatosis looks like and dx
- Being red papule lesions
2. Bacteria seen on silver stain
Bacillary Angiomatosis prevalence
Immunocompromised
Bacillary Angiomatosis tx
ABs
BARTONELLA henselae is from what
Cat scratch disease
Karposi Sarcoma is caused by what
HHV- 8
Karposi Sarcoma 4 types
- Classic Sporadic : lower extr. East Europe , Mediterranean, male
- Endemic : Africa, children , cutaneous involvement
- Iatrogenic : immunosuppressed
- AIDS associated : skin and mucous membranes and then to LNs
Karposi Sarcoma looks like
Macule patch ——> Red purple nodules and plaques on lower limbs, back, face, genitals
Angiosarcoma is what and involves what organ
Malignant tumor from vasculature
= liver
Angiosarcoma risk factors **
- arsenic (wood pesticide, agr. Pesticide) , Thorotrast, PVC production (Vinyl chloride) = effect liver
- Lymphedema : axillary mastectomy from breast cancer tx —> lymphangiosarcoma
- Radiation for Carcinoma
Angiosarcoma histology
Well to poor defined vascular spaces with BV lined by cytology Atypia (large endothelial cells and nuclei)
Angiosarcoma dx
Stain for CD31
Liver Angiosarcoma looks like
Dark red purple nodules on the liver surface
