Vasculitis (Collagen diseases of arteries) - 39

Question 1

1-Polyarteritis nodosa

Answer 1

Collagen disease affecting medium sized and small

arteries. The disease is more common in males.

Question 2

Pathology Of Polyarteritis nodosa

Answer 2

a) The arteries mainly affected are those of kidney,
heart liver, gastrointestinal tract and brain.
b) Grossly, the affected artery show multiple gray to
red nodular swellings 2-4 mm in diameter along its course.
c) microscopically, the media show fibrinoid necrosis and the arterial wall is
infiltrated by leucocytes and eosinophils. Healing occur by fibrosis resulting in
weakness of wall and formation of small mycotic aneurysms.

Question 3

Effects Of Polyarteritis nodosa

Answer 3

a)Thrombosis of the arteries causing infarcts b)Rupture of the aneurysms
causes hemorrhage.

Question 4

2) Systemic lupus erythematosus

Answer 4

A diffuse collagen disease mainly affecting females and has fatal end. :

Question 5

Pathology of SLE

Answer 5

MWAF
a) Fibrinoid necrosis: Affect small arteries , arterioles ,serous membranes and
joint capsules.
b)Wire loop glomerulonephritis: That cause renal failure.
c)Atypical verrucous endocarditis (Libman- sacks endocarditis): multiple small
adherent vegetations affect surfaces of mitral and tricuspid valves.
d)Maculopapular skin rash : has butter-fly appearance and affects the face , hands
and feet.
Many of the above lesions contain basophilic stained masses “Haematoxylin
bodies” . They are composed of nuclear material

Question 6

3. Thromboangitis obliterans (Burger’s disease)

Answer 6

segmental inflammatory condition of arteries and veins , with
thrombosis , organization and recanalization of the affected vessels. It affects
vessels of the lower limbs and sometimes upper limbs.
_ Aetiology: Not certain , but it occurs in heavy smokers

Question 7

Pathology of Thromboangitis obliterans (Burger’s Disease)

Answer 7

Early the affected vessel show thrombosis with perivascular tissue
show acute inflammation. Next the inflammation become chronic with fibrosis and
the thrombus show organization and canalization.
Effects: 1)Ischemia causing intermittent claudicating pain
2) Gangrene of the lower limb.

Question 8

Aneurysm

Answer 8

Localized dilatation of the wall of an artery or the heart.
Etiology: weakness of the vascular wall due to
connective tissue or smooth muscle abnormality

Question 9

Causes of aneurysm

Answer 9

Atherosclerosis: cause aneurysm in abdominal aorta
 Hypertension: ascending aortic aneurysm
 Congenital weakness of the arterial wall: congenital cerebral
aneurysm
 Medionecrosis: causing dissecting aortic aneurysm
 Trauma: cause false aneurysm
 Syphilis : cause aneurysm in the thoracic aorta

Question 10

Types of aneurysm

Answer 10

 Types
 True aneurysm: involve all layers of the vascular wall
According to shape
o Fusiform
o Sacular
o Dissection
 False aneurysm: wall of the aneurysm is not part of the arterial wall

Question 11

Atherosclerotic aneurysm

Answer 11

: affect aorta mainly the abdominal part and
the main branches in old age. The dilatation affect the whole
circumference so the aneurysm appear fusiform in shaped

Question 12

Dissecting aneurysm

Answer 12

rare and affect the aorta in old age due to :

medionecrosis or atherosclerosis and hypertension.

Question 13

Mycotic aneurysm

Answer 13

inflammatory occur in cerebral , coronary or

mesenteric arteries

Question 14

Congenital aneurysm

Answer 14

single or multiple saccular small aneurysms at

the points of bifurcation of the cerebral arteries.

Question 15

False aneurysm

Answer 15

Pulsating hematoma: resulting from trauma to an artery causing a
small damage .The escaped blood forms a hematoma in the periarterial tissue. The periphery of the hematoma undergoes
organization and forms a fibrous sac which communicates with the
artery through a small opening.

Question 16

Arterio-venous fistula:

Answer 16

caused by traumatic injury to an artery and the
adjacent vein as that caused by bullet or car accident. The injury result
in either: a) Aneurysmal varix: direct communication between the artery and the vein
without the intervention of a sac .
B)Varicose aneurysm: A false sac around a hematoma intervenes between and
communicates the two vessels.

Question 17

Complications of aneurysm

Answer 17

 Rupture and hemorrhage
 Thrombus formation with ischemic effects
Pressure on the surrounding structures

Question 18

Varicose veins

Answer 18

 Definition: Dilatation , elongation and tortuousity of the veins.
 Sites:
1) Superficial veins in lower limbs specially the saphenous
2) Veins at the lower end of the esophagus (esophageal varices)
3) Veins at the lower end of the rectum (piles or hemorrhoids)
4) Pampiniform plexus of the spermatic cord (varicocele)

Question 19

Causes of Varicse veins

Answer 19

1)Deficient support to venous wall either congenital or caused by obesity and
senility
2)Congenital defect in venous muscular coat
3)Incompetence or rupture of the valves in the veins
4)Increased pressure inside the vein due to:
a)Prolonged standing
b)Venous compression in pregnancy and by uterine ,ovarian, prostatic and rectal
tumours.
c)Venous obstruction by thrombosis.
d)Right sided heart failure causing increase in systemic venous pressure.
e)Liver cirrhosis and bilharzial hepatic fibrosis causing portal hypertension.

Question 20

Complications of varicose veins

Answer 20

1)Phlebothrombosis causing venous congestion and edema
2)Thrombophlebitis causing pyemia
3)Rupture causing hemorrhage and pigmentation in the surrounding tissue
4)Compression and devitalization of the surrounding tissues causes a varicose
ulcer as in the lower limbs