Blood Vessels - Chapter 11

Question 1

Arteries are divided into categories based upon _______and _______.

Answer 1

Size and structural function (p. 483)

Question 2

List the three categories of arteries.

Answer 2

Large or elastic arteries
Medium sized or muscular arteries
Small arteries (p. 484)

Question 3

List the three layers of any artery in the body. I

Answer 3

intima, media, adventitia (p. 485)

Question 4

is critical for maintaining vessel wall homeostasis and circulatory function

Answer 4

Endothelium (p. 486)

Question 5

Developmental weaknesses in the cerebral vessels in and about the Circle of Willis are known as_____.

Answer 5

Berry aneurysms (p. 503)

Question 6

Berry aneurysms are most common in what portion of the circle of Willis?

Answer 6

Anterior circulation (p. 1270)

Question 7

Abnormal communications between arteries and veins are known as ________and may result from ___________.

Answer 7

Arteriovenous fistulas
Rupture of an arterial aneurysm into the adjacent vein, from penetrating injuries that pierce the walls of the artery and vein and produce an artificial communication, or from inflammatory necrosis of adjacent vessels. (p. 485)

Question 8

List and differentiate the three distinct morphologic variants of arteriosclerosis.

Answer 8

Atherosclerosis – formation of intimal plaques that often have a grumous core rich in lipid. Mönckeberg Medial Calcific Necrosis – calcific deposits in medium-sized muscular arteries in persons older than 50 yrs.

Arteriolosclerosis – small arteries and arterioles.

Two variants – Hyaline and hyperplastic, cause thickening of vessel walls with luminal narrowing that may induce downstream ischemic injury. (p. 491)

google:
At present arteriosclerosis or arterial stiffness is classified into three lesions:-

Atherosclerosis – Atherosclerosis affects the elastic and large arteries in which there is atheroma formation.
Moenckeberg medial calcific sclerosis
Arteriolosclerosis

The arteriosclerosis lesions begin as the intima in the arterial wall starts to enlarge with the deposition of variable amounts and types of lipids, inflammatory cells, connective tissues as well as matrix proteins, enzymes and calcium deposits.

As these lesions mature, they are called atherosclerosis. Atherosclerosis is atheroma with arteriosclerosis. This is the largest killer in industrialized countries leading to hundreds of thousands of heart attacks and strokes.

There are several subclassifications of atherosclerosis including one adopted by the American Heart Association.

Moenckeberg medial calcific sclerosis is the deposition of calcium in the tunica media of the large and medium sized arteries. It is rarely seen in patients younger than 50 years.

This type of calcification affects only the walls and does not affect the lumen of the arteries unlike atherosclerosis. Moenckeberg sclerosis and atherosclerosis may occur together where both the wall and lumen may be affected.

Arteriolosclerosis affects small arterial vessels with 1 or 2 layers of smooth muscle cells in their walls only called arterioles. However, the condition affects arterioles throughout the body and is common among those with high blood pressure (hypertension) and diabetes mellitus.

Pathologically there are two subtypes of arteriosclerosis:-

hyperplastic type
hyaline type

Question 9

Define atherosclerosis and discuss the development of the various lesions associated with this disease process.

Answer 9

Atherosclerosis is characterized by intimal lesions called atheromas or atheromatous plaques that protrude into the lumen, weaken the underlying media, and leads to aneurysm formation. Primarily affects elastic arteries and large and medium sized muscular arteries. (p. 491)

Question 10

List some of the complications of atherosclerosis.

Answer 10

Myocardial infarction, cerebral infarction, aortic aneurysm, gangrene of the legs, mesenteric occlusion, chronic ischemic heart disease, sudden cardiac death, and ischemic encephalopathy. (p. 500)

Question 11

List some of the epidemiologic factors associated with the development of atherosclerosis.

Answer 11

Increasing age, male gender, family history, genetic abnormalities, hyperlipidemia, hypertension cigarette smoking, diabetes, c-reactive protein (p. 492)

Question 12

What is the major component of the total serum cholesterol that is associated with increased risk of atherosclerosis?

Answer 12

Low density lipoprotein (LDL) (p. 492)

Question 13

13. What is the most important risk factor in coronary heart disease and cerebrovascular accident? List additional possible complications of this risk factor.

Answer 13

Hypertension
Left ventricular hypertrophy (ischemic heart disease), aortic dissection, renal failure (p. 493)

Question 14

What are the two types of hypertension and relative frequencies of each?

Answer 14

Essential or primary (95%) and secondary (5%) (p. 487)

Question 15

What are some possible causes of secondary hypertension?

Answer 15

Renal disease, endocrine abnormalities, cardiovascular, neurologic (p. 487)

Question 16

The two most common mechanisms of vasculitis are _____.

Answer 16

1) Immune-mediated inflammation
2) Direct invasion of vascular walls by infectious pathogens (p. 505)

An inflammation of the blood vessels that causes changes in the blood vessel walls.
Vasculitis can cause vessel walls to thicken and narrow, cutting off vital blood supply to tissues and organs.

Question 17

List and describe one of the more common pathologic findings in infectious arteritis.

Answer 17

Mycotic aneurysm – vascular infections may weaken the arterial wall and result in the formation of a mycotic aneurysm. (p. 513)

Question 18

Aneurysmal dilatation of the aortic root, ascending and thoracic aorta occurs as the result of what specific form of arteritis?

Answer 18

Obliterative endarteritis of vasa vasorum (cardiovascular syphilis) (p. 502)

Otherwise known as an aortic root aneurysm, a dilated aortic root is when the first section of the aorta, where the aortic valve resides, becomes enlarged. When this enlargement reaches a critical size, there is a risk of it rupturing or tearing, leading to a life-threatening situation

Question 19

Define giant cell arteritis and give another more common term for this disease process.

Answer 19

Giant cell (temporal) arteritis, the most common form of vasculitis among the elderly in the US and Europe, is a chronic, typically granulomatous inflammation of large-sized to small arteries. It affects principally the arteries of the head – especially the temporal arteries but also the vertebral and ophthalmic arteries. (p. 508)

Question 20

What clinical marker is found in the serum of 90% of patients with Wegener granulomatosis (granulomatosis with polyangiitis)?

Answer 20

PR3-ANCAs (p. 516)

Question 21

Buerger disease is also know as ___________ and is characterized by ____________.

Answer 21

Thromboangiitis obliterans

Segmental, thrombosing, acute and chronic inflammation of medium – sized and small arteries, principally the tibial and radial arteries and sometimes secondarily extending to veins and nerves of the extremities. (p.512)

Question 22

Morphologically, vascular changes associated with Buerger disease are_____________.

Answer 22

Sharply segmental acute and chronic vasculitis of medium-sized and small arteries with secondary spread to contiguous veins and nerves. (p. 512)

Question 23

Define Raynaud phenomenon.

Answer 23

Raynaud phenomenon refers to paroxysmal pallor or cyanosis of the digits of the hands or feet and infrequently the tips of the nose or earlobes. It is caused exaggerated vasoconstriction of the digital arteries and arterioles. (p. 513)

Question 24

Define aneurysm.

Answer 24

An aneurysm is a localized abnormal dilation of a blood vessel or the heart. (p. 501)

Question 25

What are the two most disorders that predispose to aortic aneurysms?

Answer 25

Atherosclerosis and hypertension (p. 502)

Question 26

define true aneurysms

Answer 26

A true aneurysm involves an intact attenuated arterial wall or thinned ventricular wall of the heart. The blood within a true aneurysm remains within the confines of the circulatory system. Atherosclerotic, syphilitic, and congenital vascular aneurysms and ventricular aneurysms are examples.

Question 27

define false aneurysm

Answer 27

A false aneurysm (pseudoaneurysm) is a defect in the vascular wall leading to an extravascular hematoma that communicates with the intravascular space. Ventricular rupture after myocardial infarction that is contained by a pericardial adhesion is an example. (p. 501)

Question 28

The most common pathologic finding in dissecting aneurysms is________.

Answer 28

An intimal tear typically found in the ascending aorta, usually within 10 cm of the aortic valve. (p. 507)

Question 29

List and differentiate the two types of dissecting aneurysms.

Answer 29

Type A – more common and devastating – proximal lesions involving either the ascending portion only or both the ascending and descending aorta (also known as DeBakey type I and II).
Type B – distal lesions not involving the ascending part and usually beginning distal to the subclavian artery (DeBakey type III). (p. 505)

Question 30

Define varicose veins and list two special types that have clinical significance.

Answer 30

Varicose veins are abnormally dilated, tortuous veins produced by prolonged, increased intraluminal pressure and by loss of support of the vessel wall.
Two special types – Esophageal varices and hemorrhoids (p. 514)

Question 31

What are the two most common factors associated with the development of varicose veins?

Answer 31

Dependent posture and familial tendency (p. 514)

Question 32

List some of the more debilitating consequences of varicose veins.

Answer 32

Development of persistent edema in the extremity and ischemic changes in the skin that lead to stasis dermatitis and ulcerations. (p. 514)

Question 33

Define thrombophlebitis.

Answer 33

Venous thrombosis and inflammation Kuru (p. 514)

Question 34

The most common site for the development of thrombophlebitis is _______.

Answer 34

Deep leg veins (greater than 90%) (p. 514)

Question 35

What are some clinical predispositions to thrombophlebitis?

Answer 35

Cardiac failure, neoplasia, obesity, pregnancy, and prolonged bed rest or immobilization

Question 36

Define superior vena cava syndrome and list some of its presenting clinical signs and symptoms.

Answer 36

Obstruction of the superior vena cava is usually caused by neoplasms that compress or invade the superior vena cava, most commonly a primary bronchogenic carcinoma or mediastinal lymphoma.

Clinical signs – cyanosis, marked dilatation of the veins of the head, neck, and arms, possible respiratory distress due to compression of pulmonary vessels. (p. 515)

Question 37

Superior vena cava syndrome is caused by _______.

Answer 37

Neoplasms that compress or invade the superior vena cava, such as bronchogenic carcinoma or mediastinal lymphoma (p. 515)

Question 38

Define obstructive lymphedema and list some of the more common causes of this disease.

Answer 38

Obstructive lymphedema – Blockage of a previously normal lymphatic. Secondary to spread of malignant tumors obstructing either the lymphatic channels or the regional lymph nodes, radical surgical procedures with removal of regional groups of lymph nodes, post irradiation fibrosis, filariasis, post-inflammatory thrombosis, and scarring. (p. 515)

Question 39

What are complications caused by rupture of obstructed dilated lymphatics into the peritoneum, pleural cavity and pericardium?

Answer 39

Chylous ascites, chylothorax, and chylopericardium (p. 515)

Question 40

Define pyogenic granuloma.

Answer 40

A pyogenic granuloma is a form of capillary hemangioma that occurs as a rapidly growing, pedunculated, red nodule on the skin and gingival or oral mucosa, which bleeds easily and is often ulcerated. (p. 516)

Question 41

Define telangiectasia.

Answer 41

A group of abnormally prominent capillaries, venules, and arterioles that create a small focal red lesion, usually in the skin or mucous membranes. (p. 516)

Question 42

Name three types of vascular ectasias.

Answer 42

Nevus flammeus, spider telangiectasias, hereditary hemorrhagic telangiectasia (Osler-Weber- Rendu disease) (p. 516)

Question 43

List and differentiate the two most common forms of hemangioma.

Answer 43

Capillary hemangioma – unencapsulated aggregates of closely packed thin-walled capillaries lined by flattened endothelium.

Cavernous hemangioma – distinguished by the formation of large, dilated vascular channels.
(p. 516)

Question 44

A cystic hygroma, also known as ___________, is characterized by ____________, and may be associated with that chromosomal abnormality?

Answer 44

Cavernous lymphangioma

Cavernous lymphatic spaces in the axilla or neck Turner Syndrome, 45X karyotype (p. 517, 166)

Question 45

A glomus tumor

Answer 45

is a biologically benign but painful tumor that arises from the modified smooth muscle cells of the glomus body.

Question 46

Hemangioendothelioma

Answer 46

denotes vascular neoplasms showing histologic features and clinical behavior intermediate between the benign, well-differentiated hemangiomas and angiosarcomas.

google
“The term Hemangioendothelioma describes several types of vascular neosplasms and includes both non-cancerous (benign) and cancerous (malignant) growths. The term has also been applied to those that show ““borderline”” behavior, intermediate between entirely benign hemangiomas and highly malignant angiosarcomas. Hemangioendotheliomas are caused by abnormal growth of blood vessel cells, although the exact underlying cause for the abnormal growth is unknown.

Question 47

Hemangiopericytoma

Answer 47

derived from pericytes, the cells normally arranged along capillaries and venules. This rare neoplasm may occur as a slowly enlarging, painless mass at any anatomic site but is most common on the lower extremities and in the retroperitoneum. (p. 517, 519-520)

Question 48

An intermediate grade (borderline) vascular tumor often seen in AIDS patients is _________.

Answer 48

Kaposi sarcoma (p. 518)

Question 49

______ are malignant endothelial neoplasms with histology varying from well-differentiated tumors that resemble hemangiomas to anaplastic lesions difficult to distinguish from carcinomas or melanomas.

Answer 49

Angiosarcomas (p. 519)

Question 50

Hepatic angiosarcomas are associated with which chemical carcinogens?

Answer 50

Arsenic, Thorotrast, and polyvinyl chloride (p. 519)

Question 51

What are the two classifications of hypertension?

Answer 51

Essential hypertension and secondary hypertension (p. 487)