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Flashcards in Blood Vessels IV Deck (51):
1

abdominal aortic aneurysm

below renal aa
male smokers >50yo
severe atherosclerosis with attenuated media

also - higher incidence of ischemic heart disease

2

inflammatory AAA

5-10%
-rich in lymphocytes, plasma cells, macrophages, giant cells

3

mycotic AAA

infected with salmonella gastroenteritis***

4

when to surgically repair AAA

5cm or greater in size

5

clinical consequences of AAA

rupture
obstruction
embolism
impingement adjacent structures

**pulsating abdominal mass

6

dysphagia, dyspnea, recurrent cough, vertebral body bone pain

could be thoracic aortic aneurysm

7

syphilitic aneurysm

luetic
-tertiary stage of syphilis - involves vasa vasorum of thoracic aorta

obliterative endarteritis of vasa vasorum - ischemic injury to media of aorta - aneurysmal dilation

TREE BARKING

8

tree barking

with syphilitic aneurysm

9

aortic dissection

blood into aortic media
-often to rupture - massive hemorrhage or cardiac tamponade


men age 40-60
younger individuals with marfans

may or may not occur with aneurysm

10

type A dissection

involves ascending aorta - debakey 1 and 2

11

type B dissection

involves descending aorta - debakey 3

12

sudden onset of excruciating pain - anterior chest radiates to back - moves downward

aortic dissection

13

Tx of dissection

aggressive treatment for HTN

surgical plication allows 65-75% survival

14

dissection unusual

substantial atherosclerosis or other cause of medial scarring such as syphilis

-fibrosis limits dissection propagation

15

marfan syndrome

LOF mutation in fibrillin - FBN1 gene
majority - autosomal dominant

increased TGF-beta activity - enhanced collagen production and ECM remodeling

overgrowth of bones and mitral valve changes

elastic fragmentation and areas devoid or elastin

16

loeys dietz syndrome

marfan type 2
-mutated TGF-beta receptor

17

decreased fibrillin 1

in marfans
-leads to increased TGF-beta activity

18

long slender skeleton, subluxation of lens in eye, aneurysm and aortic dissection, aortic valve ring dilation, floppy valve syndrome

in marfans

rupture of aorta - most common cause of death

19

vasculitis

inflammation of vessels wall

two main causes - immune-mediated, infection

20

C-ANCA

PR3

in wegener granulomatosis

21

P-ANCA

MPO

in churg strauss and microscopic polyangiitis

22

kawasaki

anti-endothelial cell antibodies
anti-smooth muscle cell antibodies

23

goodpasture

anti-GBM antibodies
-affects kidney and lungs

24

constitutional symptoms

non-specific - seen with vasculitidies
-with fever, weight loss, myalgia, arthralgia, malaise, fatigue

25

giant cell arteritis

aka temporal arteritis
-large vessel vasculitis
-patient > 50yo
-associated with polymyalgia rheumatica
-most common vasculitis of elderly in US
-can lead to permanent blindness**

anti-endothelial or anti-smooth muscle antibodies

26

permanent blindness

risk with giant cell arteritis

27

patient with HA, visual disturbance, and bulging vessels on temples

giant cell arteritis

28

takayasu arteritis

large vessel vasculitis
-patient < 40)
-thickened and narrowed aorta and major branches
-weakened pulses of upper extremities**
-ocular changes, neuro sx

possible pulmonary HTN, coronary artery, renal artery, aortic valve insufficiency pathologies

29

pulseless disease

diminished radial pulses
-with takayasu arteritis

30

polyarteritis nodosa

medium sized vessel vasculitis
-young adults
-renal a involvement
-Hep B surface Ag/Ab complexes
-acute lesions - arterial fibrinoid necrosis
-healed lesions - marked fibrotic thickening of artery
-presentation depend on tissue involved - hematirua, albuminuria, hypertension

untreated - fatal disease

Tx - steroids and cyclophosphamide

31

hep B surface Ag/Ab complexes

polyarteritis nodosa

32

kawasaki disease

medium vessel vasculitis
-anti-endo and smooth m autoantibodies
-coronary arteritis association*** - decreased with IV gamma globumin and aspirin
-rash on palms and soles of feet
-strawberry tongue
-mucocutaneous lymph node syndrome

33

mucocutaneous lymph node syndrome

with kawasaki disease

34

microscopic polyangiitis

small vessel disease
-aka leukocytoclastic vasculitis
-rxn to drugs, organisms, proteins
-elevated P-ANCA (MPO)

-palpable purpura
-necrotizing GN
-pulmonary capillaritis
-hemoptysis
arthralgia
abdomen pain/bleeding
hematuria
proteiuria
muscle pain/weakness

35

churg strauss syndrome

small vessel vasculitis
-allergic granulomatosis
-eosinophil rich granulomas**
-associated with allergic rhinitis, asthma, lung infiltrates

P-ANCA (MPO)

palpable purpura
coronary arteritis and eosionphilic myocarditis

36

behcet disease

small vessel vasculitis
-recurrent oral apthous ulcers
-genital ulcers
-uveitis (inflammation of eye)

also GI, pulmonary, neuro symptoms
associated with HLA-B51

positive pathergy test

37

pathergy test

pinprick - minor trauma
-causes exaggerated rxn

in behcet disease

38

granulomatosis with polyangiitiis

wegener granulomatosis
-small vessel vasculitis

triad:
1 - acute necrotizing granulomas of resp tract
2 - necrotizing/granulomatous vasculitis affecting small/medium vessels in lungs and upper airways
3 - renal disease - focal crescent GN - hematuria and proteinuria

C-ANCA (PR3)

39

triad of wegener

resp tract necrotizing granulomas

small-medium vessel necrotizing granulomas

renal disease - necrotizing crescentic GN

40

40yo male, persistent pneumonitis, bilateral cavitary infiltrates, chronic sinusitis, mucosal ulcers, renal disease, skin rash, muscle pain, articular involvement, fever

with wegener granulomatosis

41

untreated wegener

80% of patients die within 1 year

Tx - immunosuppression

42

thromboangiitis obliterans

buerger disease
-medium/small arteries and veins, nerves
-cigarette smoking men - before age 35
-ulcerations of toes, feet, fingers
-raynaud
-exercise induced claudication
-severe pain at rest

Tx - stop smoking

43

vasculitis with smoking cigarettes

buerger disease
-thromboangiitis obliterans

44

infectious vasculitis

aspergillus and mucormycosis
-may lead to mycotic aneurysm

45

hypothermia

prolonged exposure to low temperature
-90 degrees - loss of consciousness
-bradycardia and atrial fib at lower temps

direct effects - physical disruptions and high salt concentrations

indirect effects - circulatory changes

46

alcohol

causes vasodilation
-lowers body temp faster

47

frostnip

vasoconstriction
-nose, ear, hands, feet

48

chillblain

perniones, perniosi
-nonfreezing temp and damp conditions
-chronic recurrent vasculitis with red raised lesions

49

immersion foot

trench
-feet wet - not freezing
-chronic pain, edema, blotchy discoloration
-superficial, moist, liquefactive gangrene

50

frostbite

sudden drop in temp that persists
-vasoconstriction and increased blood viscosity
-hyperemia and edema, large clear blisters, vesicles filled with hemorrhagic fluid to complete gangrene

51

raynaud phenomenon

pallor or cyanosis of digits
-primary - cold/emotion induced
-secondary - arterial insufficiency - SLE, scleroderma, atherosclerosis, buerger disease

red, white, blue of digits