Pathoma Vascular Pathology Flashcards

1
Q

Three categories of vasculitis and what defines each category and what are the examples in each category (2,3,4)

A

Large Vessel vasculitis: involves aorta and major branches. ex: Temporal (giant cell) arteritis and Takayasi arteritis

Medium-vessel vasculitis: involves muscular arteries that supply organs. Ex: Polyarteritis Nodosa, Kawasaki Disease, Buerger Disease

Small-vessel vasculitis: involves arterioles, capillaries, and venules. Ex: Wegner Granulomatosis (Granulomatosis with polyangitis), Microscopic Polyangitis, Churg-Strauss Syndrome, Henoch-Schonlein Purpura

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2
Q

Large Vesssel Vasculitis (2)

A

1. Temporal (giant cell) Arteritis: granulomatous vasculitis that classically involves branches of the carotis artery. Most common form vasculitis adults >50. F>M

Presentation: HA (temporal artery), Visual changes (opthalmic artery), jaw claudication. Can present with Polymyalgia rheumatica

Biopsy shows giant cells and intimal fibrosis. Lesions are segmental.

Tx: corticosteroids QUICKLY!

2. Takayasu Arteritis: very similar to Temporal, involves aortic artch at branch points. Neuro + visual sx. Adults <50 (young asian females) “pulseless disease”

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3
Q

Medium-Vessel Vasculitis (3)

A

1. Polyartertis Nodosa: multiple organs, lungs spared. Necrotising. Presents as HTN (renal artery), abd pain (mesenteric), neuro changes. Associated HBsAg. Early lesions transmural inflammation with fibrinoid necrosis. “String of pearls”

2. Kawasaki Disease: Asian children <4. Nonspecific sx. erythematous rash palms and soles. Coronary artery involvement. Can present as MI in child

Tx: ASA****, IVIG,

  1. Buerger Disease: Necrotising vasculitis involving digits. Ulceration, gangrene, autoamputation of fingers/toes. Associated with SMOKING**
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4
Q

Small Vessel Vasculitis (4)

A

1. Wegner Granulomatosis:“WeCner” necrotising granulomatous vasculitis involves nasopharynx, lungs, kidneys, c-ANCA, tx: cyclophosphamide, corticosteroids. Hematuria due to rapidly progressive glomerulonephritis

2. Microscopic polyangitis: necrotising vasculitis involve lung, kidney. NO granulomas, NO nasopharynx. p-ANCA. Tx: corticosteroids, cyclophosphamide

  1. Churg-Strauss Syndrome: Necrotising granulomas with eosinophils. Esp lungs and heart. Presents: asthma and peripheral eosinophilia. Serum p-ANCA+

4. Henoch-Schonlein Purpura: IgA immune complex deposition. Most common vasculitis in children. Follows URI. Palpable purpura on buttocks and legs, GI pain and bleeding. IgA nephropathy

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5
Q

How does angiotensin II raise blood pressure? (2 things)

A
  1. contract arteriolar smooth muscle, which increases TPR
  2. Pomoting adrenal release of aldosterone, which increases resorption of sodium in DCT to expand plasma volume
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6
Q

Three pathological patterns of arteriosclerosis

(overview)

A
  1. Atherosclerosis: affects intima, can be medium and large sized arteries
  2. Arteriolosclerosis: narrowing of small arterioles
  3. Monckeberg Medial Calcific Sclerosis
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7
Q

Atherosclerosis

A

-Intimal plaque that obstructs blood flow. Consists of necrotic lipid core (mostly cholesterol) with a fibromuscular cap.

Modifiable risk factors: HTN, hypercholesterolemia, smoking, diabetes

Non-modifyable: age, gender (increased males, postmenopause females), genetics

-Damage to endothelium –> Lipids Leak in –> oxidized –> consumed by macrophages –> foam cells –> deposition extracellular matric and proliferation smooth muscle. Can rupture cap.

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8
Q

Complications of atherosclerosis

A
  1. Stenosis of medium-sized vessels results in impaired blood flow and ischemia leading to peripheral vascular disease, angina, ischemic bowel disease
  2. Plaque rupture with THROMBOSIS result in MI/CVA
  3. Plaque rupture with EMBOLIZATION result in atherosclerotic emboli that is characterized by cholesterol crystals within embolus
  4. Weakening of vessel wall result in ANEURYSM
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9
Q

Arteriolosclerosis (2 types)

A

-Narrowing of small arterioles. Divided into hyaline and hyperplastic

1. Hyaline: caused by proteins leaking into vessel wall, produce vascular thickening and pink hyaline.

Consequence of LONGSTANDING HTN AND DIABETES***

Can produce end organ ischemia and glomerular scarring (arteriolonephrosclerosis) –> renal failure

2. Hyperplastic arteriolosclerosis: thickening of cesel wall by hyperplasia of smooth muscle. Consequence of MALIGNANT HTN. May lead to fibrinoid necrosis of vessel wall with hemmorhage.

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10
Q

Monckeberg Medial Calcific Sclerosis

A

Calcification of the media of muscular (medium sized arteries). Nonobstructive, NOT clinically significant. Incidental finding on X-ray or mammography

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11
Q

Aortic Dissection

A

-Intimal tear with dissection of blood through media of aortic wall.

  • Occurs within first 10cm of aorta (highest stress) WITH preexisting weakness of media (HTN, or inherited cause like Marfan or Ehlers-Danlos)
  • Sharp, tearing CP radiates to back.
  • Complications include pericardial tamponade (if goes back), obstruction of branching arteries (if goes down)

Stanford Type A: involves ascending aorta. Results aortic regurgitation, cardiac tamponade. Tx: Surgery (Type A surgeon)

Stanford Type B: descending aorta/arch. Tx: medically with Bblocker then vasodilator (Type B medicine)

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12
Q

Thoracic Aneurysm

A
  • Balloon-like dilation of thoracic aorta
  • MUST be due to weakness of wall. Classically seen in Tertiary Syphilis (endarteritis of vasa vasorum resulting in luminal narrowing) =“Tree Bark Appearance”
  • Marjor complication is dilation of aortic valve root leading to aortic valve insufficiency.
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13
Q

Abdominal Aortic Aneurysm

A
  • Balloon like dilation of abdominal aorta (below renal arteries, above bifurcation to iliac)
  • Primarily due to atherosclerosis.
  • Seen in Male, Smokers, >60, HTN

Presents as pulsatile mass. Major complication is rupture, seen when >5cm in diameter. Triad of hypotension, pulsatile abd mass, flank pain

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14
Q

Hemangioma

A

Benign tumor comprised of blood vessels. Present at birth. Regresses during childhood. Involves skin and liver

WOULD blanch if pressed on

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15
Q

Angiosarcoma

A

Malignant proliferation of endothelial cells, highly aggressive.

Involves skin, breast, liver

Liver angiosarcoma associated with PVC pipes, arsenic and thorotrast

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16
Q

Kaposi Sarcoma

A

-Low grade malignant proliferation of endothelial cells

Associated with HHV-8

Presents as purple patches, plaques, and nodules on the skin.

Seen in 3 types of pts

1. Older Eastern European Males. Tx with surgery.

2. AIDS pts: tx with antiretrovirals (to boost immune system)

3. Transplant pts: tx: decreasing immunosuppresion

17
Q

V1 vs V2, where are they located?

A

V1: vascular smooth muscle

V2: kidneys (have 2 of them)

18
Q

Epithelial lining of normal bronchi

A

-pseudostratified, columnar, ciliated epithelium (with goblet cells)

NOT squamous cells. If these are present, a metaplasia has taken place and are often a sign of an environmental exposure/irritation (like smoking)