Vascular Pathology Flashcards by Mohammed Shembesh

Most cases of vasculitis are

Not infectious

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Large vessel vasculitis include

Temporal giant cell arteritis

Takayasu arteritis

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Temporal giant cell arteritis

Most common form of vasculitis in older adults (>50) , usually affect females

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Temporal giant cell arteritis symptoms with

Carotid artery branches affection

Headache (temporal)
Visual disturbance (ophthalmic )
Jaw Claudication
Flu-like symptoms 
ESR is elevated

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Temporal giant cell arteritis treatment

Corticosteroids

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There is high risk of blindness without treatment of

Temporal giant cell arteritis

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Takayasu arteritis present in

Adults <50 years old

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Takayasu arteritis symptoms with affection aortic arch at branch point

Visual and neurologic symptoms
Weak or absent pulse in upper extremity “pulseless disease”
ESR is elevated

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Polyarteritis nodosa

Necrotizing vasculitis
Involve most organs
***Lungs are spared

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Polyarteritis nodosa present in young adults with symptoms of

Hypertension (renal artery)
Abdominal pain and melena (mesentric artery )
Neurologic disturbance
Skin lesions

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Polyarteritis nodosa associated with

Serum HBsAg

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In polyarteritis nodosa , lesions of varying stage are present result in

*****String of pearls appearance on imaging

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Kawasaki disease classically affects

Asian children <4 years

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Coronary artery involvement is common with

Kawasaki disease

Thrombosis with MI , aneurysm with rupture

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Kawasaki disease present with

Fever
Conjunctivitis
Erythematous rash of palms and soles
Enlarged cervical lymph nodes

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Buerger disease highly associated with

Smoking

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Buerger disease

.Necrotizing vasculitis involving digits
.Present with ulceration , gangrene and autoamputation of fingers and toes
.Ranaud phenomenon often present

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Medium vessel vasculitis include

Polyarteritis nodosa
Kawasaki disease
Buerger disease

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Takayasu arteritis treatment

Corticosteroids

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Wegener granulomatosis

Necrotizing granulomatous vasculitis involving nasopharynx ,lungs and kidney

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Wegener granulomatosis present with

Sinusitis and nasopharyngeal ulceration
Hemoptysis and bilateral nodular lung infeltrate
Hematuria due RPGN
Serum c-ANCA correlate with disease activity

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WG present in

Middle aged males

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Microscopic polyangiitis similar to WG but ……………. and ……………. are absent

Nasopharyngeal involvement , granuloma

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Serum p-ANCA level correlate with

Microscopic polyangiitis activity and churg Strauss syndrome

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Churg Strauss syndrome

Necrotizing ***granulomatous vasculitis with eosinophils | Present with **Asthma and **peripheral eosinophilia

HSP

Vasculitis due to IgA immune complex deposition

Most common vasculitis in children is

HSP

HSP present with

Palpable purpura on buttock and legs | ****Hematuria (IgA nephrolathy)

HSP usually occur after

Upper respiratory tract infection

Systemic hypertension defined as

>140/90 mmHg

Primary HTN due to

Unknown etiology (95% of cases)

Primary HTN risk factors

``` Age Race Obesity Stress Lack of physical exercise High salt diet ```

In Renal artery stenosis there is

Increased plasma renin | Unilateral atrophy of affected kidney

Important causes of renal artery stenosis

1. Ahtherosclerosis (in elderly males) | 2. Fibromuscular dysplasia ( in young females)

Benign HTN

Mild or moderate elevation in blood pressure | Classically silent , vessels and organs are damaged over time

Malignant HTN definition

Severe elevation in BP (>200/120) | May arise from preexisting benign HTN or de novo

Malignant HTN present with acute organ damage as :

.Acute renal failure , headache and papilledema | .Medical emergency

Three pathological pattern of arteriosclerosis

Atherosclerosis Arteriolosclerosis Monckeyberg medial sclerosis

Atherosclerosis is

Intimate plaque that obstruct the blood flow

Modifiable risk factors of atherosclerosis

HTN Hypercholesterolemia Smoking Diabetes

Nonmodifiable risk factors of atherosclerosis

Age Gender Genetics

Complications of stenosis medium sized vessels

Peripheral vascular disease (popliteal a.) Angina (coronary a.) Ischemic bowel disease (mesenteric a.)

Complication of plaque raputure with thrombosis

MI (coronary a.) | Stroke (middle cerebral a.)

Complications of atherosclerosis

Stenosis Plaque raputure with thrombosis Plaque raputure with embolisation Weaking of vessel wall (aneurysm )

Arteriolosclerosis types

Hyaline and hyperplastic

Hyaline arteriolosclerosis caused by

Leakage of protein into the vessel wall

*****Hyaline arteriolosclerosis seen in

Benign HTN | Diabetes

Hyaline arteriolosclerosis classically produce

``` Glomerular scaring (arteriolonephrosclerosis) Progress to chronic renal failure ```

Hyperplastic arteriolosclerosis show

Onion skin appearance

Hyperplastic arteriolosclerosis seen with

Malignant HTN

Hyperplastic arteriolosclerosis classically causes

Acute renal failure with flea bitten appearance

May lead to fibrinoid necrosis of the vessel wall

Hyperplastic arteriolosclerosis

Monckeyberg medial calcific sclerosis

Classification of the media , non-obstructive

Aortic dissection definition

Intimal tear with dissection of blood through the media of aortic wall

Aortic dissection occurs in

The proximal 10cm of the aorta with preexisting weakness of the media

Causes of Aortic dissection

HTN (most common cause) | Inherited defects of connective tissue

Aortic dissection present with

Sharp tearing chest pain radiate to the back

Aortic dissection complication is

Pericardial tamponade (most common cause of death)

Thoracic aneurysm is

Ballon-like dilation of the thoracic aorta | Due to weakness in the aortic wall

Thoracic aneurysm classically seen in

Tertiary syphilis (result in tree-bark appearance of aorta)

Complications of thoracic aneurysm

1. Dilation of aortic valve root result in aortic insufficiency 2. Compression of mediastinal structures 3. Thrombosis/embolism

AAA (Abdominal aortic aneurysm) usually occur at

***** below the renal arteries but above the aortic bifurcation

AAA primarily due to

Atherosclerosis (classically seen in male smokers >60yrs old with HTN)

AAA presentation

.Pulsatile abdominal mass | .Grows with time

Major complication of AAA is

Rupture , especially when >5cm in diameter

AAA rupture present with triad of

Hypotension , pulsatile abdominal mass and flank pain

Vascular Pathology Flashcards

(66 cards)