vessel pathology Flashcards
(144 cards)
1
Q
large aa
A
aka elastic
aorta, its large brr, and pulmonary aa
2
Q
medium sized aa
A
aka muscular
other brr of aorta
3
Q
small aa
A
< 2mm in diameter
4
Q
vasa vasorum
A
small aa that feed medium and large aa
in outer 1/2-2/3 medulla
5
Q
arterioles
A
20-100um
w/in substance of tissues and organs
6
Q
veins
A
venous valves in extremities large diameter large lumen 2/3 of all the blood is in vv thin less well organized walls
7
Q
post capillary venules
A
site of leukocyte exudation and vascular leakage
8
Q
capillaries
A
approximately he diameter of red blood cell or larger
endothelial cell lining (no media)
surrounded by pericytes
rapid exchange of diffusible substances
9
Q
lymphatics
A
endothelial cell lining (no media)
valves in larger lymph vessels
10
Q
endothelial cells
A
contain weibel palade bodies
junctions normally impermeable to large molecules
11
Q
weibel-palade bodies
A
membrane bound storage organelles that contain vWF
12
Q
anticoagulant, antithrombotic, fribrinolytics from endothelium
A
prostacyclin
thrombomodulin
heparin-like molecules
plasminoen activator
13
Q
prothrombotics from endothelium
A
vWF
TF
Plasminogen activator inhibitor
14
Q
modulators of blood flow from endothelium
A
vasoconstrictors (endothelin, ace)
vasodilators (NO, prostacyclin)
15
Q
regulators of inflammation and immunity from endothelium
A
IL1, IL6, chemokines
adhesion molecules( VCAM-1, ICAM, E-selectin, P-selectin)
histocompatilibility Ags
16
Q
regulators of cell growth from endothelium
A
stimulators (PDGF, CSF, FGF)
inhibitors (heparin, TGFbeta)
17
Q
other functions of endothelium
A
maintenance of permeability
oxidation of LDL
18
Q
vascular smooth mm
A
vasoconstriction and dilation
GFs and cytokines
migrate to intima and proliferate following injury
synthesize collagen, elastin, and proteoglycans
can have phagocytic activity
19
Q
berry aneurysms
A
aka congenital or berry
2% of autopsies
most in circle of willis
saccular type aneurysm in aa
20
Q
arteriovenous fistulas
A
rare abnormal communications btwn aa and vv
most congenital, some produces
short-circuit blood and caue heart to pump additional volume
21
Q
accelerated HTN
A
end organ damage
22
Q
malignant HTN
A
accelerated plus papilledema
23
Q
renal causes of HTN
A
acute glomerulonephritis chronic renal disease polycystic disease renal aa stenosis renal vasculitis renin-producing tumor
24
Q
endocrine causes of HTN
A
cushings primary aldosteronism congenital adrenal hyperpalsia licorice exogenous hormones pheochromocytoma acromegaly hypo/hyper thyroidism pregnancy
25
CV causes of HTN
```
coarctation of aorta
polyarteritis nodosa
increased intravascular volume
increased CO
rigidity of aorta
```
26
neurologic causes of HTN
phychogenic
increased intracranial pressure
sleep apnea
acute stress, inducing surgery
27
liddle syndrome
moderatly severe salt sensitive HTN due to increased distal tubular reabsorption of NA due to over reaction to aldosterone stimulation
28
3 patterns of arteriosceloris
monckeberg medial cacific scleriosis
arterioloscerosis
atherosclerosis
29
monckeberg medial calcific sclerosis
in mm aa w/no vessel lumen narrowing and ossify
30
arteriolosclerosis
in small aa and arterioles
| hyaline arterolosclerosis or hyperplastic arterioloscerlosis
31
hyaline arteriolosclerosis
```
protein deposition (hyalinized)
seen in aging, DM, benign nephrosclerosis, HTN
```
32
hyperplastic arterilosclerosis
cell death
onion skinning
+/- necrotizing arteriolitis
seen in malignant HTN
33
non modifiable risk factors for atherosclerosis
genetics
family Hx
increasing age
male gender
34
modifiable risk factors for atherosclerosis
```
hyperlipidemia
HTN
cigarette smoking
DM
inflammation
```
35
metabolic syndrome
obesity, dyslipedemia, HTn, and insulin resistance
| can also have hypercoagulability and inflammatory state
36
class II LDLR mutations
most common
| receptor protein transport form ER to golgi impaired due to abnormal protein folding
37
lipoprotein a
associated w/higher risk of coronary and cerebrovascular disease
38
elevated plasminogen activator inhibitor 1
strong predictor of risk for major atherosclerotic events
39
acute phase reactant
synthesized primarily by the liver
opsonizes bacteria and activating C'
predicts the risk of MI, stroke, peripheral arterial disease, and sudden cardiac death
lowering CRP itself does not decrease risk
smoking cessation, weight loss, statins, and exercise all reduce CRP
40
infections which may contribute to atherosclerosis
chlamydia pneumoniae, herpesvirus, and cytomegalovirus
41
COX 1 inhibitors
aspirin
preferentially inhibits COX1 at low doses
blocks thromboxane and increases prostacyclins
42
COX2 inhibitors
NSAIDS
| blocks prostacyclins and increases thromboxanes
43
abdominal aneurysms
atherosclerosis
| M>F, smokers, 50+
44
thoracic aneurysms
HTN
45
other causes of aneurysms
marfans, loeys-dietz, ehlers-danos, scurvey, trauma, congenital defects, syphiils and vasculitides
46
mycotic aneuysms
infections
from embolization of spetic embolus (infective endocarditis)
from extension of adjacent suppurative process
from circulating organisms infecting arterial wall
47
true aneuysms
bounded by arterial wall component or myocardium
48
sacular aneurysm
appears rounded
49
fusiform aneurysm
ivolvoes long segment of a and is not rounded
50
false aneurysm
aka pedudoaneurysm
| hematoma secondary to trasmural rupture
51
inflamatory abdominal aortic aneurysm
5-10%
rich in lymphocytes, plasma cells, and macrophages
often giant cells
cause uncertain, usually occur at younger age
52
mycotic abdominal aortic aneurysms
atherosclerotic AAA that have become infected
| salmonella gastroenteritis
53
risk of rupture
6cm 25%
| greater then 5cm surgically repaired
54
obliterative endarteritis
tertiary stage of syphilis (leus) involces vasa vasorum (arterioles) of thoracic aorta
55
syphilitic aortits
obliterative endarteritis of vasa -> ischemic injury of media -> loss of medial elastic fibuers and mm cells
can lead to aneurysmal dilation -> aortic valve imcompetence
tree-barking appearance
56
aortic dissection
>90% men
40-60% w/HTN
arteriolosclerosis -> smooth m loss
in younger people may be CT disorder (marfans, ehlers-danlos, scurvey)
can be iatrogenic
rarely associated w/pregnancy
occasionally secondary to vasa vasorum rupture
57
Debakey I
begins in ascending aorta and extends into descending aorta
58
Debakey II
isolated to ascending aorta
59
Debakey III
isolated to descending aorta
60
Type A
debakey I and II
| begins in ascending aorta
61
Type B
debakey III
| isolated to descending aorta
62
Marfans Syndrome
loss of fnx mutation of fibrillin
FBN1 gene
autosomal dominant, 25% sporadic
due to decreased fibrillin-1 there is increased TGFbeta -> growth
63
loeys-dietz syndrome
type II marfans
| due to mutations in TGFbetaR
64
infectious vasculitis
```
bacterial- nisseria
rickettsial- RMSF
Spirochetal- syphilis
fungal- aspergillosis, mucormcoses
viral- herpes-zoster, varicella
```
65
IC mediated vasculitis
```
infection (hep B,C)
Henoch-schonlien purpura
lupus
RA
polyarteritis nodosa
drug induced hypersensitivity
cyroglomulinemia
serum sickness
```
66
ANCA mediated vasculitis
wegener granulomatosis
microscopic polyangitits
churg strauss syndrome
67
direct AB mediated vasculitis
goodpastures
| kawasaki disease
68
cell meidated vasculitis
oran allograft rejection
inflammatory bowel disease
paraneoplastic vasculits
69
unknown vasculitis
giant cell
| takayasu arteritis
70
non-specific symptoms of vasculitis
```
fever
weight loss
myalgia
arthralgia
malaise
fatigue
thrombosis
ischemia
nerve pain (depends of cause)
```
71
large vessel vasculits
```
giant cell (temporal) arteritis
takayasu arteritis
```
72
medium vessel vasculitis
polyarteritis nodosa
| kawasaki disease
73
small vessel vasculitis
wegners
churg-strauss syndrome
microscopic polyangitis
74
MPO-ANCA
aka p-ANca
| antineutrophil cytoplasmic Abs directed against myeloperoxidase
75
PR3-ANCA
aka c-ANCA
antineutrophil cytoplasmic Abs
against proteinase 3
76
giant cell arteritis
aka temporal
most comon
usually >50
ophtalmic aa involvement -> diploplia and permanent blindness
may cause giant cell aoritis and thoraci aortic aneurysm
can involve coronary aa
2/3 have anti-endothelial or anti-smooth m Abs
77
takayasu arteritis
granulomatous inflammation of aorta dn brr
less then 50, females < 40
marked weakening of pulses -> aka pulseless disease) and reduced BP of UL
78
aa involved w/takayasu arteritis
```
ocular
pulmonary
coronary
renal
aortic valve insufficiency
```
79
polyarteritis nodosa
```
necrotizing inflammation in small to medium aa, arterioles, capillaries, or venules
usually young adults
renal arterial involvement COD
no glomerulonephrtis
30% have hep B Ag/Ab complexes
treat w/steroids and cyclophosphamide
```
80
kawasaki disease
large, medium, or small aa
usually self limitee in cheildren
anti-endothelial cell and smooth m autoAbs
coronary aa often infvolved
amin cause of aquired pediatric heart disease in north american and epidemic in Japan
81
kawasaki disease is associated with
mucocutaneous lymph node syndrome
acute self-limiting disease w/fever, conjuctival and oral erythema, strawberry tongue, and erosion, edema of hands and feet, erythema of palms and soles, desquamative skin rash and enlargement of cervical lymph nodes
82
microscopic polyangitis
aka leukocytoclastic vascultis
necrotizing vasculitis w/few or no immune deposits (pauci immune)
p-ANCA
83
presentation of microscopic polyangitis
palpable purpura of skin
necrotizing glomerulonephritis
hemoptysis, arthralgia, abdominal pain or bleeding, hematuria, proteinuria, hemorrhage, and m pain or weakness
84
churg strauss syndrome
```
aka allergic granulomatosis and angiitis
Eos!!!!
necrotizing vasculitis
involves respiratory tract
strong association w/allergic rhinitis, bronchial asthma, lung infiltrates
blood eosinophilia
p-ANCA
```
85
presentation of churg strauss syndrome
Eos!!
palpable purpura
coronary arteritis and eosinophilic myocarditis
severe renal disease infrequent
86
bahcet disease
neutrophillic vasculits of small-medium aa
triad: recurrent oral aphthous ulcers, genital ulcers, uveitis
can also have GI, pulmonary, and neuro symptoms
can rupture aneurysms
associated w/HLA-B51
can have positive pathergy test- pin prick ulcerates
87
Wegeners
aka granulomatosis w/polyangitis
triad- acute necortizing granulomas of upper and lower respiratory tract
nectozings or granulomatous vasculitis affecting small-med vessels
renal disease in form of focal necrotizing, often crescentric glomeruloneprhtis w/hematuria and proteinuria +/- renal failure
c-ANCA
88
Clinical presentation of wegeners
```
M>F, about 40
persistent pneumonitis, bilateral nodular and cavitary inflitraes
chronic sinusitis in 90%
mucosal ulcerations of nasopharynx
renal disease
skin rashes
mm pain
articular involvement
mononeuritis or polyneuritis
fever
responds to chemo, steroids, anti TNF
```
89
Thromboangiitis olterans
aka beurgers disese
semental thrombosin, acute and chronic inflammation of medium sized an small aa (tibial, radial) extending into vv and nn of extremities
90
buerger disease presentation
```
cigarette smokers
<35
chronic ulceration, toes, feet, fingers, and gangrene
secondary raynauds
exercise induced instep claudication
severe pain, even at rest
stop smoking
```
91
infectious vasculitis
sometimes from direct invasion of bacteria or fungi (aspergillus and mucormycosis)
can frequently accompany bacteria pneumonia
can occur adjacent to caseous TB abscesses
can occur in superficial cerebral menigitis
may be secondary to septic emboli
may result in mycotic aneurysms or induce thrombotic infarction
92
frostnip
vasoconstriction fingers, nose, toes-> discoloration
93
chilblain
aka perniones/perniosis
due to non-freezing temps and damp conditions
chronic, recurrent vasculitis w/red raised lesions
94
immersion foot
aka trench fot
feet have been wet, but not freezing
may not heal
chronic pain, edema, and blotchy discoloration
often produces superficial, moist, liquefactive gangrene
95
frostbite
sudden sharp drops in temp
vasoconstriction and increased viscosity of blood
hyperemia and edema
large clear blisters, vesicles filled w/hemorrhagic fluid
dry gangrene
96
primary raynauds
cold or emotion induced vasoconstirction
late in course inimal thickening can occur
median age 14
distal- proximal: blue-white-red
97
secondary raynauds
SLE, systemic sclerosis, atherosclerosis, buergers
98
phelbosclerosis
elastic tissue degredation and spotty calcifications w/in media
can occur w/varicose vv
99
superior venal caval syndrome
usually neoplasm compresses or invades w/cyanosis and dilation of vv of head, neck, and arms
if pulmonary vessels also compressed causes respiratory distress
100
inferior venal caval syndrome
neoplam (renal cell, hepatic cell, and adrenal Cx carcinoma) or a thrombus propagates upward
leg edema, lower abdominal distention, superficial collateral vv distention
if renal vv involved massive proteinuria
101
lymphangitis
infections involving lymphatics w/red streaks
group A beta hemolytic strep
in severe cases produces cellulits or focal abscesses
102
acute lymphadenitis
red streaks w/painful enlarged regional lymph nodes
103
obstructive (secondary) lymphedema
dilation of lymphatics w/increased interstitial fluid
caused by:
-malignant tumors obstructing lymphatic channels or lymph nodes
-removal of regional nodes
postirradiation fibrosis
filariasis
postinflammatory thrombosis and scarring
chronic edema can lead to thickened skin- brawny induration or peau d'orange
104
primary lymphedema
- isolated congenital defect
- familial Milroy disease due to lymphatic agenesis or hypoplasia
- lympedema praexox- age 10-25, usually female, unknown cause, edema begins in feet and accumulates
105
chylous ascites, chylothorax, chylopericardium
caused by rupture of obstructed lymphatics into peritoneum, pleural cavity, or pericardium
106
benign neoplasms
hemangiomas (capillary, cavernous, pyogenic granuloma)
lymphangioma (simple/capillary, cavernous)
glomus tumors
107
non-neoplasm benign issues
```
vascular ectasias (nevus flammeus, spider telangiectasia, hereditary hemorrhagic telangiectasis)
reactive vascular proliferations (bacillary angiomatosis)
```
108
intermediate grade- malignant neoplasms
kaposi sarcoma
| hemagioednothelioma
109
malignant neoplasms
agniosarcoma
| hemagiopericytoma
110
hemangiomas
angiomatosis- large segment of body
malignant transformations are rare
7% of all benign tumors in infancy and childhood
common in skin and liver
111
capillary hemangiomas
- most common vascular tumor, usually skin, subQ, and mucous membranes, but can be in any organ w/a vascular supply
- lumina may be thrombosed, ruputure of vessels can casues scarring w/hemosiderin pigments
112
juvenile hemangioma
strawberry type
capillary hemagiomas of skin in newborns
grows rapidly in first few months and regresses by age 7 in 75-90%
113
cavernous hemangioma
larger, less circumscribed, and more frequently involves deep structures
may be locally destructive
no tendency to regress
intravascular thrombosis w/associated dystrophic calcification
hemangiomas of the brain threatening
114
hemagioblastomas
+/- cavernous hemagiomas in von hippel lindau disease
angiomatous lesions cerebellum, brainstem, and eye
cystic neoplasms in pancreas and liver
other visceral neoplasms
115
pyogenic granuloma
```
aka lobular capillary hemagioma
polypoid capillary hemagioma
rapidly growing red nodule
skin or gingival or oral mucosa bleeds easily and often ulcerated
1/3 post trauma
edema and inflammatory infiltrate
```
116
granuloma gravidarum
pyogenic granuloma that occurs in gingiva of 1% of pregnant women
regresses postpartum
117
lymphangioma circumscriptum
aka capillary/simple lymphangioma
small lymphatic channels
tend to occur subQ in head and neck and axilla
absence of luminal lymphangioma
118
cavernous lymphangioma
aka cystic hygroma
in children in neck or axilla, and rarely retroperitoneal
massively dialted cystic lymphatic spaces
occur in turners syndrome
genetic testing asap
119
glomus tumors
```
aka glomangioma
benign
PAINFUL
modified cells of glomus body
(anteriovenous anasomosis)
mostly in distal digits
small, elevated, rounded, red-blue, firm nodules
```
120
telangiectasia
congenital anomaly or acquired permanent exaggeration of preformed vessels
121
nevus flammeus
birthmark
most common form of sctasia
port wine stains- usually don't fade)
sturge-weber syndrome
122
sturge-weber syndrome
aka encephalotrigeminal angiomatosis
uncommon congenital disorder
venous angiomatous masses in leptomengies
ispilateral port-wine stain nevi w/trigeminal n distribution
often associated w/metal retardation, seizures, hemiplegia, and radiopacities in skull
123
spider telangiectasia
dialted subQ aa or arterioles about a central core that blanches when pressure applied to center
usually face, neck, or upper chest
most frequent in pregnant women and cirrhosis of liver due to increased E2
124
hereditaty hemorrhagic telangiectasia
aka osler-weber-rendu disease
congenital malformations consisting of dilated capillaries and vv
present at birth and distributed widely over skin and mucous membranes of oral cavity, lips, respiratory, GI, and GU tracts
autosomal dominant
TGFbeta signaling mutations
125
bacillary angiomatosis
```
gram neg bacilli of bartonella family
first seen in aids
skin, bone, brain
domestic cat is reservoir and cat flea vector -> cat scratch disease
b quintana- trench fever
HIF1alpha
```
126
bacillary peliosis
closely related to bacillary angiomatosis vascular lesion
| liver and spleen
127
kaposi sarcoma
```
HHV-8/KSHV
95% of kaposi lesions are infected w/KSHV
infects endothelial cells
viral induced G protein induces VEGF
immunosupressed and AIDS patients
most are asymptomatic
```
128
kaposi stages
patch stage
plaque stage
nodular stage
129
patch stage
pink to purple solitary or multiple macules
| dilated angulated blood vessels and chronic inflammatory cells
130
plaqe stage
larger, violaceous dermal jagged vascular channels, lined by plump spindle cells w/occasional mitoses w/RBC extravasation
131
nodular stage
raided nodular lesions
often accompanied by involvement of lymph nodes and viscer
sheets of spindle cells w/mitotic figures and slit like spaces w/rows of red cells
132
types of kaposi sarcoma
chronic/classic/european
lymphadenopathic/african/endemic
transplant/immunosupressed associated
AIDS- associated
133
chronic KS presentation
-older men of eastern european (ashkenazi jews) or -Mediterranean descent
multiple red-purple skin plaques or nodules, primarily on the arms or legs spreading proximal -viscera or mucosa becomes involved in 10% of patients
134
chronic KS treatment
resection of primary lesions and recurrences
radiation
chemotherapy for extensive or disseminated disease
135
lymphadenopathic KS
young bantu children of south africa (same region as burkitt lyphoma)
extreemly aggresive 100% mortality in 3 years
localized or generalized lymphadenopathy
skin lesions sparse
136
lymphadenopahtic KS treatment
chemo or radiation
137
transplant associated KS
```
months-years post transplant w/high doses of immunosuppressants
aggressive
lymph nodes, mucosa, and visceral organs
internal involvement usually fatal
skin lesions may be absent
```
138
transplant KS treatment
withdrawl or reduction of immunosuppressives
| chemo, radiation
139
AIDs associated KS
most common cancer in US aids patients
lesions of have no site of predilection, but involvement of lymph nodes and gut w/wide dissemination tends to occur early
most patiensts eventually succumb to opportunistic infectious complications of AIDs not KS
140
AIDs associated KS treatment
antiretroviral therapy
| angiogenesis inhibitors may be helpful
141
hemangioendothelioma
intermediate btwn hemangiomas and angiosarcomas
142
epithelioid hemangioendothelioma
vascular tumor occurring around medium and large vv in soft tissues of adults
inconspicuous defined vascular channels and tumor cells are plump and often cuboidal
most cured by excision but 50% recur
20-30% metastasize
15% die from metastases
143
angiosarcoma
malignant and vary formo differentiated to anaplastic
more often in older adults
most common in skin, soft tissue, breast, liver
5 yr survival 30%
can be induced by radiation and w/foreign material
CD31, CD34, Factor VIII, vWF
144
cutaneous angiosarcoma
small often asymptomatic, red nodules
| eventually become large, fleshy, pale, gray-white, with central softening, necrosis, and hemorrhage
