Pathoma - Arteriosclerosis - Fundamentals Of Pathology

Front 1

What does arteriosclerosis mean (the word itself)?

Back 1

arterio - artery
sclerosis - hardening

Front 2

What three pathologic patterns to atherosclerosis are there?

Back 2

(1) Atherosclerosis
(2) Arteriolosclerosis
(3) Mönckeberg medial sclerosis

Front 3

In atherosclerosis we get a thickening of the __________ of the blood vessel wall. It usually occurs in what sized vessels?

Back 3

intima

Usually occurs in medium- and large-sized blood vessels.

Front 4

Arteriolosclerosis usually occurs in what sized vessels?

Back 4

small blood vessels

Front 5

What happens in Mönckeberg medial sclerosis?

Back 5

Calcification of the media of a blood vessel.

Front 6

How does Mönckeberg medial sclerosis present?

Back 6

It doesn't. It is clinically nonsignificant unless it is associated with atherosclerosis. Seen as incidental finding on X-ray or mammography.

Front 7

What is atherosclerosis?

Back 7

Intimal plaque that disrupts blood flow.

Front 8

The plaque in atherosclerosis consists of what?

Back 8

Mostly consists of a necrotic lipid core (key component is cholesterol). It has a fibromuscular cap. Core can often undergo dystrophic calcification

Inside the circle on the picture we see expansion of the intima with a necrotic lipid core.

Front 9

Pathognomonic lesion of atherosclerosis is __________.

Back 9

fibrous cap

Front 10

What is increased in patients with disrupted plaques?

Back 10

CRP

Front 11

Sites of atherosclerosis in descending order.

Back 11

(1) Abdominal aorta (MC site)
(2) Coronary artery
(3) Popliteal artery
(4) Internal carotid artery

Front 12

Risk factors for atherosclerosis are divided how?

Back 12

Modifiable and nonmodifiable risk factors.

Front 13

Modifiable risk factors for atherosclerosis include [...]

Back 13

(1) HTN
(2) Hypercholesterolemia
(3) Smoking
(4) Diabetes

Front 14

Nonmodifiable risk factors for atherosclerosis?

Back 14

(1) Age
(2) Gender (increased risk in males)
(3) Genetics (family history is highly predictive of risk)

Front 15

What is the pathogenesis of atherosclerosis?

Back 15

1. Endothelial cell damage (e.g. HTN, tobacco, homocysteine, ox. LDL)
2. Lipids enter the intima and gets oxidized.
3. Macrophages/lipids adhere to dmged endothelium
4. Macrophages eat ox. LDL and release cytokines that cause hyperplasia of SMC
5. SMC also take up cholesterol. They secrete cytokines that produce ECM (collagen, proteoglycans, elastin)

Front 16

What is a precursor lesion to atherosclerosis?

Back 16

Fatty streak

Front 17

Fibromuscular cap is due to what?

Back 17

Inflammation and healing with deposition of collagen and proliferation of smooth muscle cells.

Front 18

What role does atherosclerosis play in disease in the Western world?

Back 18

It accounts for MORE THAN 50% of disease in the Western world

Front 19

Give some examples of atherosclerosis in different arteries and how they present.

Back 19

(1) Stenosis of e.g. popliteal artery with peripheral vascular disease

(2) Angina (coronary artery)

(3) Ischemic bowel disease (mesenteric aa.)

Front 20

You usually don't get symptoms of atherosclerosis until you have more than _____ % of stenosis.

Back 20

70%

Front 21

Except for stenosis, what is another complication of atherosclerosis?

Back 21

Plaque rupture with thrombosis. This happens at it's "neck". It would expose necrotic lipid core, activating coagulation cascade.

Front 22

Plaque rupture with thrombosis may result in what?

Back 22

(1) Myocardial infarction (coronary artery)
(2) Stroke (middle cerebral artery)

Front 23

Aside from stenosis and plaque rupture, what is another complication of atherosclerosis?

Back 23

Plaque rupture with embolization (part of plaque embolizes). Results in atherosclerotic embolus.

Front 24

The hallmark of atherosclerotic emboli is what?

Back 24

Cholesterol clefts in emboli

Front 25

List the complications of atherosclerosis.

Back 25

(1) Stenosis with ischemia
(2) Plaque rupture with thrombosis
(3) Plaque rupture with embolization
(4) Weakening of vessel wall

Front 26

Weakening of vessel wall in atherosclerosis results in what? Why?

Back 26

Aneurysm (e.g., abdominal aorta).

Because atherosclerosis represents a diffusion barrier to oxygen. The wall becomes weak (it is dependent on oxygen as everything else).

Front 27

Arteriolosclerosis is what?

Back 27

Narrowing of small arterioles

Front 28

Arteriolosclerosis is divided into what?

Back 28

(1) Hyaline type
(2) Hyperplastic type

Front 29

What happens in hyaline arteriolosclerosis? How does it look in microscope?

Back 29

Proteins leaking into the wall of the vessel. This produces vascular thickening. Seen as pink hyaline on microscopy.

Front 30

What people get hyaline arteriolosclerosis?

Back 30

(1) Those with long-standing benign HTN (high bp forces protein into wall)
(2) Diabetics (non-enzymatic glycosylation of basement membrane, this makes it leaky, protein leaks in)

Front 31

What is a consequence of hyaline arteriolosclerosis? (general)

Back 31

Reduced vessel-caliber and end-organ ischemia.

Front 32

Hyaline arteriolosclerosis classically produces what?

Back 32

Glomerular scarring (arteriolonephrosclerosis). Ischemia will scar glomeruli. This is why patients with DM get chronic renal failure, the glomeruli get scarred.

Front 33

Hyaline arteriolosclerosis in the kidney may progress to what?

Back 33

Chronic Renal Failure (CRF)

Front 34

The patient had diabetes. Describe the gross appearance of the organ.

Back 34

We see scarring on the kidney from long-standing hyaline arteriolosclerosis. (arteriolonephrosclerosis)

Front 35

What does hyperplastic arteriolosclerosis involve?

Back 35

Involves thickening of vessel wall by hyperplasia of smooth muscle.

Front 36

What is this?

Back 36

Hyperplastic arteriolosclerosis. Note the 'onion-skin' appearance.

Front 37

Hyperplastic arteriolosclerosis is due to what?

Back 37

Malignant hypertension. SMC respond to super high bp by hyperplasia.

Front 38

What does hyperplastic arteriolosclerosis lead to? (general)

Back 38

Results in reduced vessel caliber with end-organ ischemia.

Front 39

Malignant HTN may lead to ___________ of the vessel wall.

Back 39

fibrinoid necrosis

Front 40

Malignant HTN classically causes what?

Back 40

Fibrinoid necrosis with acute renal failure with 'flea-bitten' appearance

Front 41

Mönckeberg medial calcific sclerosis is _____________ (mildly/non) obstructive.

Back 41

non

Front 42

What is this?

Back 42

Mönckeberg medial calcific sclerosis.