Vascular Pathology

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Lab findings in PAN

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p-anca. HBsAg+ in 30%, anemia, leukocytosis

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Microscopic features of PAN

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Segmental necrotizing vasculitis in three stages: fibrinoid necrosis with neutrophils, fibroblast proliferation, nodular fibrosis with loss of internal elastic lamina

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Lab findings in PAN

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p-anca. HBsAg+ in 30%, anemia, leukocytosis

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Microscopic features of PAN

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Segmental necrotizing vasculitis in three stages: fibrinoid necrosis with neutrophils, fibroblast proliferation, nodular fibrosis with loss of internal elastic lamina

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Clinical features of PAN

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Affects all organs except lungs. Fever, hematuria/renal failure/hypertension, abdominal pain/GI bleeding, myalgia/arthralgia

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Clinical features of Wegner granulomatosis

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Bilateral pneumonitis with nodular and cavitary infiltrates, chronic sinusitis, nasopharyngeal ulcerations, renal disease

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Microscopic features of Wegner granulomatosis

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Necrotizing vasculitis of small vessels (granulomas), necrotizing granulomas of respiratory tract, focal necrotizing glomerulonephritis

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Lab findings in Wegner granulomatosis

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c-anca

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Treatment of Wegner granulomatosis

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cyclophosphimide

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Clinical features of temporal arteritis

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Throbbing unilateral headache, visual disturbances, jaw claudication

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Microscopic features of temporal arteritis

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Segmental granulomatous vasculitis with multinucleated giant cells and fragmentation of the internal elastic lamina with intimal fibrosis and luminal thickening

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Diagnosis, lab findings and treatment of temporal arteritis

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Dx.: biopsy of temporal artery. Lab: increased ESR. Rx.: steroids

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Clinical features of Takayasu asteritis

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Loss of pulse in upper extremities, visual disturbances, neurologic abnormalities

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Microscopic features of Takayasu arteritis

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Granulomatous vasculitis with massive intimal fibrosis, thickening of the aortic arch and narrowing of the major arterial branches

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Clinical features of Buerger's disease

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Severe pain in affected extremity, thrombophlebitis, Raynaud phenomenon, ulceration and gangrene. Associated with heavy cigarette smoking

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Microscopic features of Buerger's disease

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Recurrent neutrophilic vasculitis with microabseses, segmental thrombosis and vascular insuficiency

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Clinical features of Kawasaki disease

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Affects children < 4. Acute febrile illness, conjuctivitis, maculopapular rash, lymphadenopathy, coronary aneurysms in 70% of cases

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Microscopic features of Kawasaki disease

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Segmental necrotizing vasculitis with coronary aneurysms

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Diseases that feature Raynaud phenomenon

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SLE, CREST, Buerger, atherosclerosis

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Raynaud diseasse

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Small artery vasospasm resulting in blanching cyanosis of fingers and toes precipitated by cold temperature and emotions

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Henoch-Schonlein purpura

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IgA-C3 immunocomplexes, IgA nephropathy (Berger disease), palpable purpura on buttocks

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Major risk factors for atherosclerosis

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Hyperlipidemia, hypertension, smoking, diabetes

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Most common sites for atherosclerosis

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Abdominal aorta followed by coronary arteries

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Complications of atherosclerosis

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Ischemic heart disease, abdominal aortic aneurysm, peripheral vascular disease (pain, pulselessness, paresthesia, claudication), TIA (vertebral basilar oclussion), renovascular hypertension (high renin).

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Pathophysiology of essential hypertension

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Retention of sodium and water with increase in stroke volume (systolic pressure). Sodium in smooth muscle opens up calcium channels with vasoconstriction of arterioles (increased diastolic pressure). Low renin hypertension.

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Complications of hypertension

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Concentric ventricular hypertrophy, AMI, hyaline arteriosclerosis, nephrosclerosis and CRF, intracranial bleeds, athersoclerosis

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Renovascular hypertension

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Atherosclerosis of renal artery orifice in males or fibromuscular hyperplasia in women. Severe hypertension, epigastric bruit. High renin hypertension. Screen with captopril.

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Captopril screening test for renovascular hypertension

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In renovascular hypertension there's decreased RPF and high levels of renin and angiotensin II. With captopril (ACE inhibitor), there's loss of negative feedback on renin and exagerated high levels of renin post-stimulation. The test has the potential for renal failure if bilateral renal artery stenosis is present as AII is responsible for maintaining renal blood flow.

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Ahterosclerotic aneurysms

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MC site is abdominal aorta below renal arteries (no vasa vasorum). Pulsitile mass with pain and abdominal bruit

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Syphilitic aneurysm

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Obliterative endarteritis of vasa vasorum with ischemia and atrophy of ascending aorta, aortic insuficiency, airway encroachment and laryngeal nerve involvment (brassy cough)

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Associated diseases of dissecting aortic aneurysm

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Marfan, Ehlers-Danlos, copper deficiency (no lysyl oxidase)

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Signs and symptoms of dissecting aortic aneurysm

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Acute retrosternal severe chest pain, aortic insuficiency and cardiac tamponade

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Phlebothrombosis Vs. Thrombophlebitis

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Phlebothrombosis is venous thrombosis of deep veins without inflamation or infection. Thrombophlebitis is venous thrombosis of superficial veins due to inflamation and infection

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Signs, symptoms, diagnosis and complications of DVT

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Leg swelling, warmth, erythema. Increased venous pressure from deep to superficial veins (which drain in deep veins) produces varicosities in superficial system. Complications are thromboembolism, thrombophlebitis. Dx.: Doppler

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Signs, symptoms and causes of thrombophlebitis

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Palpable cord, pain, induration, warmth, erythema. MCC is superficial varicose veins, phlebothrombosis, catherthers, drug abuse

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Clinical features of varicose veins

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Edema, thrombosis, stasis dermatitis, ulcerations

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Clinical features of superior vena cava syndrome

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Compression of SVN by primary lung cancer. Blue discoloration of the face, arms and shoulders, dizziness, convulsions, visual disturbances, distended jugular veins

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Clinical features of Kaposi sarcoma

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Malignant endothelial cell tumor caused by HHV-8. Multiple red-purple patches, plaques or nodules. Spindle shaped cells