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114 Cards in this Set
- Front
- Back
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what is Arteriosclerosis?
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Hardening of the arteries
Secondary to Arterial Wall Thickening |
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Which vessels are affected by Arteriosclerosis?
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Small Arteries
Arterioles |
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Clinical causes of Arteriosclerosis?
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HTN
DM |
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Pathological finding w/ Arteriosclerosis?
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Lumen Narrowing
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What is Medial Calcific Sclerosis?
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Calcification of the Media w/ no lumen narrowing
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Which vessels are affected by Atherosclerosis?
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Large to Medium sized arteries
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As far as layers go, which is affected in atherosclerosis?
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the INTIMA!!!!!!!!!!
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Three bad results of Plaques?
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Obstruction-->ischemia
Rupture-->Thrombosis Weaken underlying media-->Aneurysm |
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Non-modifiable risk factors for Atherosclerosis?
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Increasing Age
Male Gender Family History Genetic Disorder |
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Modifiable Risk Factors for Atherosclerosis?
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Hyperlipidemia
HTN Cigarettes Diabetes C-Reactive Protein and Inflammation |
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The 8 factors of the Pathogenesis of Atherosclerosis
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Chronic Endothelial Injury
Lipoprotein Accumulation Monocyte Adhesion to Endothelium Platelet Adhesion Factor Release Smooth Muscle Cell Prolif ECM Production Lipid Accumulation in Cells |
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What is the first gross change visible in atherosclerosis?
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Fatty Streaks
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In plaques, what is the white parts composed of?
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Collagen
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What is the #1 place you'd expect to find atherosclerosis in an elderly patient?
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Abdominal Aorta right about the iliac bifurcation
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Around which artery branchings is atherosclerosis in the Abd Aorta common?
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The intercostals
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4 Different Pathogeny leading to Aneurysms?
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Atherosclerosis
Syphillis (tertiary) Dissection secondary to Cystic Medial Necrosis Congential (berry) |
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Where would you typically find an aneurysm due to atherosclerosis?
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Abd Aorta
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Where would you typically find an aneurysm due to Tertiary Syphillis?
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Thoracic Aorta
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Where would you typically find an aneurysm due to a dissection secondary to cystic medial necrosis?
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Variable, but often thoracic aorta
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Where would you typically find an aneurysm due to congenital issues?
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Cerebral Arteries
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Pathogenesis of an Abdominal Aortic Aneurysm?
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Atherosclerosis leading to thinning and weakening of media
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Typical patient with an AAA?
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>50 year old male
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Typical location of AAA?
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between renal brancing and iliac bifurcation
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Types of AAA?
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Fusiform (diffuse)
Saccular (outpouch) |
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Which type predominates?
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Fusiform
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Complications from an AAA?
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Rupture
Obstruction Embolism |
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Location of Thoracic Aortic Aneurysms
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Ascending Aorta, just distal to aortic valve
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Predominate type for TAA?
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Saccular
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Gross Findings w/ a TAA?
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Wrinkling of intima (tree bark)
Obliterative endarteritis of vasa vasorum |
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Histological Findings w/ a TAA?
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Patchy loss of Elastic fibers in media
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TAA Complications
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Aortic Valvular Ring Dilation
Aortic Insufficiency Congestive Heart Failure |
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Another aortic disease not associated w/ atherosclerosis?
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Aortic Dissection
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Etiology of Aortic Dissection?
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90% HTN
Connective Tissue Disorder in younger folks |
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Typical Aortic Dissection patient?
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40-60 year old male
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Which CT diseases can --> Dissection/
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Marfan's
Cystic Medial Degeneration |
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Typical Location of Aortic Dissection?
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Beginning in Asc Aorta and extending from thoracic to abd
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Morphology of Aortic Dissections?
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Intimal Tear
Dissection of blood into media Extends Proximally-->Distally |
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Aortic Dissection Complications
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Rupture
Massive Catastrophic Hemorrhage-->hemothorax Rupture into Pericardium-->tamponade |
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Most common location of cerebral aneurysm?
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Anterior Communicating Artery
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What is a condition that increases your risk of a berry aneurysm?
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Polycystic Kidney Disease
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What is vasculitis?
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Inflammation of walls of vessels
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Associated Sx's of vasculitis?
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Fever
Myalgia Arthralgias Malaise |
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Etiology of Vasculitis
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Immune-mediated
Pathogen Invasion Physical/Chemical Injury Infectious or Noninfectious |
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Which vessels are affected by Noninfectious Vasculitis?
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Small to Larger Arteries
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Definition of Noninfectious Vasculitis?
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Systemic Necrotizing Vascular Inflammation of Variable Pathogenesis
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Different disorders associated w/ vasculitis?
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SLE
Wegener Kawasaki Giant Cell (temporal) Arteritis Takayasu Arteritis Polyarteritis Nodosa |
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Specific Etiology of SLE vasculitis?
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Immune Complexes
antiDNA |
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Specific Etiology of Wegener associated vasculitis?
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Antineutrophil cytoplasmic Ab
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Specific Etiology of Kawasaki associated vasculitis?
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Antiendothelial Cell Ab
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What is the most common vasculitis?
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Giant Cell (Temporal) Arteritis
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Type of inflammation in Temporal Arteritis?
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Chronic, Granulomatous Inflammation
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Which arteries are affected by Temporal Arteritis?
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Small to Large
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Besides the Temporal Artery, which other arteries can be involved in Giant Cell Arteritis?
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Vertebral and Opthalmic
Aorta (rarely) |
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Typical Patient w/ temporal arteritis?
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Older (>50)
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Typical Sx's associated w/ Giant Cell Arteritis?
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Fever
Fatigue Wt Loss HA Facial Pain Painful to Palpation Abrupt Optical Sx's |
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How do you Dx Temporal Arteritis?
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Biopsy Temporal Artery
2-3cm length required due to segmental involvement |
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Pathology of Temporal Arteritis?
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Nodular Intimal Thickening
Lumen Stenosis and Thrombosis Granulomatous Inflammation of Inner Media Lymphocytes and Multinucleated Giant Cells w/ fragmented internal elastic lamina |
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Takayasu Arteritis
type of inflammation? |
Granulomatous
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Takayasu Arteritis
vessels involved? |
medium to larger arteries
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Clinical Sx's of Takayasu Arteritis
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Weak Pulse in upper extremities
Visual Defects -->blindness |
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Typical Takayasu Arteritis patient?
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Females
Under 40 |
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Takayasu Arteritis
Pathology |
Aortic Arch w/ narrowing of great arteries
Irregular thickened intima-->luminal stenosis Granulomatous Infl w/ giant cells and intense mononuclear infl of media Pathcy Medial Necrosis Adventitial Infl Collagenous Scarring of Wall |
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Polyarteritis Nodosa
vessels involved? |
Small-->Medium
Spares arterioles, venules, capillaries |
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Typical age of Polyarteritis Nodosa patients?
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Young Adults
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Polyarteritis Nodosa
Associated Sx's? |
Malaise
Fever Wt Loss Abd Pain Melena Renal |
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Polyarteritis Nodosa
Ag association? |
Hep B Ag present in 30%
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Phases of Polyarteritis Nodosa
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acute
chronic |
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Polyarteritis Nodosa
Acute Phase Kickers? |
Transmural Inflammation
Fibrinoid Necrosis |
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Polyarteritis Nodosa
Chronic Phase Kickers |
Fibrous Nodular Thickening
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Polyarteritis Nodosa
What else can be involved |
Kidney (arterial)
Heart Liver GI Muscle Nerve Skin |
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Polyarteritis Nodosa
what is not involved? |
Lung
Glomeruli |
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What is the leading cause of acquired heart disease in children?
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Kawasaki (involves heart 20% of the time)
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Kawasaki vessel involvement?
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Vasculitis of Medium to Large Arteries
Possibly Coronary Arteries |
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What can happen when Kawasaki affects Coronary Arteries?
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Can cause aneurysms which may rupture or thrombose --> MI
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HYPERSENSITIVITY LEUKOCYTOCLASTIC VASCULITIS
etiology? |
Immunologic Reaction to Ag
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HYPERSENSITIVITY LEUKOCYTOCLASTIC VASCULITIS
What types of things can be the Ag? |
Aspirin
PCN Strep Staph TB Hep |
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HYPERSENSITIVITY LEUKOCYTOCLASTIC VASCULITIS
which vessels are involved? |
Small Vessels
Arterioles, Caps, Venules |
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HYPERSENSITIVITY LEUKOCYTOCLASTIC VASCULITIS
involvement? |
Skin
Possibly Systemic (lung, glomeruli) |
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HYPERSENSITIVITY LEUKOCYTOCLASTIC VASCULITIS
How can it present on the skin? |
Same Aged Lesions
Palpable Purpura on Lower Extremities |
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HYPERSENSITIVITY LEUKOCYTOCLASTIC VASCULITIS
how might it systemically present? |
Hemoptysis (lung)
Hematuria (glomeruli) |
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CHURG-STRAUSS SYNDROME
type of vasculitis? |
Systemic
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CHURG-STRAUSS SYNDROME
presentation? |
Bronchial Asthma
Allergic Rhinitis |
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CHURG-STRAUSS SYNDROME
Marker? |
pANCA
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CHURG-STRAUSS SYNDROME
involvement? |
Small-Med vessels
Lung Heart Spleen Nerves Skin Renal (infrequent) |
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CHURG-STRAUSS SYNDROME
histopath? |
Granulomatous Inflammation w/ intense eosinophil prolif
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WEGENER'S
Triad? |
-Acute Necrotizing Granulomas of Upper and Lower Resp Tract
-Necrotizing/Granulomatous Vasculitis of small/med vessels, esp in lungs -Focal necrotizing Glomerulonephritis |
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WEGENER'S
Typical Pt? |
Male
40-50 |
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WEGENER'S
Clinical Presentation? |
Persistent Pneumonitis w/ bilateral nodular infiltrates w/ cavitation
Chronic Sinusitis Mucosal ulcers of pharynx Renal Sx's |
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WEGENER'S
Markers? |
cANCAs in 95%
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Another name for Buerger Disease?
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Thromboangiitis Obliterans
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Thromboangiitis Obliterans
vessels involved? |
Small and Medium Arteries
Tibial and Radial |
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Thromboangiitis Obliterans
Kickers |
Smoking Related
< 35yrs old Cold Sensitivity (Raynaud) Ulcers of fingers, toes, feet Severe pain at rest Instep Claudication |
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INFECTIOUS VASCULITIS
Different Causes? |
Bacterial (neisseria)
Rickettsial (RMSF) Spirochetal (syphilis) Fungal (aspergillosis, mucor) Viral (zoster) |
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What is the two venous pathologies we learned about?
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Varicose Veins
Thrombophlebitis |
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VARICOSE VEINS
vessels involved? |
Superficial Veins of Upper and Lower Extremities
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VARICOSE VEINS
etiology |
Prolonged Inc Intraluminal Pressure
Venous Stasis and Pedal Edema from incompetent valves secondary to dilatation |
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VARICOSE VEINS
Secondary Sx's? |
Stasis Dermatitis
Ulceration of overlying skin |
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how are varicose veins and thromboemboli intertwined?
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THEY AREN'T
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What types of cancer can --> Thrombophlebitis?
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Adenocarcinoma of pancreas or colon b/c of inc mucous secretion
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What is the most common vascular tumor?
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Hemangioma
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Types of Hemangioma?
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Capillary or Cavernous
Superficial (skin) or Internal (liver) ALL ARE BENIGN |
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What makes up a hemangioma?
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inc blood filled vessels
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CAPILLARY HEMANGIOMA
locations? |
Skin
Subcu Lips |
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Morphology of CAPILLARY HEMANGIOMA
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Not Encapsulated
Closely packed thin wall capillaries |
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Largest single type of vascular tumor?
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CAPILLARY HEMANGIOMA
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what type do kids get that regress?
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CAPILLARY HEMANGIOMA
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Cavernous Hemangioma
kickers |
Large Dilated Vessels
Less Circumscribed Often deeper tissue Rare Giant Form (face, extremities) |
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GLOMUS TUMOR
kickers |
benign, but painful
Distal Digits (periungal) SMC's of Glomus Body |
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What is a glomus body?
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specialized arteriovenous anastomosis involved in thermoregulation
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Besides HIV patients, who else gets Kaposi's?
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Older, Easter European Men
Transplant Associated |
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Histo of Kaposi's?
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Spindle Cells
Slit Spaces |
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What is the malignant vascular cancer?
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Angiosarcoma
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What is an Angiosarcoma?
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Malignant Endothelial Cell Neoplasm
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Special Form of angiosarcoma?
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Hepatic Form from carcinogenic exposure
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