06 - Pathology Blood Vessels
Terms
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- Simple tubular structures made up of a layer of _____ cells surrounded by one or more layers of ________ cells
-
Endothelial
Smooth Muscle - Layers of blood vessels
-
Tunica Intima
Tunica Media
Tunica Adventitia - The Aorta and Large Arteries are _____
- Elastic
- The smaller arteries are ____ arteries
- muscular
- Tiniest blood vessels
- Capillaries
- Blood vessels important in maintaining blood pressure
- Arterioles
- The majority of the clotting factors are produced in the _______ with the exception of _______, which has a component of which that is produced in the endothelial cells.
-
Liver
Factor VIII - Vascular smooth muscle is involved in _____ and _____
- Vasoconstriction and Dilation
-
VAscular Smooth Muscle is involved in __1___synthesis.
After injury to the blood vessel it can ___2___.
It has receptors for __3__
It can also perform __4__ -
1. Matrix (collagen, elastin)
2. migration and proliferation
3. lipoproteins
4. Phagocytosis -
Atherosclerosis is a disease of ____ and ____ arteries.
It is accumulation within the ______ of smooth muscle cells and lipids. -
Medium and Large sized
Intima - Leading cause of death in the US
- Ischemic Heart Disease
- Macrophage with ingested lipid =
- Foam cells
- Stages of atherosclerotic plaque development
-
1. Fatty Streak
2. Fibrous plaque
3. Thrombus on top of Atheroma - 1st step in Atherosclerosis and possible causes (5)
-
Chronic Endothelial injury
-increased lipids
-cigarette smoking
-homocysteine
-infections
-Hypertension - 2nd step in Atherosclerosis
- endothelial dysfunction such as increased permeability allowing lipids and cells to trickle thru endothelium
- 3rd step in Atherosclerosis
-
Smooth Muscle emigration from Media to Intima.
Macrophage activation and secretion of cytokines - 4th step in Athersclerosis
-
Macrophage and smooth muscle cells engulf lipid
Fatty Streak development - 5th step in Atherosclerosis
-
Smooth muscle proliferation
Collagen and ECM deposition
Extracellular Lipid
Fibrofatty Atheroma - Type of Atheromas that are more dangerous
- Soft ones with more lipids because they can rupture more easliy
- Initial lesion of Atherosclerosis
-
Fatty streak - Two components of Atheroma
-
1. Fibrous cap
2. Soft center (atheroma) - What is the risk factor for Atherosclerosis?
- any factor associated with a doubling in the incidence of ishemic heart disease
- 4 Nonmodifiable Major risk factors for Atherosclerosis
-
1. Increasing Age
2. Male
3. Family History
4. Genetic Abnormalities - 4 "Potentially controllable" risk factors for Atherosclerosis
-
1. Hyperlipidemia
2. Hypertension
3. Cigarette Smoking
4. Diabetes - Type of cholesterol that is more atherogenic
- Oxidized LDL
-
Cholesterol Metabolism and Atherosclerosis:
-__1__ defect.
-Polymorphism of __2__
-Lipoprotein__3__ -
1. LDL receptor defect = Familial Hypercholesterolemia
2. Apolipoprotein E
3. Lipoprotein (a) - Apolipoprotein that causes reduced or absent HDL
- ApoA1
- Enzyme Defects that cause Atherosclerosis (3)
-
1. Lipoprotein Lipase --> Type 1 Hyperlipidemia
2. Hepatic Lipase --> elevated IDL and LDL --> Severe Atherosclerosis
3. LCAT --> mild hypertriglyceridemia, reduced HDL - Receptor defect that causes severely elevated LDL
- Familial Hypercholesterolemia
- 4 complications of Atherosclerosis
-
1. Acute occlusion --> ischemic necrosis
2. Chronic occlusion --> atrophy
3. Aneurysm formation
4. Embolism - Most common sites of Severe Atherosclerosis (5)
-
1. Abdominal Aorta and Iliac Arteries
2. Proximal Coronary Arteries
3. Thoracic Aorta, Femoral, and Popliteal Arteries
4. Internal Carotid Arteries
5. Vertebral, basilar, and middle cerebral arteries - 4 Non-invasive measures for Atherosclerosis Intervention
-
1. Dietary control and exercise
2. Lipid lowering drugs
3. Anti-oxidant supplements
4. Aspirin - 6 Invasive measures for Atherosclerosis intervention
-
1. Balloon angioplasty
2. Fibrinolytic therapy
3. Endarterectomy
4. Endovascular atherectomy
5. Arterial by-pass
6. Stenting -
Drugs:
High LDL --> 1
HIgh Lp(a) --> 2
high plasma Triglyceride -> 3
Low HDL -> 4
Hypertension -> 5
Hyperglycemia -> 6
Hyperhomocysteine -> 7
High Fibrinogen -> 8 -
1. Statins
2. Nicotinic acid
3. Fibric acid
4. Nicotinic acid
5. Thiazide diuretics
6. Insulin
7. Folic Acid
8. Fibric Acid - Complication with Balloon Angioplasty and Vascular replacement
- Destruction of endothelial wall causing re-stenosis
- Aneurysms: localized __1__ of blood vessles caused by a congenital or acquired weakness in the __2__
-
1. dilation
2. media - 4 types of Aneurysms
-
Dissecting
Arteriovenous
*Fusiform
*Saccular
*most common - Classification of Aneurysms by Etiology (5)
-
1. Atherosclerotic
2. Syphilitic
3. Dissecting
4. Mycotic
5. Congenital - Atherosclerotic aneurysms most commonly occur in the __1___. They are usually of this type: __2__. They may contain a __3__. Microscopically there is destruction of __4__
-
1. Abdominal Aorta and common Iliac Arteries
2. Fusiform
3. Mural Thrombosis
4. arterial wall elastic fibers - 3 clinical features of Atherosclerotic aneurysms
-
1. Rupture: emergency with severe pai, shock, bleeding into ab/thoracic cavity
2. Local ischemic effects due to compression of surrounding arteries
3. Ab pain due to compression of nerves - Atherosclerotic aneurysms greater than _____ have a great risk of rupture
- 5 cm
- Factors of Aortic Aneurysms that leads to Mural Thrombosis
-
1. exposure of sub-endothelial tissue to the blood which results in thrombosis
2. Stagnation or alteration in blood flow in the dilated vessl allows for Thrombosis - Abdominal Aortic Aneurysms are usually located ______
- below the renal artery orifices
- What is an Aortic Dissection?
- a form of hematoma within the vessel wall = blood flowing through the layers of the wall
- Cause for 90% of Aortic Dissections
- Older males who have hypertension
- Other causes for Aortic Dissection
- Marfan Syndrome and Cystic Medial necrosis
- What is Cystic Medial Necrosis
-
fragmentation of elastic fibers in the Media (associated with pregnant women and Marfan syndrome) - Most common site of Aortic dissection
- Ascending Aorta usually within 10 cm of Aortic Ring
- Clinical presentation of person with Aortic Dissection
- Severe, tearing chest pain that starts in the chest and radiates in the direction of the dissection = along the arch of aorta and down into the abdomen.
- Aortic Dissection characteristically results in __1__, most often into the __2__, causing hemopericardium and fatal __3__
-
1. aortic rupture
2. pericardial sac
3. cardiac tamponade - What is a double-barreled aorta?
- Dissecting aneurysm that has ruptured back into the lumen of the Aorta
- Define Type A and B Dissection Aneurysms
-
Type A = ascending aorta
Type B = descending aorta -
Syphilitic Aneurysm:
Incidence: __1__
Most common site: __2__
Intima appearance: __3__
Obliterative __4__ of the __5__ with __6__ infiltration
Organism: __7__ -
1. uncommon
2. Thoracic Aorta
3. Tree Bark appearance (due to necrosis and scarring)
4. Endarteritis
5. Vasa vasorum (supplies blood to intima media)
6. Plasma cell
7. Treponema Pallidum - Syphilitic aneurysm can affect the ascending aorta and the aortic ring leading to ________
- Aortic Valve Insufficiency causing Left Ventricular Dilation and Hypertrophy
-
Berry Aneurysm:
Involves the __1__ arteries.
Congenital defect in __2__ of blood vessels.
The most frequent cause of __3__ hemorrhage
Age range: 4
Morph: 5 -
1. Cerebral
2. muscularis (media)
3. subarachnoid
4. usually 30-40
5. Saccular - Berry Aneurysms usually occur at this general spot
- bifurcations of cerebral arteries
- Mycotic Aneurysms result from __1__ and __2__ of the vessel wall
-
1. microbial infection
2. weakening - Vessels most commonly affected by Mycotic Aneurysms (3)
-
Aorta
Cerebral vessels
Splanchnic arteries - What is a Pseudoaneurysm?
- leakage of blood from an artery into the surrounding tissue with persistent communication between the originating artery and the terminating blood filled cavity
- Another word for Vasculitis
- Angiitis
- Vasculitis due to Immune Complexes (3)
-
Henoch Schonlein
Lupus Vasculitis
Polyarteritis Nodosa (HBV associated) - Vasculitis due to Direct Antibody Attack (2)
-
Goodpasture's Syndrome
Kawasaki disease - Vasculitis associated with ANCA (Anti-neutrophil Cytoplasmic Antibodies) (3)
-
Wegener's
Microscopic Polyangiitis
Churg Strauss -
Polyarteritis Nodosa:
Artery types: __1__
__2__ involvement of arteries.
__3__ necrosis with infiltration of __4__.
Associated with __5__.
Can produce small __6__ -
1. Small and Medium arteries
2. Patchy
3. Fibrinoid
4. Eosinophils
5. Thrombosis
6. Aneurysms (nodosa) -
Polyarteritis Nodosa:
-Associated with __1__ in 30% of patients.
-Organs involved __2__ (4)
-spares these arteries: __3__
-DOC's: __4__ (2) -
1. Hepatitis B
2. Kidney, Heart, Skeletal muscle, Skin
3. Pulmonary
4. Steroids and Cyclophosphamide - This is common if the kidneys are involved in Polyarteritis Nodosa
- Hypertension
- Giant Cell Arteritis alternate name
-
Temporal Arteritis
Granulomatous Arteritis -
Giant Cell Arteritis:
-Focal, chronic __1__ inflammation of __2__ arteries
-Age group: __3__
-Artery morph: __4__
-__5__ in lumen is common
- presents with __6__
-__7__ symptoms in 50% of patients
-Elevated __8__
-
1. granulomatous
2. temporal
3. >50
4. cord-like and nodular
5. thrombus
6. temporal headhache
7. Visual (ophthalmic artery)
8. ESR
9. Males -
Wegener's Granulomatous:
-Vessels involved: __1__
- Sites affected: __2__ (3)
-serum antibody present: __3_
-__4__ and __5__ inflammation -
1. Small arteries and veins
2. Nasal sinuses, Lungs, Kidneys
3. c-ANCA
4. Necrosis
5. Granulomatous - Hypersensitivity Angiitis alternative name
- Microscopic Polyarteritis
- What is Hypersensitivity Angiitis due to?
- response to exogenous substances
-
Hypersensitivity Angiitis:
-Cutaneous lesions due to _1_
-Vessels affected: __2__
-may be a feature of other systemic diseases such as __3__.
-__4__ is present
-Clinical presentation: __5__ -
1. Leukocytoclastic vasculitis = PMN's release tissue degrading substances
2. Small -> arterioles, capillaries, venuoles
3. Lupus Erythematosus
4. p-ANCA
5. Palpable Purpura - Difference between Hypersensitivity Angiitis and Polyarteritis Nodosa
-
HSA vessels are all at the same stage of inflammation.
PAN vessels may be at all stages of acute and chronic inflammation - Churg-Strauss Syndrome alternate name
- Allergic Granulomatosis and Angiitis
-
Churg-Strauss Syndrome:
-Systemic vasculitis with prominent __1__.
-affects young persons with history of __2__
-widespread __3__ vascular lesion.
-Vessels affected: __4__
-__5__ is present in serum -
1. Eosinophilia
2. Asthma
3. necrotizing
4. small and medium arteries and veins
5. p-ANCA -
Takayasu Arteritis:
-known as __1__ disease
- Vessels affected: __2__
-persons affected: __3__
-__4__ thickening and obliteration of __5__
- absent __6__ pulse -
1. Pulseless
2. Aortic arch, large arteries
3. Young women
4. INTIMA
5. lumen
6. upper extremities -
Kawasaki Disease:
-Alternate name:__1__
- Age group: __2__
- Clinical manifestations: __3__ (4)
-may cause aneurysms in __4__ -
1. Mucocutaneous lymph node syndrome
2. < 4 yoa
3. Fever, rash, conjuctival and oral lesions, Lymphadenitis
4. Coronary Artery - Thrombo-angiitis Obliterans alternate name
- Buerger Disease
-
Buerger Disease:
-Vessels involved: __1__
- painful __2__ disease, often leading to __3__
-associated with __4__
-Intermittent __5__ -
1. small and medium arteries
2. ischemic (occlusive)
3. gangrene
4. SMoking
5. claudication - Large Vessel Vasculitis' (2)
-
Giant Cell Arteritis
Takayasu Arteritis - Medium-sized Vessel Vasculitis (2)
-
Polyarteritis Nodosa
Kawasaki disease - Small Vessel Vasculitis (5)
-
Wegener's Granulomatosis
Churg-Strauss Syndrome
Leukocytoclastic Vasculitis
Henoch Schonlein Purpura (IgA immunocomplexes)
Microscopic Polyarteritis -
Antineutrophil Cytoplasmic Antibodies:
Heterogenous group of __1__ against enzymes mainly in __2__ -
1. Autoantibodies
2. Neutrophil Granules - c-ANCA is seen in _____
- Wegener's
- p-ANCA is seen in these 2
-
Microscopic Polyarteritis
Churg-Strauss -
Raynaud Phenomenon:
-Intermittent, __1__ attacks of __2__ of fingers or toes leading to __3__
-Related to exposure to __4__
-Due to __5__
-Primary type occurs in __6__
-Associated with __7__ -
1. bilateral
2. ischemia
3. pallor, pain, parasthesia
4. Cold
5. Arterial spasm
6. young females
7. Scleroderma - 4 Benign Tumors of Blood Vessels
-
1. Hemangioma
2. Granuloma Pyogenicum
3. Vascular Ectasia
4. Glomus Tumor - Borderline (intermediate) Tumor of Blood Vessels
- Hemangioendothelioma
- Malignant Tumors of Blood Vessels (3)
-
1. Angiosarcoma
2. Hemangiopericytoma
3. Kaposi Sarcoma - Only great concern with Hemangiomas
- Is if they start to bleed
- 2 type of Hemangiomas
-
Capillary Hemangioma
Cavernous Hemangioma - Histology of Cavernous Hemaniogmas
- Large vascular spaces lined by FLATTENED endothelial cells
- A malignant neoplasm of vascular origin characterized by MASSES of Endothelial cells
- Angiosarcoma
- Development of HEPATIC Angiosarcomas is associated with... (3)
-
Polyvinyl Chloride
Arsenic
Thorotrast (Thorium Dioxide) - Sites where Angiosarcomas occur (4)
-
Skin
Soft Tissue
Breast
Liver - Histology of Angiosarcomas
-
irregular vascular spaces lined by Malignant-apearing endothelial cells with HYPERCHROMATIC NUCLEI - Explain "Lymphedema Associated Angiosarcoma"
- Development of an Angiosarcoma in the Lymphedematous arm of a patient who has has AXILLARY LYMPH NODE DISSECTION for breast cancer (due to Statis)
- Alternate name for "Lymphedema Associated Angiosarcoma"
- Stewart-Treves Syndrome
- Classic Kaposi's Sarcoma affects these people
- Older European men
- African Kaposi's Sarcoma presents with this
- Lymphadenopathy in African men and children
- Transplants associated KS is due to this
- Immunosuppression
- AIDS associated KS occurs in these people and with what co-infection?
-
Homo Males
HHV-8 - 3 Stages of Lesion development in KS
-
1. Patch stage
2. Plaque Stage
3. Nodular stage - Benign capillary proliferation involving the skin/visceral organs in AIDS patients caused by Bartonella Henselae (Cat Scratch Fever)
-
Bacillary Angiomatosis
*responds to Antibiotics* - What are varicose veins?
- enlarged tortuous veins
- Risk Factors for Varicose Veins of the LEGS (6)
-
1. Increasing Age
2. FEMALES
3. Hereditary predisposition
4. Obesity
5. Posture (standing job)
6. Increased Venous Pressure - 2 Clinical features of Varicose Veins
-
Swelling
Dull Pain - 2 Complications of Varicose Veins
-
Stasis Dermatitis
Stasis Ulcers - List 3 other sites where Varicose Veins occur (other than leg)
-
1. Esophageal Varices = portal hypertensio due to Cirrhosis
2. Hemorrhoids = internal/external hemorrhoid plexus of rectum
3. Varicocele = pampiniform plexus of Scrotum - Thrombus of Veins without Inflammation
- Phlebothrombosis
- Thrombus of veins associated with Inflammation
- Thrombophlebitis
- Which one is more dangerous - Thrombophlebitis or Phlebothrombosis? Why?
- Phlebothrombosis b/c it is more likely to break off and produce Pulmonary Emboli
-
An acute inflammation involving Lymphatics, usually BACTERIAL in origin causing painful red streaks in the SUBCUTIS - Lymphangitis
- Occlusion of Lymphatics leading to accumulation of interstitial fluid
- Lymphedema
- 5 causes of Lymphedema
-
1. invasion of lymphatics by malignant cells
2. radical surgery
3. post-irradiation fibrosis
4. post-inflammatory scarring
5. parasitic infection --> Filariasis - Arteriosclerosis = __1__ and __2__ of the ARTERIES
-
1. thickening
2. Hardening - Arteriosclerosis due to aging
- Senile Arteriosclerosis
- Medial Calcification Sclerosis
- Monckeberg's Medial Sclerosis
- Monckeberg's Medial Sclerosis usually occurs in these arteries and affects this age group
-
Arteries of Upper/Lower Extremities (radial & Ulnar)
> 50 yoa
*usually asymptomatic - Hypertension: Systolic pressure > __1__ or Diastolic pressure > __2__
-
1. 140 mm Hg
2. 90 mm Hg - What is Secondary Hypertension?
- 5-10% of cases in which a DEFINITE CAUSE can be identified
- What is Primary Or Essential Hypertension?
- 90-95% of cases that have UNKNOWN etiology
- Secondary Causes of Hypertension
-
R = REnal
E = Endocrine
N = Neurogenic
A = Aortic
L = Labile - Renal causes of Secondary Hypertension (4)
-
1. Stenosis of Artery -> Renin release -> Angiotensin -> 1. constricts arterioles 2. Aldosterone release -> Sodium retention
2. Fibromuscular Dysplasia
3. Atherosclerosis
4. Glomeruonephritis/ Pyelonephritis - Endocrine causes of Secondary Hypertension
-
1. Adrenal Cortical Hyperfunction (Aldosterone) = Cushing's
2. Adrenal Medullary Hyperfunction (Catecholamines) = Pheochromocytoma -
Essential Hypertension is a product of __1__ and __2__.
It is influenced by __3__ and __4__ -
1. Cardiac Output
2. Peripheral Resistance
3. Renal function
4. Sodium Homeostasis -
Pathogenesis of Essential Hypertension:
-Genetic defect in __1__
-Genetic defect in __2__ in vascular smooth muscle
-Variation in genes encoding __3__ -
1. Renal Sodium excretion
2. Sodium/Calcium transport
3. Angiotensinogen - Hypertension Risk Factors (6)
-
1. Family History
2. High Sodium intake
3. Stressful lifestyle
4. Obesity
5. High Alcohol intake
6. ORAL CONTRACEPTIVES -
Clinical Manifestations of Hypertension:
-Early = 1
-Later = 2 -
1. Headhache, nosebleeds, tinnitus, dizziness
2. Stroke, Heart failure, Renal failure - Changes associated with Benign Hypertension
-
Hyaline or Sclerotic Arteriolar changes that are slowly progressing - Describe Malignant Hypertension
-
Rapidly progressive, Arteriolar spasm, Edema, Necrosis
CNS and Renal Complications - Describe the Histology of Malignant Hypertension
-
- concentric, "onion-skinned" thickening of the smooth muscle (hyperplasia)
- Fibrinoid Necrosis
- No inflammation -
Vascular Pathology in Hypertension:
-Accelerates __1__
-Potentiates __2__ and __3__ -
1. Atherogenesis
2. Aortic Dissection
3. Cerebrovascular Hemorrhage - Hyaline changes in arteriolar walls indicate _______
- Hyaline Arteriosclerosis = Benign HTN
- "Onion-skin" lesions with Fibrinoid Necrosis indicate ________
- Hyperplastic Arteriosclerosis = Malignant HTN
-
Factors indicating Adverse Prognosis in HTN:
-Race: __1__
-Age: __2__
-Sex: __3__
-Persistent Diastolic pressure > __4__ -
1. black
2. younger age
3. males
4. 115