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Path 11 Vessels

LECOM Path Ch 11 Blood Vessels

As Arterial vessels get smaller the ratio of wall thickness to lumen diameter becomes greater
These are the principal points of physiologic resistance to blood flow arterioles
Halving the diameter of a vessel increases resistance by how much 16 fold
Vascular leakage preferentially happens where postcapillary venules
Relative to arteries, Veins typically have larger____, Larger_____ and thinner____ larger diameters, larger lumens, thinner walls
Vasculogenesis vs Angiogenesis denovo in embryogenesis vs in mature organism
Arteriogenesis remodeling of existing arteries in response to chronic changes
These are found in vascular endothelial cells walls Weibel-Palade bodies
Weibel-Palade bodies store von Willebrand’s factor
Stereotypical response to vessel wall injury is intimal thickening Are intimal and neo-intimal cells identical?
Cardiac output determined by (3) heart contractility, heart rate, blood volume
mutations in the renal Na+ channel lead to Liddle Syndrome
2 types of small vessel disease in HTN hyaline and hyperplastic arteriolosclerosis
Hyaline arteriolosclerosis: Cause plasma protein leakage across damaged endothelial cells
Arterioles with homogenous, pink hyaline thickening and luminal narrowing. Dx? Hyaline arteriosclerosis
Hyperplastic arteriolosclerosis: Seen in malignant/severe HTN
Arterioles with concentric laminated thickening of walls and luminal narrowing. Reduplicated BM and smooth muscle cells. Dx? And what else do you see ? Hyperplastic arteriolosclerosis; fibrinoid deposits and necrotizing arteriolitis esp in the kindney
Calcific, even bone, deposits in walls of muscular arteries after the age of 50. Dx? And is it dangerous? Monckeberg medial sclerosis; no
Demographic for AAA 50+yo male smokers
MC location of a AAA below the renal arteries and above the bifurcation
What do AAAs usually contain inside of them poorly organized, bland, laminated mural thrombus
Inflammatory AAA shows dense periaortic fibrosis with increased lymphs and m acrophages
Mycotic AAA shows infection usually with Salmonella, with suppurative desctruction of the media
3 size classes of AAA and risk of rupture 4-5cm 1%; 5-6cn 11%; >6cm 25%
Dysfunction endothelial cells show (3) increased permeability, enhanced leukocyte adhesion, altered gene expression
7 steps in atherosclerosis Endothelial injury; Accumulation of LDL; Monocyte adhesion; platelet adhesion; Factor release; SM cell proliferation and ECM production; lipid accumulation; E.A.M.P.F.SmEc.L
3 places plaques like to form exiting vessels, branch points, posterior aorta wall
Dominant lipids in atheromatic plaques cholesterol and cholesterol esters
Production of this protein on ECs increases plaque formation VCAM-1
What converts a fatty streak into a mature atheroma intimal SM cell proliferation and ECM deposition
3 growth factors that cause ECM and SM cell growth in atheromas PDGF, FGF, and TGF-α
2cm lesion with lipid-filled macrophages in the intima of the aorta of a 10yo. Normal or disease? Dx? Normal; fatty streak
2 key processes in atherosclerosis intimal thickening and lipid accumulation
Thoracic or abdominal aorta involved in atherosclerosis more often? Abdominal
3 components of atherosclerotic plaques cells: SM, T cell, macrophage; ECM: collagen, elastic, and proteoglycans; lipids intra and extracellular
Critical stenosis is Dx when what happens? And at what % typically? when demand exceeds supply and 70% occlusion
3 catagories of plaque change Rupture/Fissure; Erosion/Ulceration; Hemorrhage into the atheroma
Vulnerable plaques have either large volume of lipid accumulation or thin fibrous cap
Inflammation of a plaque can cause rupture how decreases TIMP production leading to increased fibrous cap reabsorption
One stabilizer of plaques and one exacerbator of them, pharmacologically statin and adrenergic stimulation
Most common time for MI 6am to noon
Saccular or fusiform aneurysm are true or false true aneurysm
Arterial dissection is Dx when blood enters the arterial wall itself
Marfan’s: defect and causes what in vessels fibrilin gene defect, weakening and progressive dilation
Loey-Deitz Syndrome: defect and what happens in vessels mutated TGF-β receptors, vessels rupture easily
Ehler-Danlos syndrome: defect and what is seen in vessels defective Collagen Type III; Weak vessel walls
Cystic medial degeneration: caused by and what is seen ischemia/scurvy/Marfan; degenerative changes, SM cell loss, increasing GAGs
MC location of Aneurysms associated with atherosclerosis abdominal aorta
Atherosclerosis causes wasting of what layer of vessel media
Soft yellow lesion in a vessel, lipid core, white fibrous cap, protruding into the lumen. Dx? atherosclerotic plaque
Most significant independent risk factor for atherosclerosis genetic/ family history
Modifiable risk factors for atherosclerosis (5) hyperlipidemia, HTN, DM, C-reactive protein, Cigarette smoking
Atherosclerosis is initiated by what endothelial damage/dysfunction
Aortic dissection occurs in what 2 demographics men 40-60 with HTN or youth with connective tissue diseases
MC preexisting histology present in dissections cystic medial degeneration
MC location for aortic dissection ascending aorta, within 10 cm of aortic valve
Where the dissection usually happens in the layers of the aorta middle and outter 3rds
Type A disections are between the aortic valve and arch, proximal lesions
Type B disections are not involve the ascending aorta, usually after SC artery
What causes injury in Immune complex vasculitis (2) compliment activation or recruitment of Fc-receptor bearing cells
Drug hypersensitivity with vascular involvement is mediated by antibody complexes
Vasculitis secondary to virus is usually mediated by? And example antibody complex; HBV and 30% w/ polyarteritis nodosa
ANCAs are directed against what? (3) neutrophil primary granules; monocyte lysosome; EC
What is p-ANCA or MPO-ANCA directed against lysosomal enzyme creating ROS
What is c-ANCA or PR3-ANCA directed against neutrophil azurophilic granule
2 diseases characteristic with p-ANCA microscopic polyangiitis and Churg-Strauss syndrome
Disease charachteristic with c-ANCA Wegener granulomatosis
Anti-endothelial cell Ab charachteristic of what disease Kawasaki disease
MC vasculitis is elderly Americans Giant Cell Arteritis
Granulomatous vasculitis, medium and small arteries, an affect aorta Giant Cell Arteritis
Temporal Arteritis, characteristic findings multinucleated giant cells and elastic tissue fragmentation, intimal scarring
50% of Giant Cell Arteritis Pt’s present with ophthalmic artery involvement and permanent blindness
Demographic of Giant Cell Arteritis elderly population
Granulomatous vasculitis of medium to large arteries, transmural fibrous thickening, of the aortic arch Takayasu Arteritis
Early perivascular monos around vasa vasorum, later with medial fibrosis, granulomas, and acellular intimal thickening Takayasu Arteritis
Weakening of upper extremity perfusion pressures Dx (2 names) Pulseless disease or Takayasu arteritis
Takayasu vs Giant Cell Aortitis Different in Dx younger than 50 is Takayasu
Demographic of Takayasu arteritis young people, if over 50 it’s giant cell
Necrotizing vasculitis of small to medium arteries, pulmonary circulation is spared PAN
4 tissues affected in PAN, in order Kidney, heart, liver, GI
Linked to PAN in 30% of Pt’s HBV
ANCA’s with PAN none
Lesions in PAN, same age or different different ages
Sharply circumscribed arterial fibrinoid necrosis with neutrophilic infiltrates. Dx and stage PAN; acute lesion
Marked fibrotic thickening of artery with associated elastic lamina fragmentation. Dx and stage PAN; healed lesion
PAN, demographic young adults with NSC
Acute febrile disease in infants and children Kawasaki Disease
T cell hypersensitivity mediated arteritis of medium-large vessels, unknown Ag, in children Kawasaki Disease
MI in a baby without Chagas Kawasaki Disease
Child, LA, fever, skin rash, oral/conjuctival erythema Dx Kawasaki Disease
2 common causes of infectious vasculitis from local invasion Aspergillus and Mucor
Heavy smoker with extremity vascular involvement Buerger Syndrome
Segmental, thrombosing, acute/chronic inflammation of medium/small vessels in extremities Buerger
Necrotizing or granulomatous vasculitis in small to medium upper airway/lung vessel; necrotizing granulomas of upper/lower respiratory track; glomerulonephritis Wegener Granulomatosis
Mediator and ANCAs in Wegener’s T-cell vs inhaled antigen or microbe; c-ANCA
Demographic and outcome in Wegener 40yo men; 80% 1 year mortality w/o Tx
Granulomas that may coalesce to produce nodules that cavitate in the respiratory track Wegener
Necrotizing arteritis of very small vessels Microscopic Polyangiitis
Microscopic Polyangiitis lesions vs PAN MPA all same stage
ANCAs associated with Microscopic Polyangiitis p-ANCA
Fragmented neutrophilic nuclei, fibrinoid necrosis, necrotizing glomerulonephrosis and pulmonary involvement Microscopic Polyangiitis
Small-vessel necrotizing vasculitis associated with asthma, allergic rhinitis and extravascular necrotizing granulomas Churg-Strauss Syndrome
PAN like lesions with addition of eosinophils and granulomas Churg-Strauss
MCC of mortality of Churg-Strauss eosinophilic infiltrates of the heart/cardiac involvement
Young women, drastic vasoconstriction, benign clinical course Dx? Primary Raynaud
Vascular insufficiency due to arterial narrowing by other condition. Dx? Secondary Raynaud
Superficial lower extremity veins, tortuous and dilated varicose vein
2 specific varicosities hemorrhoids and esophageal varicies
4 common predisposing factors for DVT hypercoaguable state, prolonged immobilization, infection, CHF
SVC syndrome: Cause and effects tumor compression or invasion of SVC; dusky appearance, dilation of head, arm, neck veins
IVC Sydrome: Cause and effects tumor compression or invasion; dilated leg and lower body veins, proteinuria
Common bacterial cause of lymphangitis β-hemolytic Strep
Spread of infection into lyphatics Dx? lymphangitis
This is caused by obstructionof the lymphatic system, increases interstitial fluid lymphedema
Cause of primary lymphatic agenesis Milroy Disease
3 types of hemangioma capillary hemangioma, Cavernous hemanioma, Pyogenic granuloma
MC vascular tumor capillary hemangioma
Un-encapsulated clustering of tiny thin walled vessels, usually on skin Capillary hemangioma
Un-encapsulated lesion with large thin walled vascular spaces, on skin, liver, CNS cavernous hangioma
Proliferating capillaries with interposed edema and inflammation, Ulcerated polypoid variant, often after trauma Pyogenic Granuloma
Small blister like bleb filled with small lymphatic channels, lined with EC Simple/Capillary lymphangioma
Poorly encapsulated, can be large, found in children’s neck and axilla Cystic hygroma/ Cavernous lymphangioma
Tiny spot usually under fingernail with aggregate, nests, and masses of specialized glomus cells, with branching vascular channels Glomangioma
Vascular ectasias are actually just dilation of pre-existing vessels Nevus flammeus is
Minute, subcutaneous arterioles, in a radial fasion spider telangiectasia
Rare autosomal disease with multiple small, aneurysmal telangiectasias, on skin and mucous membranes Hereditary Hemorrhagic telangiectasia / Osler-Weber-Rendu disease
Vascular proliferation from opportunistic infection in the immunocompromised Bacillary Angiomatosis
Bacterial cause of bacillary Angiomatosis Gram negative Bartonella sp.
4 types of Kaposi Sarcoma Classic, African/endemic, transplant-associated, AIDS associated
Virus associated with Kaposi Sarcoma HHV-8 or KSHV
3 stages of Kaposi Sarcoma lesions Patches; Raised Plaques; Nodular lesions
A well differentiated angiosarcoma is called hemangiosarcoma
3 causes of hepatic angiosarcomas arsenic/pesticides; polyvinyl chloride; Thorotrast
Gray-white soft-tissue mass; in arm of woman post-radical mastectomy in lymph lymphangiosarcoma
Created by: csheck