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Pathology of Vasculature - Coggle Diagram

- - - - Giant Cell Arteritis
        
        Granulomatous inflammation
        
        Elderly patients
        
        Carotid Artery - Temporal Branch
        
        Presentation
        
        Headaches
        
        Blindness
        
        Treatment
        
        High dose steroids
      - Takayasu arteritis
        
        Epidemiology
        
        YOung patients
        
        Asian women
        
        Presentation
        
        Absent peripheral pulses
        
        Visual distubances
        
        Granulomatous inflammation
      - Aorta and large branches to limbs, head, neck
    - - Main visceral arteries and their branches
      - Polyarteritis Nodasa
        
        Presentation
        
        Necrotising Inflammation
        
        Aneurysm
        
        Associated with Hep B
        
        Usually involving renal artery, sparing pulmonary artery
        
        Young adults
      - Kawasaki Disease
        
        Children
        
        Coronary arteries with aneurysm - cardaic complications
        
        Mucocutaneous lymph node syndrome
        
        Acute
        
        Febrile
    - - Arterioles, venules, capillaries, small arteries
      - GPA - Granulomatosis with polyangiitis
        
        Granulomatous inflammtion of respiratory tract
        
        Necrotising vasculitis of glomeruli
        
        c-ANCA
      - EGPA
        
        Eosinophil-rich granulomatous inflammation of respiratory tract
        
        Necrotising vasculitis of small vessels
        
        Asthma and blood eosinophilia
        
        p-ANCA
      - Microscopic polyangiitis
        
        Necrotising small vessel vasculitis
        
        Few immune deposits
        
        Necrotising glomerulonephritis and pulmoanry capillaritis common
        
        p-ANCA
      - Henoch-Schonlein Purpura
        
        90% in children
        
        Usually self limiting
      - Cryogobulinaemia
        
        Type I, II, III
        
        Many causes
      - Goodpasture Disease
        
        Pulmonary haemorrhage and rapidly progressive glomerulonephritis
  - - - Eg.
        
        • SLE Systemic Lupus Erythematosus
        
        Anti dsDNA
        Anti- nuclear antibody (ANA)
        
        • RA
        
        • Cryoglobulinaemia
        
        IgG
        IgM
        Compliment
        
        • IgA vasculitis (HenochSchonlein purpura)
        
        • Drug reactions
        
        Polyarteritis Nodosa
        
        30% Hep B related
        Immune complex: HBsAg
        
        • Hep B and C
      - Diseases associated with detection of serum
        immune reactants and complement
    - - • Kawasaki’s disease
      - • Goodpasture’s syndrome
    - - Eg
        
        • Microscopic polyangiitis
        
        • Eosinophilic granulomatosis with polyangiitis (EGPA) (previously Churg-Strauss)
        
        • Granulomatosis with polyangiiitis (GPA) (previously Wegener’s)
      - Serum antibody directed against enzymes
        present in neutrophils, endothelial cells and
        monocytes
      - c-ANCA
        
        Cytoplasmic immunofluorescent pattern, specific for proteinase 3 (PR3)
        
        Granulomatosis with polyangiitis
      - p-ANCA
        
        Perinuclear immunofluorescent pattern, specific for myeloperoxidase (MPO)
        
        EGA and Microscopic polyangiitis
    - - Organ allograft rejection
    - - Bacteria (Neisseria)
      - • Fungal (Mucormycosis)
      - • Viral
      - • Rickettsial
      - • Spirochetal (Syphilis)
    - - • Giant cell vasculitis
        
        • Takayasu arteritis
        
        • Polyarteritis nodosa
- - - - Solid mass of blood constituents formed within the vasculature
    - - Pathological formation of blood clot at site of activation of coagulation system
    - - Migration through the vasculature to a distant site
      - Results in ischaemia and infarction
      - Lung
        
        Pulmonary embolism (PE)
      - Brain
        
        Stroke
      - GI tract
        
        Ischaemic bowel
    - - Inadequate blood supply to an organ / part of body resulting in reversible cell injury OR irreversible cell injury with necrosis (infarction)
        The degree of damage depends on the duration of ischaemia and the tissue's metabolic needs
    - - Tissue necrosis due to ischaemia
  - - - Reflex neurogenic mechanism
        
        Endothelia damage leads to local secretion of endothelin (vasoconstrictor)
    - - Temp platelet plug created via platelet adhesion, acivation and aggregation
      - Endothelial injury
        
        Von Willebrand factor binds
        
        Platelets adhere
        
        Granule release - ADP, TXA2
        
        Recruitment
        
        Aggregation - temp heamostatic plug
    - - Permanent plug created via activation of coagulation cascade (thrombin), fibrinogen converted to insoluable fibrin, with further platelet recruitment
      - Tissue factor from damaged endothelium
        
        Extrinsic coagulation cascase triggered
        
        Generation of thrombin
        
        Fibrin polymerisation
        
        Further platelet recruitment
        
        Fibrin meshwork deposition + aggregated platelets = Permanent clot
    - - Limits haemostatic plug to site of injury
      - Fibrinolytic Pathway
      - Anti-Coagulation Pathways
  - - - Thromboxane-A synthetase
        Thromboxane A2 (TXA2)
- - - - Almost always occulsive
      - Site of statis - extremities
      - Due to coagulation cascade activation
      - Predisposing factors
        
        Immobilisation
        
        Surgery
        
        Trauma
        
        Pregnancy
        
        Hypercoagulable state
      - Consequences
        
        Embolism
        
        Rarely ischaemia
    - - Large vessels, Heart
        
        Non-occlusive / mural thrombi
      - Small vessels
        
        Often occlusive thrombi
      - Lines of Zahn
        
        Alternating layers of platelets and fibrin with red blood cells
        
        Usually superimposed on atherosclerotic plaque
      - Consequences
        
        Ischaemia / infarction
        
        Embolism
        
        Atherosclerotic plaque
  - - - Thrombi accumulate additional platelets and fibrin - vessel obstruction
    - - Dislodgement of thrombus/ fragment of thrombus and transported
    - - Fibrinolysis
    - - Thrombi induce inflammation and fibrosis - replacement oby scar - may obliterate lumern
    - - Capillaries invade thrombus to restablish blood flow
  - - - Angina
      - Raynaud phenomenon
    - - Surgery
      - Torsion
      - Tumour
    - - Blood diverted to one organ or tissue due to increased demands, compromising the supply of another
    - - Sickle cell disease
    - - Factors
        
        • Size of vessel
        
        • Size of vascular territory
        
        • Partial / total vascular occlusion
        
        • Duration of ischaemia
        
        • Metabolic needs of tissue involved
        
        • Presence or absence of alternative
        
        (collateral) circulation
      - Infarction
  - - - Anti-platelet
        
        Reduced ADP
        
        Prostacyclin and nitic oxide
      - Anti-coagulant
        
        Heparin-like molecules (activte antithrombin III)
        
        THrombomodulin (activates protein C)
        
        Protein S synthesis
      - Fibrinolytic
        
        t-PA
    - - Production of vWF
      - Production of tissue factor
      - Binding of factors IXa and Xa
  - - - eg MI, aneurysm, AD, hyperviscosity syndromes
      - Platelets have contact with endothelium
        Dilution of clotting factors prevented
    - - eg. Ulceratd atherosclerotic plaque
      - Swirling currents with pockets of stasis promotes endothelial injury
  - - - Prolonged bedrest/immobilisation
      - • Oral contraceptive use
      - • Myocardial infarction
      - • Atrial fibrillation
      - • Pregnancy/hyper-oestrogenic states
      - • Malignancy
      - • Tissue damage: surgery, trauma, burns
      - • Anti-phospholipid syndrome
    - - Common: Mutationin Factor V gene. prothrombin gene
      - Rare
        Antithrombin III deficiency
        Protein C deficiency
        Protein S deficiency
      - Very rare:
        Fibronolysis defects
  - - - Obstruction
        
        Myocardial infarction - coronary artery throbosis
        
        Cerebral infarction - carotid artery trombosis
        
        Acute lower limb ischaemia and infarction - femoral / politeal artery thromosis
      - Embolism
        
        Cardiac / Aortic mural thrombemboli
        Brain, kidneys, spleen
    - - Obstruction
        
        Local congestion, swelling
        
        Pain, tenderness
        
        Oedema and impared venous drainage
        
        Infection and varicose ulcers
      - Embolism
        
        Thrombi at or above knee - pulmonary embolis m
- - - - Small vessel
        
        Clinically silent
        
        Becomes incorporated into vascular wall
        
        Associated with pulmonary HTN
      - Medium vessel
        
        Pulmonary haemorrhage -/+ infarct
      - Large vessel
        
        Sudden death
        
        RV failure
        
        Cardiovascular collapse
  - - - Ischaemic limb
      - Dry gangrene
    - - Stroke
      - Neurological deficit
      - Death
    - - Mesenteric ischaemia
      - May be fatal
    - - May be asymptomatic
      - Identified on autopsy
  - - - Long bone fractures
      - Soft tissue tauma
    - - Pulmonary insufficiency
      - Anaemia
      - Neurological symptoms
      - Thrombocytopaenia
      - 1-3 days post injury
  - - - Obstetric procedures
      - Chest wall injury
      - Decompression sickness
- - - - Thrombohemorrhagic disorder is a medical condition characterized by both bleeding and clotting at the same time
    - - Pancreas
      - Prostate
      - Lung
      - Stomach
    - - HELLP syndrome
      - Retained non-viable foetus
      - Amniotic fluid embolism
    - - Meningococcaemia
      - Sepsis
      - Malaria
    - - Major trauma
      - Burns
      - Extensive surgery
    - - Aortic aneurysm
      - Liver disease
      - Shock
- - - - Diagnosis of thromboembolic disease when likelihood is low