Bloods Vessel

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    BLOODS VESSEL

    In general vascular abnormalities cause clinical disease

    by:

    1. Progressively narrowing the lumina of vessel &

    producing ischemia of the tissue perfused by that

    vessel.

    2.Provoking intravascular thrombosis, causing acute

    obstruction or embolism or both!.

    ".#eakening the walls of vessels there by leading to

    dilatation or rupture.

    I.Congenital anomaly:

    1.$erry aneurisma.

    2.%rteriovenous fistula.

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    II.Atherosclerosis & other forms of

    arteriosclerosis.

    A.Atherosclerosis:

    haracteri'ed by intimal thickening & lipid deposition.

    (he basic lesion, the atheroma, or fibrofatty pla)ue

    consists of a raised focal pla)ue within the intima,

    having a core of lipid mainly cholesterol & cholesterol

    ester! and a covering fibrous cap.

    *eath from cardiovascular disease in +.. rose from 1-

    of all deaths in 1/"0 to - in 1/3.

    4isk factors for atherosclerosis :

    Major:

    5iperlipidemia hypercholesterolemia,

    hypertriglycerimia!.

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    Minor:

    6besity, physical inactivity, male gender, increasing

    age, family history, stress, oral contraceptives, high

    carbohidrat intake.

    %therosclerotic pla)ue have three principalcomponents:

    1. ell, including smooth muscle cell, macrophages

    and other leucocytes.

    2. onnective tissue e7tracellular matri7, including

    collagen, elastic fibers & proteoglycans.

    ". Intracellular & e7tracellular lipid deposits.

    (he complicated lesion of atherosclerosis:

    1. alcification.

    2. 8ocal rupture or gross ulceration.

    ". (hrombosis.

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    -. 5emorrhage.

    B.MOC!EBE"#$S Arteriosclerosis.

    9edial calcific sclerosis!.

    haracteri'ed by ring like calcifications within the

    media of medium si'ed to small muscular arteri.

    (he calcification is not associated with anyinflammatory reaction, and the intima and adventitia

    are largely un affected.

    (he calcific deposit do not narrow the lumen.

    C.A"%E"IOLOSCLE"OSIS.

    9arked by proliferation or hyaline thickening of the

    walls of small arteries & arteriol.

    III.ILAMMA%O"' DISEASE( %)E

    VASC*LI%IDES.

    +.#iants cell ,tem-oral arteritis.

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    (he most common of the vasculitides, is a focal

    granulomatous inflammation of arteries of medium si'e

    and small si'e that affects principally the cranialvessel, especially the temporal arteries in older

    individuals rare before age !, but also the

    vertebrae and ophthalmic arteries!.

    (he histologic change:

    1. ;ranulomatous lesion with giant cell.

    2.

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    virtual obliteration of the great vessels arising in the

    arch.

    (he cause and pathogenesis are unknown.

    0.1OL'A"%E"I%IS ODOSA #"O*1 ,1A.

    P%< is manifested by necroti'ing inflammation of

    small or medium si'ed muscular arteries.(ypically involving renal and visceral vessel & sparing

    the pulmonary circulation.

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    9ucocutaneous lymph node syndrome!.

    Is an arteritis involving large, medium si'e & small

    arteries of the coronary arteries! that is associatedwith the mucocutaneus lymph node syndrome usually in

    young children & infant 3 yonger then four years

    old!.

    (he acute illness is manifested by fever, con=unctival &

    oral erythema & erosion, edema of the hands & feet,

    erytheme of the palm & soles, a skin rash often with

    des)uamation & enlargement of cervical lymph node it

    is usually self limited.

    4.Microsco-ic -olyangitis.

    9icroscopic polyarteritis , hypersentivity!.

    (his type of necroti'ing vasculitis generally affects

    smaller vessel than P%< arteriols, capillaries, &

    venules!.

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    intermediate & small arteries & sometimes vein of the

    e7tremities.

    (he condition had accured almost e7clusively in menwho were heavy cigarret smoker.

    IV.Ane6risma & Dissection.

    A.An ane6risma is a locali'ed abnormal dilatation ofany vessel.

    6ccur in any artery or vein of the body, most commonly

    the aorta.

    %therosclerosis, the most fre)uent etiology of

    aneurysm causes arterial wall thinning through medial

    destruction secondary to pla)ue that originates in the

    intima.

    >):?%bdominal aortic aneurysm.

    ?yphilitic luetic! aneurysm.

    B.AO"%IC DISSEC%IO:

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    Is an catastrophic illness characteri'ed by dissection

    of blood along the luminar planes of the aortic media,

    with formation of blood filled channel within the aorticwall & that often rupture, causing massive hemorrhage.

    In contrast to atherosclerotic and syphilitic aneurysm,

    aortic dissection is not usually associated with marked

    dilatation of the aorta.

    ome dissection are related to the inheritedconnective tissue disorder marfan syndrome, an

    autosomal dominant disease of connective tissue

    fibrillin, characteri'ed by skeletal, cardiovascular &

    ocular manifestation.

    (he serious cardiovascular complication is dilatation ofthe aortic rootannuloaortic ectasia! and mitral valve

    prolapsed.

    V.VEI & L'M1)A%ICS.

    A.Varicose 9eins.

    %re abnormali dilated, turtous veins produced by

    prolonged, increased intraluminal pressure.

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    (he superficial veins of the legs are the preponderant

    site of involvement.

    Portal hypertention cirrhosis of the liver! leads tovarices in the esophageal & hemorhoidal veins!.

    B.Lym-hangitis.

    C.Lym-eema:

    (he most common causes:

    1. pread of malignant tumor.

    2. 4adical surgical procedure.

    ". Post irradiation fibrosis.

    -. 8ilariasis.

    . Post inflammatory thrombosis & scarring of

    lymph channel!.

    VI.%*MO".

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    +.)emangioma:

    apillary hemangioma:

    %re composed of blood vessels that resemble

    capillaries, narrow, thin walled & lined by relatively thin

    endothelium. +sually occurring in the skin,

    subcutaneous tissue & mucous membrane of the oral

    cavities & lips, they may occur in internal vicera, such

    as liver, spleen & kidney.

    avernous hemangioma:

    *istinguished by the formation of large cavernous

    vascular channels.

    6ften occurring in childhood, they have predilection

    for the skin of the head & neck & mucosal surface of

    the body, also found in many viscera, particulary the

    liver, spleen, pancreas, & occasionally the brain.

    /.#"A*LOMA 1'O#EIC*M;ranulation tissue

    type hemangioma!.

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    6f uncertain neoplastic nature & currently considered

    a plypoid form of capillary hemangioma, these masses

    appear as e7ophytic red nodule on the skin & gingival ororal mucosa & are often ulserated.

    0.#LOM*S %*MO".,#lomangioma.

    % benign but e)uisitely painful tumor that arise from

    the modified smooth muscle cell of the glomus body.

    % neuromyoarterial receptor that is sensitive to

    variation in temperature & regulates arterial flow.

    2.VASC*LA" EC%ASIA ,%elangiectasia.

    *esignates a group of abnormally prominent capillaries,

    venules & arteriol that created a small focal red lesion,

    usually in the skin or mucous membrane.

    4.)EMA#IOEDO%)ELIOMAintermediate

    malignancy!.

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    % true neoplasma of vascular origin composed

    predominantly of masses of endothelial cell growing in

    and about vascular lumina.

    5.A#IOSA"COMA ,)EMA#IOSA"COMA.

    Is a malignant neoplasma of vascular origin,

    characteri'ed by masses of endothelial cell displaying

    the celluler atypia & anaplasia characteristic of

    malignancy.

    7.)EMA#IO1E"IC'%OMA ,malignant

    (he origin of these tumors to pericyte most of these

    neoplasms are small.

    (hey consist of numerous capillary channel surrounded

    by & enclosed within nest & masses of spindle shaped

    cells. (hat these cell are outside the basement

    membrane of the endothelium.

    ;.!A1OSI$S SA"COMA.

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    onsist spindle shaped stromal cell containing irregular,

    angulated, slit like spaces filled with red cells & lined

    by recogni'able endothelium, interwined with normalvascular channels.

    B.L'M1)A#IOMA:

    +.SIM1LE ,ca-illary lym-hangioma.

    (hese masses composed of small lymphatic channels

    tend to occur subcutaneously in the head & neck region

    & in the a7illa.

    /.CAVE"O*S L'M1)A#IOMA ,cystic hygroma.

    omposed of cavernous lymphatic spaces and therefore

    are analogous to cavernous hemangioma.

    0.L'M1)A#IOSA"COMA.

    (he tumor is composed of channels lined by anaplastic

    endothelial cells.

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    %)E )EA"%

    auses of cardiovascular dysfunction:

    1. @oss of blood.

    2. Iregular heart beat.

    ". 6bstructed flow.

    -. 4egurgitant flow.

    . Pump failure.

    ?ontractile dysfunction s