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kuliah PATOLOGI ANATOMI-KARDIOVASKULAR
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Budiana Tanurahardja/ Rahmiati/Lisnawati
DEPARTMENT of ANATOMIC PATHOLOGYDEPARTMENT of ANATOMIC PATHOLOGYFACULTY OF MEDICINE UNIVERSITY of INDONESIAFACULTY OF MEDICINE UNIVERSITY of INDONESIA
20132013
Vascular pathology
Vascular Pathology
Normal blood vessels.
Aneurysms.
Hypertension.
Vasculitis.
Varices.
Neoplasms.
Normal blood vessels
Arteries : large/elasticmedium size/muscular/distributesmall arteries ( < 2 mm ).
Arterioles : 20 - 100 u .
Capillaries: 7 - 8 u.
Postcapillary venules.
Collecting venule.
Normal blood vessel
Normal blood vessels
Veins :Smallmediumlarge.
Lymphatic.
The main components : endothelial cells.smooth musclesTunica intima, tn. media, tn.adventitia
Normal blood vessel
Normal blood vessels Normal blood vessel
Normal blood vessels Normal blood vessel
Normal blood vessels
Main cellular components : endothelial cells smooth muscle cells
Endothel : Weibel- Palade bodies 0,1x0,3u storage organelle for vWF.
IHC : antibody to vWF (factor VIII related Ag) ; CD31
Vascular abnormalities caused by 2 mechanism : narrowing/complete obstruction
weakening of the walls : dilatation/rupture
Normal blood vessel
Aneurysm
Aneurysm is localized abnormal dilatation of blood vessel.
True and false
Saccular and fusiform.
Etiology: atherosclerosis, cystic medial degeneration, congenital, infection (mycotic aneurysm), syphilis, trauma,systemic disease, immunologic.
Dissecting aneurysm: blood enters the wall of the artery, dissecting the layers.
Aneurysm
Berry aneurysm
Occurrence among patient with heritable systemic disorders ( autosomal dominant
polycystic kidney, Ehlers-Danlos syndrome type IV,neurofibromatosis type I, Marfan syndrome)
fibromuscular dysplasia of arteries coarctation of aortaCigarette smoking and hypertension ( 54 % of the
patient)
Berry aneurys
m
Berry aneurysm
Saccular aneurysm.
The most frequent cause of subarachnoid haemorrhage circle of Willis.
The 4th most common CVA after : atherosclerotic thrombosis, embolism and hypertensive haemorrhage.
2 % in autopsy.
Pathogenesis: unknown.
Genetic factor may be important.
Berry aneurys
m
Berry aneurysm Berry aneurys
m
Berry aneurysm Berry aneurys
m
Aneurysm Aneurysm
Dissecting aneurysm Dissecting Aneurysm
Hypertensive vascular disease
Hypertension : elevated blood pressure diastole : > 90 mm Hg.Systole : > 140 mm Hg.
90%-95%: idiopathic (essential hypertension}
5%-10 : secondary renal ,endocrine, cardiovascular, neurologic.
Hypertensive vascular
disease
Classification of blood pressure in adults
Category systolic diastolic
NormalHigh normalHypertension:Stage 1 (mild)Stage 2 (moderate)Stage 3 (severe )Stage 4 (very severe)
< 130130-139
140-159160-179180-209> 210
< 8585-89
90-99100-109110-119> 120
Morphology
Hyaline arteriolosclerosis: in elderly patients normotensive or hypertensive, but
more generalized and severe in hypertensive.common in diabetes.
Hyperplastic arteriolosclerosis: related to severe acute elevation of blood pressure
(diastole > 110 mmHg).laminated thickening of the walls of arteriole that
consist of smooth muscle cells and reduplicated basement membrane.
ArteriolosclerosisElderly patient:
normal/hypertensive.
Diabetes.
Leakage plasma component ,matrix production by smooth muscle cells hyaline deposition.
benign nephrosclerosis.
Arteriolosclerosis
Acute /severe hypertension.
Onion skin
often : accompanied by deposits of fibrinoid and acute necrosis necrotizing arteriolitis(kidney)
Vasculitis
Inflammation of the walls of the vessels.
Classification :direct infection: bacterial, rickettsial, spirochaetal,
fungal, viral.Immunologic:
immunecomplex mediated : SLE, RA, ANCA (antineutrophil cytoplasmic
autoAb )mediated: Wegener granulomas,microscopic polyangiitis, Churg-Strauss syndrome
direct antibody attack mediated: Goodpasture, Kawasaki (antiendothelial)
Vasculitis
Vasculitis
cell mediated: allograft organ rejection, IBD, paraneoplastic vasculitis.
unknown: giant cell temporal arteritis, Takayasu arteritis, PAN.
Other classification: large vessel vasculitis (giant cell,Takayasu) medium-sized vessel vasculitis (PAN,
Kawasaki)Small vessel vasculitis (Wegener ).
Vasculitis
Vasculitis Vasculitis
Thromboangiitis obliterans
Vein and lymphatics
Varicose veins (varices): abnormally dilated, tortuous veins produced by prolonged, increased intraluminal pressure.
Thrombophlebitis and phlebothrombosis.
Lymphangitis and lymphedema : lymphangitis caused by bacterial infection group A beta hemolytic streptococcus.
Lymphedema caused by occlusion of lymphatic drainage.
Varicose veins
Pathogenesis: obese persons have greater tendency poor tissue support.
The most important factor is posture long periods of standing . Even in normal person simple orthostatic edema.
Other conditions : pregnancy, intravascular thrombosis, tumor mass.
Microscopically : variation in thickness dilation and hypertrophy of smooth muscle and subintimal fibrosis, degeneration of elastic tissue, and spotty calcification in the media (phlebosclerosis).
Varices
Statis dermatitis.
Varicose ulcers.
Neoplasm
Benign : hemangioma: Capillary,cavernous.
lymphangioma: capillary,cavernous.
pyogenic granuloma(lobular capillary)glomus tumor.
Neoplasm
Intermediate grade neoplasms.Kaposi sarcoma.HemangioendotheliomaHemangiopericytoma.
Malignant neoplasm.angiosarcoma.
Congenital cavernous hemangioma
Haemangioma
cavernous capillary
Angiosarcoma
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